For people with diabetes, medication is essential. Whether traditional insulin or non-insulin diabetes treatment, missing one dose of any medication can be dangerous for their health and lead to costly and complex outcomes.
And yet, the cost of diabetes treatment has led some patients to make financial sacrifices to afford what they are prescribed or even ration their medication. A study from the American Diabetes Association, found $1 out of every $4 in U.S. health care costs is spent on caring for people with diabetes.
Express Scripts has been at the forefront of driving down the cost of insulin and diabetes treatment for many years. Since launching in 2020, the Express Scripts Patient Assurance® program has ensured people with diabetes in participating plans would not pay more than $25 for a 30-day supply of insulin. Today nearly two-thirds of Express Scripts members pay $25 or less for their insulin at the pharmacy counter – either through the Patient Assurance Program, which has grown to serve close to 11 million lives, or their plan’s benefit design.
More affordable diabetes treatment is especially critical to those who are already financially vulnerable and most likely to face the choice between paying for medications or other expenses. And, because diabetes management doesn’t always require insulin, the Patient Assurance Program was expanded to include non-insulin diabetes treatment including DPP-4 inhibitors, GLP-1 agonists and SGLT2 inhibitors, capping member copays at $25 for up to a 34-day supply of select diabetes medications.
Improved Adherence for Diabetes Treatment
In addition to capping the cost of insulin, the Patient Assurance Program improves adherence by removing cost as a barrier to care – coupled with clinical support to help patients take their medication as prescribed.
Research from Express Scripts examined adherence rates for members using non-insulin hypoglycemic agents used to treat Type 2 diabetes. In 2021, members enrolled in the Patient Assurance program improved adherence to their Type 2 diabetes treatments by 2.5%.
For members with household incomes of less than $50K, the data showed improved adherence by 5.7% for those enrolled. This is critical because diabetes does not affect all people equally. Diabetes is typically more common in communities with lower employment and wealth, and less access to healthy food, higher education and health care. These disparities in social determinants of health make preventing and managing type 2 diabetes more challenging.
Previous research in 2020 found that members newly diagnosed with Type 1 diabetes, or those filling an insulin product for the first time, are 30% more likely to continue therapy when enrolled in the Patient Assurance program than those not enrolled.
Savings Impact for Patients and Plan Sponsors
Patients taking insulin saved more than $18 million with point-of-sale discounts in 2022 alone, totaling more than $45 million in patient savings on insulin since the program launched. In total, approximately 395,000 patients with diabetes received financial relief of nearly $78 million when their plan sponsor enrolled in the Patient Assurance program in 2022.
For patients with Type 2 diabetes, their total diabetes-related cost share, inclusive of medical and pharmacy costs, decreased by 50.5% when enrolled in the Patient Assurance program – resulting in $135 million in total savings since 2020.
This also results in lower total medical costs for plan sponsors. Our study of patients with Type 2 diabetes using non-insulin treatment found that total medical cost related to diabetes events for patients enrolled in Patient Assurance was lower on average by 16.3% or $1,151 less than for patients not enrolled – close to $550 million in total medical cost savings. This is driven by 18.6% lower outpatient costs, 17.7% lower inpatient costs and 12.1% lower emergency room costs.