Out-of-Pocket Spending for Insulin by Medicare Beneficiaries After Monthly Caps

Was implementation of a $35 monthly insulin out-of-pocket cap in Medicare associated with changes in spending, insulin use, or clinical outcomes among Medicare beneficiaries with type 2 diabetes?In this cohort study of 4.8 million US Medicare beneficiaries from 2019 to 2023, an interrupted time-series analysis found that implementation of the insulin out-of-pocket cap in 2021 and 2023 was associated with significant reductions in insulin out-of-pocket spending, increased insulin use, lower hemoglobin A levels, and small increases in rates of severe hypoglycemic events.These findings suggest reducing cost-sharing policies could improve access and adherence to essential medications for patients with chronic conditions.

Corresponding Author: Benjamin N. Rome, MD, MPH, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 41 Avenue Louis Pasteur, Ste 17, Boston, MA 02115 (brome@bwh.harvard.edu).

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