American Diabetes Association
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Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018

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posted on 2021-02-09, 22:56 authored by Hui Shao, Michael Laxy, Stephen R. Benoit, Yiling J. Cheng, Edward W. Gregg, Ping Zhang

To estimate trends in total payment and patients’ out-of-pocket (OOP) payments of non-insulin glucose-lowering drugs by class from 2005 to 2018.


We analyzed data for 53 million prescriptions from adults aged above 18 years with type 2 diabetes under fee for service plans from the 2005-2018 IBM® MarketScan® Commercial Claims Rx Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate non-linear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change.


Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, alpha-glucosidase inhibitors, and thiazolidinedione have declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors, have increased by $2181 (88.4%), $3721 (77.6%), and $1374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for non-insulin glucose-lowering drugs was the main driver that explained the total payment increase.


Average annual payments and OOP payment for non-insulin glucose-lowering drugs have increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver.