Impact of First Dollar Coverage for Insulin
By Xcenda |
Xcenda conducted an analysis to understand the impact of expanding ‘first dollar coverage’ for patients with diabetes taking insulin in HDHPs. We found that, on average, patients with diabetes in HDHPs pay approximately 3.5 times more OOP per insulin prescription compared to non-insulin prescriptions. While less than one-third of patients with diabetes in HDHPs are required to meet their deductible before their insulin is covered, OOP costs would be 2.4 to 3.7 times lower if they had first dollar coverage for insulin. Exempting insulin from the deductible could save certain patients with diabetes in HDHPs more than $1,500 annually in OOP costs and allow them to spread their OOP costs more evenly throughout the year.
With growing acknowledgement that coverage is not the same as access, rethinking benefit design is important. Patients need to be able to afford the OOP costs of medicines in order to be able to access them; allowing first dollar coverage is one step forward for diabetes patients.
This work was funded by the Pharmaceutical Research and Manufacturers of America; editorial control was maintained by Xcenda.