Insulin is rationed by over a million people in the United States due to high costs.

 Due to high costs, an estimated 1.3 million adults in the United States with diabetes ration insulin, increasing their risk of diabetes-related complications such as organ damage, blindness, and even death.

Insulin costs vary widely in the US depending on the type of insurance someone has  Clynt Garnham Medical/Alamy
Insulin costs vary widely in the US depending on the type of insurance someone has  Clynt Garnham Medical/Alamy

A standard unit of insulin costs nearly $100 in the United States, compared to $12 in Canada and $7.52 in the United Kingdom. Depending on their health insurance, some people in the United States pay almost nothing for insulin, while others must pay the full cost.

Adam Gaffney of the Cambridge Health Alliance in Massachusetts and his colleagues examined data from the 2021 National Health Interview Survey to determine how such costs influence insulin use. The US Centers for Disease Control and Prevention administers the survey to adults from a random sample of US households each year to collect information on income, health status, insurance coverage, and other topics.

In 2021, 982 people with diabetes who use insulin responded to the survey, which for the first time asked whether they had skipped insulin doses, took less insulin than needed, or delayed buying insulin to save money in the previous year. Around 16.5% of the group said yes to at least one of the questions. The CDC designed the survey to be nationally representative, so Gaffney and his colleagues extrapolated from it to estimate that approximately 1.3 million American adults with diabetes use insulin on a regular basis.

"That speaks volumes about the state of our healthcare system," Gaffney says. Many people with diabetes are unable to control their blood sugar levels without insulin, increasing their risk of chronic complications, he claims.

Insulin rationing was highest among those without health insurance, with nearly 30% limiting insulin use. About 19% of people with private health insurance rationed insulin, compared to 16% of those with Medicare, the federal health insurance program for people 65 and older. According to Gaffney, this is most likely due to the high out-of-pocket costs associated with some private insurance plans.

People who were Black, under the age of 65, or had a low-to-middle income were also more likely to ration insulin than people from other socioeconomic groups. According to Andrew Mulcahy of the RAND Corporation in Washington DC, these demographics are already known to face higher insulin costs due to healthcare disparities.

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As part of the Inflation Reduction Act, Congress passed legislation earlier this year capping insulin costs for Medicare recipients at $35. A similar cap for people with private insurance was included in an earlier version of the bill, but it was removed during negotiations.

"I don't think it will make a significant difference because the Medicare population is already doing relatively well on this measure," Mulcahy says. "To truly address the root issue, you must also consider reaching out to patients with private coverage and, most importantly, patients without any coverage at all."

Annals of Internal Medicine, DOI: 10.7326/M22-2477


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