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Background <p>Insulin is a life-saving medication for people with diabetes, but access barriers, such as high costs, can result in rationing. Multiple policies have been introduced to limit insulin out-of-pocket costs over the past 5 years.</p> Objective <p>To compare rates of cost-related insulin rationing among patients prescribed insulin in 2024 vs. 2017, and to examine broader insulin rationing due to cost-related barriers, insurance delays, or pharmacy shortage</p> Design <p>A 22-item cross-sectional survey conducted from April to July 2024 compared with a survey conducted from June to August 2017.</p> Setting <p>Yale Diabetes Center</p> Participants <p>Adults with type 1 or type 2 diabetes prescribed insulin, with 199 (60.1%) completing the survey in 2024 and 199 (56.2%) in 2017.</p> Main Measures <p>Rates of cost-related insulin rationing and broader rationing due to access barriers, including cost, insurance delays, and pharmacy shortages.</p> Key Results <p>In 2024, among 199 respondents (mean age of 52.4&#xa0;years, 47.7% female, 58.3% white, and 47.2% type 1 diabetes), 48 (24.1%) reported cost-related insulin rationing compared to 51 (25.5%) of 199 respondents in 2017 (<i>p</i> = 0.41). Characteristics of participants who reported cost-related insulin rationing were similar between 2024 and 2017, but with a higher proportion of adults with type 1 diabetes in 2024 (63.0%) compared to 2017 (43.1%, <i>p</i> = 0.05). In 2024, 75 participants (37.7%) reported insulin rationing due to cost, insurance delays, or pharmacy shortages. In a multivariable model, age, sex, race, ethnicity, income, and insurance coverage were not significantly associated with rationing, but patients with type 2 diabetes had lower odds (OR 0.34, 95%CI 0.13–0.87) compared with type 1 diabetes patients.</p> Conclusions <p>Despite new policies addressing insulin costs since 2017, one in four patients at Yale Diabetes Center rationed insulin due to cost in 2024, unchanged from 2017. Over one-third reported rationing due to broader access barriers. These findings highlight the ongoing need to comprehensively address insulin affordability and access.</p>

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Insulin Rationing Persists Despite Policy Changes: Repeated Cross-Sectional Studies, 2017 vs 2024

  • 期刊论文

  • 发表日期：

    2025年11月5日

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  • Sefia Khan,
  • Nadera Rahman,
  • Laura M. Nally,
  • Darren B. Warren,
  • Megan E. Branda,
  • Kasia J. Lipska

摘要

Background

Insulin is a life-saving medication for people with diabetes, but access barriers, such as high costs, can result in rationing. Multiple policies have been introduced to limit insulin out-of-pocket costs over the past 5 years.

Objective

To compare rates of cost-related insulin rationing among patients prescribed insulin in 2024 vs. 2017, and to examine broader insulin rationing due to cost-related barriers, insurance delays, or pharmacy shortage

Design

A 22-item cross-sectional survey conducted from April to July 2024 compared with a survey conducted from June to August 2017.

Setting

Yale Diabetes Center

Participants

Adults with type 1 or type 2 diabetes prescribed insulin, with 199 (60.1%) completing the survey in 2024 and 199 (56.2%) in 2017.

Main Measures

Rates of cost-related insulin rationing and broader rationing due to access barriers, including cost, insurance delays, and pharmacy shortages.

Key Results

In 2024, among 199 respondents (mean age of 52.4 years, 47.7% female, 58.3% white, and 47.2% type 1 diabetes), 48 (24.1%) reported cost-related insulin rationing compared to 51 (25.5%) of 199 respondents in 2017 (p = 0.41). Characteristics of participants who reported cost-related insulin rationing were similar between 2024 and 2017, but with a higher proportion of adults with type 1 diabetes in 2024 (63.0%) compared to 2017 (43.1%, p = 0.05). In 2024, 75 participants (37.7%) reported insulin rationing due to cost, insurance delays, or pharmacy shortages. In a multivariable model, age, sex, race, ethnicity, income, and insurance coverage were not significantly associated with rationing, but patients with type 2 diabetes had lower odds (OR 0.34, 95%CI 0.13–0.87) compared with type 1 diabetes patients.

Conclusions

Despite new policies addressing insulin costs since 2017, one in four patients at Yale Diabetes Center rationed insulin due to cost in 2024, unchanged from 2017. Over one-third reported rationing due to broader access barriers. These findings highlight the ongoing need to comprehensively address insulin affordability and access.