Table. Estimated Reimbursement Prices of and Out-of-Pocket (OOP) Costs for 30-Day Insulin Dispenses, 2006, 2012, and 2017a.
| Parameter | Estimated value (95% CI) | ||
|---|---|---|---|
| 2006 | 2012 | 2017 | |
| Estimates per 30-d dispense among all insulin users | |||
| Insulin, US$ | |||
| Price | 143 (119-167) | 280 (268-291) | 394 (370-418) |
| OOP costs per 30-d dispense | 36 (33-39) | 45 (43-46) | 38 (36-41) |
| Share of price paid by patient, % | 24 (22-26) | 16 (15-17) | 10 (8-11) |
| OOP estimates per member per mo, US$b | |||
| All insulin users | 52 (48-57) | 72 (70-75) | 64 (60-68) |
| HSA | 93 (82-104) | 146 (140-153) | 141 (130-152) |
| HRA | 62 (48-75) | 105 (98-113) | 108 (94-121) |
| No account | 52 (49-56) | 63 (61-65) | 48 (44-51) |
Abbreviation: HDHP, high-deductible health plan; HRA, health reimbursement arrangement; HSA, health savings account.
All US dollar amounts were adjusted for inflation and standardized to 2017 dollars using the medical expense Consumer Price Index data from 2006 to 2017. Members with a HDHP-HSA must pay the full costs of medications, including insulin, until they reach their deductible. Those with HRA and no-account plans pay for medications according to a copayment schedule. The percentage refers to the amount members paid for insulin divided by the imputed median price of insulin for a given year. Estimates were derived from an autoregressive model with intercept, trend, and change in trend2 terms, adjusting SEs for autocorrelation and removing nonsignificant terms. The 95% CIs were derived from the estimates from the time-series model by substituting parameters for specific points in time (ie, 2006, 2012, and 2017). The eMethods section in the Supplement provides more details.
Insulin OOP costs were calculated at the per member per month level to account for multiple insulin prescription fills in a given month.