Close Management of Diabetes Medications Lowers Medical Costs

Affordable diabetes treatment is critical for improving health outcomes, especially for the financially vulnerable.
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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. 

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. The 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.

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.

Improved Adherence for Diabetes Treatment

New 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

In 2021, approximately 220,000 patients with diabetes received financial relief totaling $42.7M when their plan sponsor enrolled in the Patient Assurance program. With addition of cardiovascular therapies to this program, we expect participating patient savings in 2022 to reach approximately $60M.

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.

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. This is driven by 18.6% lower outpatient costs, 17.7% lower inpatient costs and 12.1% lower emergency room costs.

See how our solutions can help
Express Scripts PBM Patient Assurance Program
The Patient Assurance program protects patients from high out-of-pocket costs, capping member copays at $25 for up to a 34-day supply of select diabetes and cardiovascular medications.

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