Abstract 18944: Affordability of Insulin for Non-Elderly Adults in the United States Following $35 Monthly Out-of-Pocket Cap

Abstract

Introduction: In March 2023, insulin manufacturers in the United States announced price reductions, with Eli Lilly adding a $35 OOP cap on their unbranded insulin products. Aims: To investigate estimated OOP savings of a $35 insulin cap for non-Medicare patients. Methods: We used the 2019 Medical Expenditure Panel Survey (MEPS). Non-Medicare adults aged 18-64 who filled at least one insulin prescription were included. We identified insulin prescriptions with OOP spending above $35 and estimated savings using a $35 OOP cap. For each respondent, we calculated annual insulin OOP spending, average OOP spending per prescription, and total estimated OOP savings with a $35 OOP cap. Analyses were done in SAS. Results: Over 4.1 million non-elderly civilians filled 32.7 million insulin prescriptions in 2019, totaling $1.7 billion in OOP costs, or $418 per person (Table 1). There were 1.6 million people (39.5%) eligible for reduced OOP spending under a $35 OOP cap. Those eligible were more often male and medium- or high-income. Only 16% of publicly insured patients were eligible for savings with a $35 OOP cap, compared to 53% among privately insured and 52% among uninsured groups. Of those eligible for savings, we estimated a $35 OOP cap would have reduced average annual OOP insulin spending from $984 to $231, saving an estimated $1.2 billion. Uninsured patients would see a 93% reduction in OOP spending. Hispanic patients would see an 87% reduction in OOP spending, compared to 73% among non-Hispanic patients. Near poor and low-income patients would see greater OOP reductions than patients in other income groups. Conclusions: Populations most likely to benefit under a $35 OOP insulin cap are those with the highest cost-sharing requirements, such as the uninsured and those just above the threshold for income-based social services. Future work should assess how insulin OOP caps affect patient adherence and outcomes.