Switching To Newer Insulin For Type 2 Diabetes Comes At A Cost

Many people with diabetes have switched to newer forms of insulin called analogs, because they can make the disease easier to manage. But that switch can be expensive, a study finds.

Researchers at the Yale University School of Medicine looked at insurance claim data to see how people with Type 2 diabetes were using insulin, and how much it cost.

From 2000 to 2010, the number of people with Type 2 diabetes who filled at least one prescription for insulin rose from 10 to 15 percent.

At the same time, there was a radical shift in the kind of insulin used. In 2000, 88 percent of people with Type 2 diabetes using insulin chose human insulin forms. By 2010, 91 percent of people chose synthetic or analog forms.

And that switch can be expensive, since analogs are more expensive than regular insulin. Out of pocket costs for people using insulin for Type 2 rose $19 per prescription in 2000 to $36 in 2010, according to a study published Tuesday in JAMA, the journal of the American Medical Association.

That means that with insulin use increasing along with patients' costs, out-of-pocket spending on insulin more than tripled from $133 million in 2000 to $432 million in 2010 for every 100,000 patients with Type 2 diabetes, according to Dr. Kasia Lipska, an instructor in medicine at Yale University Medical School who led the study.

The number of severe hypoglycemic events those people declined slightly over that time period, but not enough that it was statistically significant.

"What worries me about these findings is that the shift has been so dramatic and so nearly universal," Lipska told Shots. "It's hard to imagine that all these patients are informed about the choice they're making, and that for them in particular that it's worth it."

This study only looked at people who had private insurance, so it doesn't include what people might be paying through other forms of insurance or without insurance coverage.

Some forms of analog insulin act quickly, making it possible to inject just before or right after a meal. They include aspart, glulisine and lispro. Others, including detemir and glargine, provide relatively constant levels of the drug for hours, and may help people avoid the risk of low blood sugar at night.

Patents for analog forms of insulin are expiring in the next few years, and manufacturers are interested in making biosimilar products, the equivalent of generics for prescription drugs. It's not hard to see why; global sales of insulin reached $16.7 billion in 2011, up 12.5 percent since 2010.

But biosimilars might not offer people the big price savings we've seen with generic drugs, Lipska says. "There are high costs of approval and development, and only a few companies that have the expertise."

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