ABOUT THE REPORT
Even in the current healthcare climate, which is feeling the impact of the social and economic disruptions related to COVID-19, healthcare and medicine costs remain a key concern for patients, payers, and policymakers. Diabetes is a high-profile therapy area that is often considered a driver of financial challenges for both payers and patients. It has a large and growing patient population, ranks among the top three therapy classes in terms of both utilization and drug spend for both commercial payers and Medicare, and contributes significantly to CMS costs due to high volumes dispensed. However, several key misunderstandings persist around the prices of these critical medicines. As policymakers consider significant changes to U.S. drug pricing, including rules potentially impacting diabetes pricing, this report provides analyses of pricing, and context to inform those decisions.
Diabetes costs have been a significant focus for stakeholders. The report provides detailed analyses around diabetes drug pricing, including list price, net manufacturer price, and out-of-pocket costs for patients as a function of various insurance programs. Diabetes prices have risen significantly in the past five years on a list-price basis though manufacturer net revenues have been declining and for patient out-of-pocket costs, reductions have not been uniformly observed though they have been flat or have risen only slightly overall. The report also looks at prescription abandonment related to out-of-pocket costs, and how these costs can interrupt a patient’s ability to pay. The report examines the impact of insurance coverage and finds that commercially-insured patients have higher initial cost exposure than Medicare patients, but can use coupons to offset costs and a significant proportion are doing so, such that their final out-of-pocket costs are similar to that of Medicare patients. Finally, the report details current U.S. policies and other shifts in the diabetes landscape that will impact diabetes spending over the next few years.