Medicare Beneficiaries Are More Likely to Reach Catastrophic Spending on Insulin

Among people who filled at least one insulin prescription, 14.1% reached catastrophic health spending — out-of-pocket medical spending greater than 40% of a household’s remaining income after subsistence needs are met — and almost two-thirds of them were Medicare beneficiaries, according to a recent Health Affairs study.

The study was based on data from the Medical Expenditure Panel Survey in 2017 and 2018. Among the respondents who filled at least one insulin prescription, 41.1% were covered by Medicare and 35.7% by private insurance. Median annual out-of-pocket spending on insulin was $97.72, while people with Medicare coverage and private insurance paid much more than Medicaid enrollees.

When compared to Medicare beneficiaries, those in the 100% self-pay group spent 662.9% more out-of-pocket and those in the private coverage group spent 96.8% more. Among people who reached catastrophic spending on insulin in 2017 and 2018, 21.1% were covered by Medicare, followed by Medicaid (19.4%). Family income also played a role: 55.6% of people with an annual household income under $21,638 experienced catastrophic spending.

The research indicated that elderly patients with low family incomes were at the greatest risk for high out-of-pocket spending, and “policies that cap monthly out-of-pocket spending on insulin for Medicare beneficiaries are likely to be impactful.”

SOURCE: “Catastrophic Spending On Insulin In The United States, 2017–18,” Health Affairs. doi: 10.1377/hlthaff.2021.01788 HEALTH AFFAIRS 41, NO. 7 (2022): 1053–1060.

This infographic was reprinted from AIS Health’s biweekly publication RADAR on Drug Benefits.

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