Younger people are more likely to skip or skimp on doses.


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A research letter published in the November 2022 Annals of Internal Medicine sheds light on how U.S. insulin prices are affecting some Americans with diabetes. In an analysis of data from the Centers for Disease Control and Prevention's 2021 National Health Interview Survey, researchers found that 16.5% of insulin users-or an estimated 1.3 million people in the United States-rationed the drug in the last year due to cost. Rationing methods included delaying insulin purchase, taking a smaller dose than needed, and skipping doses.

Figure. Advocates wi... - Click to enlarge in new windowFigure. Advocates with the nonprofit T1International approach Eli Lilly's offices in New York City, where they held a vigil honoring those with diabetes who lost their lives due to the high cost of insulin. Photo by Erik McGregor / LightRocket via Getty Images.

The study's authors also analyzed the demographics of the respondents who said they ration insulin. The practice was more common among uninsured (29.2%) or privately insured (18.8%) individuals than among those who have Medicare (13.5%) or Medicaid (11.6%). Black people (23.2%) were more likely to ration insulin than White or Hispanic people (16%), as were people under age 65 (20.4%) compared with those ages 65 and older (11.2%).


"In the ICU, I have cared for patients who have life-threatening complications of diabetes because they couldn't afford this lifesaving drug," the study's lead author, Adam Gaffney, said in a statement to Public Citizen. "Universal access to insulin, without cost barriers, is urgently needed."


Insulin costs at least four times more in the United States than in comparable countries, and its retail prices have surged in recent years. According to a 2020 JAMA analysis of changes in drug prices between 2007 and 2018, insulin's cost increased by 262%, though with negotiated discounts the net price increase for people with some form of health insurance was 51%.


Recent efforts at the federal level to address the problem have yielded mixed results. With the passing of the Inflation Reduction Act, out-of-pocket insulin costs are now capped at $35 per month for all Medicare beneficiaries. However, the Senate failed to pass legislation last year that would have enacted the same price cap for Americans who have private insurance.


At least 20 states and the District of Columbia have enacted monthly out-of-pocket price caps for insulin, although most of the laws apply to people who have state-regulated health insurance plans-not the uninsured or employees of self-insured companies, where the majority of Americans with employment-based health insurance work. California, meanwhile, announced in 2022 that it plans to address high insulin prices by manufacturing and selling its own low-cost version of the drug.-Diane Szulecki, editor