Written by Ari Parker — Updated: Wednesday, March 8, 2023
As the inflation rate soars, congress considers the Inflation Reduction Act of 2022. Because the legislation could significantly affect prescription drug prices in America, with a potentially life-saving impact on insulin costs, Chapter’s data team wanted to understand the difference in insulin prices and access for Medicare beneficiaries across the US.
Cost inequality, plan availability, and inconsistent coverage result in drastic differences that can cost Medicare beneficiaries with diabetes thousands each year. For this study, Chapter’s data team used proprietary data that includes pricing details for all active PD and MA+PD plans from September 1, 2022 to December 31, 2022 in order to examine the impact to Americans in the months leading up to and including the Annual Enrollment Period.
On average, one person receiving the same treatment may spend somewhere between $1,113 and $10,689 on insulin in the four-month period as a result of inconsistencies in geographic access and coverage.
People with diabetes who have insulin coverage may be spending at least 4.5% of the local median income on insulin in this time frame.
When insulin is not covered, depending on the state a person lives in, they could spend anywhere from 7% to more than 26% of the local median income on insulin.
It’s been previously demonstrated that the average annual out-of-pocket spending on insulin can vary greatly by state. Previous data does not account for the prices of prescription drug plans, the availability of plans, and one’s cost of living—all of which impact the actual cost of insulin to consumers.
Access to plans varies widely, not only from state to state but also from zip code to zip code. As a result, assuming insulin is covered on a beneficiary’s Part D (PD) or Medicare Advantage (MA+PD) plan, the average cost may be anywhere from $1,113 to $1,891 for the cost of insulin, simply based on your geographic location, pharmacy selection, and the plans available.
We found that the cost of insulin makes up the highest percentage of the local median income in Pennsylvania, where the average cost of insulin for beneficiaries on a plan that covers the drug equates to at least 4.5% of the median income. The dollar amount is $1,769 in the analyzed time frame, which is just over half the cost of food per capita.
Additionally, in both Wisconsin and New Mexico, the average cost of insulin (when covered) makes up 4% or more of the median income. On the low end, the average cost of insulin takes up less than 1.5% of the median income in four states: Kansas, Texas, Arizona, and Utah.
Not only does the average cost of insulin differ depending on where you live, but there is also variability in the number of plans that cover insulin. In some cases, the percentage of plans that fully cover insulin is as low as 26%.
The level of coverage a Medicare beneficiary receives for insulin may vary. Factors such as limited access, additional health needs, and plan misinformation can result in a beneficiary selecting a plan with suboptimal insulin coverage. This could leave the same person in Connecticut (where the difference between the average cost under covered plans and uncovered plans is the highest) spending anywhere from $1,613 to $10,689 on insulin on average from September through December.
In the chart below, we've ranked the states based on the average cost of insulin on uncovered plans.
One might wonder why a person with diabetes would choose a Medicare plan that doesn’t provide coverage for their insulin. Additional healthcare needs and misinformation are two likely culprits in the case of overpaying for insulin on Medicare.
People with diabetes may have additional health conditions and prescriptions. When choosing prescription drug coverage, an individual may need to prioritize another prescription, resulting in undercoverage of their insulin.
We’ve already shared that the number of plans covering the chosen insulin is below 30% in some states. Unfortunately, a common mistake in Medicare is assuming prescription drug coverage is the same across plans. Misinformation is fueled, in part, by two factors:
Lack of Transparency: Many Medicare brokers are not required to search a minimum number of plans available to beneficiaries and are incentivized to recommend plans offered by contracted carriers.
Confusion: Often referred to as a maze, Medicare can be difficult to understand, and many Americans feel rushed to pick coverage. This results in many Medicare beneficiaries choosing coverage that may not fit their needs.
The cost of insulin is high enough that many people with diabetes feel forced to skip or skimp on doses. As several prescription drug prices rise faster than inflation, further increasing the disparity in prescription drug costs between the US and comparable nations, Americans seek relief. Consequently, congress is actively considering out-of-pocket caps and drug price caps in the Inflation Reduction Act of 2022.
Medicare beneficiaries with diabetes shouldn’t have to choose between debt or death. Medicare was created to provide affordable healthcare to aging Americans, but geographic inequality and inconsistent coverage leaves many people with diabetes holding the bag.
Chapter is dedicated to helping seniors maximize the benefits they receive from Medicare by comparing every plan available to them. Our data show that controlling the price of a drug used by about 11% of Americans would provide more equitable access to healthcare. In the current economy, as millions cope with rising daily expenses, providing equally affordable access to a necessary drug across the US will empower aging Americans to manage their diabetes and live longer, healthier lives.
We used proprietary data that includes pricing details for all active PD and MA+PD plans from September 1, 2022 to December 31, 2022. In addition, Chapter’s proprietary recommendation engine estimated drug costs, including premiums, prescription refills, and how those costs change in different phases of coverage (e.g. pre-deductible and catastrophic). To account for plan variance by zip code, we looked at plans available in the most populous zip code in each state. To account for cost variance caused by pharmacy selection, we utilized pharmacy data to run our analysis for four distinct pharmacies in each zip code. To normalize these costs against typical wealth and cost of living in different localities, we analyzed how these drug costs compared to the median annual household income in each zip code.
For this report, we chose to analyze costs for both Lantus and Humalog, as many diabetics will have to take both long-acting and rapid-acting insulin to manage their condition. We assumed that the sample patient takes 1 dose of each form of insulin everyday. We selected Lantus and Humalog specifically because they are the most common types of insulin used by people with diabetes, and had better coverage across Medicare plans relative to their generic counterparts. When referring to insulin coverage, “covered” plans provide coverage for both Lantus and Humalog and “uncovered” plans provide coverage for neither. In this study, “coverage” means that the drug is available on the plan’s formulary.