Glucagon Prescribing and Costs Among U.S. Adults with Diabetes, 2011-2021
OBJECTIVE: To characterize contemporary trends in glucagon fill rates and expenditures in a nationwide cohort of adults with diabetes, overall and by key demographic and clinical characteristics.
RESEARCH DESIGN AND METHODS: In this retrospective cohort study, we examined 1) glucagon fill rates per 1000 person-years and 2) patient out-of-pocket and health plan costs per filled glucagon dose among adults with diabetes included in OptumLabs® Data Warehouse between January 1st, 2011, and March 31st, 2021.
RESULTS: The study population was comprised of 2,814,464 adults with diabetes with a mean age of 62.8 (SD, 13.2) years. The overall glucagon fill rate decreased from 2.91 to 2.28 per 1000 person-years (-22%) over the study period. Glucagon fill rates increased in groups at high risk for severe hypoglycemia; from 22.46 to 36.76 (+64%), from 11.64 to 16.63 (+43%) and 16.08 to 20.12 (+25%) among patients with type 1 diabetes, patients treated with short-acting insulin and those with history of severe hypoglycemia, respectively. White patients, women, higher income individuals, and commercially-insured patients had higher glucagon fill rates when compared to minorities, males, lower income individuals, and Medicare Advantage patients, respectively. Total cost per dosing unit increased from $157.97 to $275.32 (+74%) among commercial beneficiaries and from $150.37 to $293.57 (+95%) among Medicare Advantage beneficiaries.
CONCLUSIONS: Glucagon fill rates are concerningly low and declined between 2011 and 2021, though increased in appropriate subgroups with type 1 diabetes, using short-acting insulin, or a history of severe hypoglycemia. Fill rates were disproportionately low among minorities and low-income individuals.