Out-of-Pocket Costs Highest With Commercial Insurance for T1D

The cost burden for type 1 diabetes is higher for patients with commercial insurance compared with patients covered by public plans, according to a study abstract in the Journal of Managed Care & Specialty Pharmacy.

“The out-of-pocket (OOP) cost burden of diabetes is high. Among patients diagnosed with type 1 or type 2 diabetes, OOP spending grew at a 3.4% average annual rate from 2009 to 2013, with OOP spending accounting for 12.8% of total per capita spending in 2013,” researchers wrote. “Yet the magnitude of cost sharing among patients with type 1 diabetes specifically, and the differential among payer types, are unknown.”

Researchers conducted a retrospective analysis using the 1999-2014 Medical Expenditure Panel Survey and the supplemental Diabetes Care Survey to estimate out-of-pocket costs for patients with type 1 diabetes covered by commercial, Medicare, and Medicaid plans. Among 1984 patients with type 1 diabetes included in the study, 46.3% were insured by Medicare, 35.1% by commercial insurance, and 18.6% by Medicaid.

More than 28% of total health expenditures were out-of-pocket for patients primarily insured by commercial plans, the study found. Patients with Medicaid or Medicare had statistically significant lower out-of-pocket shares of total expenditures (-12.6% and -10.1%, respectively).

“Our findings indicate that in a US population, type 1 diabetes patients with commercial insurance have a higher OOP cost burden than that experienced by Medicare or Medicaid beneficiaries,” researchers wrote. “Future research should assess the impact of OOP cost burden on treatment adherence, access to high-quality care, and patient outcomes.”

The study, which was sponsored by the type 1 diabetes advocacy nonprofit JDRF and the Leona M. and Harry B. Helmsley Charitable Trust, was presented at AMCP Nexus 2018.

—Jolynn Tumolo

Reference

Sussman M, Benner J, Watzker A, Griffiths R. Differential cost sharing among patients with type 1 diabetes across payer types: findings from the Medical Expenditure Panel Survey. Journal of Managed Care & Specialty Pharmacy. 2018;24(10-a):S39-S40.

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