Factors Contributing to the Rising National Cost of Glucose-Lowering Medicines for Diabetes During 2005–2007 and 2015–2017

OBJECTIVE <p> </p> <p>We examined changes in glucose-lowering medication spending and quantified the magnitude of factors that are contributing to these changes. </p> <p> </p> <p>RESEARCH DESIGN AND METHODS</p> <p> </p> <p>Using the Medical Expenditure Panel Survey, we estimated the change in spending on glucose-lowering medications during 2005–2007 and 2015–2017 among adults aged 18 years or older with diabetes. We decomposed the increase of total spending by medication groups: for insulin by human and analog; and for non-insulin by metformin, older, newer, and combination medications. For each group, we quantified the contributions by the number of users and cost-per-user. Costs were in 2017 US dollars.</p> <p> </p> <p>RESULTS</p> <p> </p> <p>National spending on glucose-lowering medications increased by $40.6 billion (240%), of which insulin and non-insulin medications contributed $28.6 billion (169%) and $12.0 billion (71%), respectively.<a> </a><a></a><a>For insulin, the increase was mainly associated with higher expenditures from analogs</a> (156%). For non-insulin, the increase was a net effect of higher cost for newer medications (+88%) and decreased cost for older medications (-34%). Most of the increase in insulin spending came from the increase in cost-per-user. However, the increase in the number of users contributed more than cost-per-user in the rise of most non-insulin groups.</p> <p> </p> <p>CONCLUSIONS</p> <p> </p> <p><a>The increase in national spending on glucose-lowering medications during the past decade was mostly associated with the increased costs for insulin</a>, analogs in particular, and newer non-insulin medicines; and cost-per-user had a larger effect than the number of users. Understanding the factors contributing to the increase helps identify ways to curb the growth in costs. </p>