INTRODUCTION

Insulin is a life-saving medication for more than seven million Americans living with diabetes.1 However, affordability of insulin has become a major problem in recent years with approximately 25% of patients reporting using a lower dose than prescribed due to high out-of-pocket cost.2 The three major insulin manufacturers advertise cost-sharing support programs for qualifying patients. However, the extent that such programs provide actual financial relief to patients is unclear. This study reviewed manufacturer-sponsored cost-sharing support programs for insulins to understand the extent of the support provided and the patient populations served.

METHODS

We reviewed the public-facing websites of the three major insulin manufacturers as of January 7, 2021.3,4,5 Inhaled insulins, insulin combination products, and over-the-counter insulins were excluded. We collected information on type of assistance available, patient eligibility criteria, duration, and amount of assistance provided.

RESULTS

Insulin manufacturers provided some form of patient cost-sharing support for all their insulin products. The main forms of cost-sharing support were copay cards, savings programs, and patient assistance programs (PAP) (Table 1). Copay cards reduce the amount that privately insured patients pay out-of-pocket for products covered by their insurance. Savings programs help reduce the cost for uninsured and other cash-paying patients. Manufacturer PAPs provide insulin free of cost to some Medicare and uninsured patients. No program was available to Medicaid patients.

Table 1 Types and Eligibility of Manufacturer-Sponsored Insulin Cost-Sharing Assistance Programs
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Support programs differed on the level of cost-sharing assistance, quantity of insulin provided, and program duration (Table 2). Copay cards limited out-of-pocket costs to $0–$99, on a per-month or per-fill basis, and a maximum of 90-day supply per fill. Most cards established maximum allowable savings per month or per year. Card expiration varied between the end of the calendar year and up to 24 months after enrollment.

Table 2 Manufacturer-Sponsored Insulin Cost-Sharing Assistance Programs: Main Characteristics
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Savings programs offered a range of out-of-pocket costs between $35 and $99 per monthly fill; most programs established a maximum quantity (from 3 vials/2 pen packs to 10 vials/10 pen packs) per fill. One program established a threshold of maximum savings. Most savings programs expired at the end of the calendar year.

PAPs required prescribers to specify insulin type and amount, and most programs only supplied the insulin directly to the provider. PAPs provided free insulin at a maximum of 120-day supply per fill and a maximum 12-month duration. For all copay cards, savings programs, and PAPs, it was unclear whether patients could re-enroll after program expiration.

The level of savings offered varied according to the manufacturer and the type of program: a regimen with insulin glargine and insulin aspart could cost as low as $25 per month through copay cards and $198 per month through the same manufacturer’s savings program. Savings also varied according to the type of insulin: the newer and more expensive insulin degludec cost as low as $5 with a copay card, but the older insulin detemir from the same manufacturer did not have a copay card. Similarly, the manufacturer did not offer a copay card for its follow-on insulin aspart, but it offered a copay card for its more expensive reference product for as low as $25 out-of-pocket cost.

Overall, information about the programs was often in fine print, or was accessible only after entering personal information such as name, date of birth, email, and mailing address. PAP applications required comprehensive personal information, including social security number and proof of income, as well as information on the prescribing provider.

DISCUSSION

All three insulin manufacturers offered cost-sharing offset programs for their products. Patient out-of-pocket costs tended to be lower with copay cards than with savings programs, and some programs were more generous for newer, more expensive products. This suggests that manufacturer-sponsored cost-sharing support programs may provide greater benefits to privately insured patients and to patients taking newer and more expensive insulin products. Further research should look into how many patients utilize these programs, the level of support that patients actually receive, and whether these programs are sufficient to meet patients’ needs. The equity implications of such programs and the potential returns they generate for drug manufacturers should also be the focus of future investigations. Meanwhile, providers can help improve affordable access to insulin by familiarizing themselves with the various cost-sharing offsets for insulin and which programs best suit their patients’ needs.