Diabetes expenses have decreased, but are still high

NEW YORK (Reuters Health) - Out-of-pocket expenses for diabetes treatment have gone down for many U.S. patients over the past decade, according to a new study. But nearly a quarter of people with diabetes still face high expenses.

In particular, “(out-of-pocket) expenses declined in the people with public insurance and in people with low income between 2001 and 2011,” mostly because prescription drug costs went down, Rui Li told Reuters Health by email.

Li led the study at the Division of Diabetes Translation, part of the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention in Atlanta, Georgia.

The researchers examined data from ten years of a nationwide medical expenditure study. They defined people with high out-of-pocket expenses as those spending more than 10 percent of their family income on health care.

In 2001 and 2002, 28 percent of adults under age 65 with diabetes faced a high expense burden, which decreased to 23 percent by 2011, according to results published in Diabetes Care.

The dip was biggest for people with public insurance like Medicare or Medicaid: 43 percent of them had burdensome out-of-pocket expenses in 2001 and 2002, compared to 21 percent in 2011.

For people with private insurance, the proportion under high expense burden increased slightly over the course of the study.

The average person with diabetes accounted for more than half of the total out-of-pocket medical expenses of his or her family.

On the whole, expenses went down mostly because prescription drug spending went down, the authors write.

Over the last decade, Medicaid has made cheaper generic drugs more attractive to patients and prescribers, partly by limiting the amount of brand-name drugs that can be prescribed at one time.

“Any move to lowering expenses is great, but as the authors point out, there are some changes in the way the data was reported just around the time they show the major changes, so there still needs to be some caution with interpretation,” said Dr. Robert J. Rushakoff, a diabetes researcher at the University of California, San Francisco.

Rushakoff was not involved with the study.

It’s also possible that out-of-pocket expenses have gone down because people stopped being able to afford them at all, he told Reuters Health in an email.

High out-of-pocket costs for diabetes patients are a problem outside the U.S. as well, Li said.

“A study of 35 low and middle income countries found that persons with diabetes experienced differentially higher out-of-pocket medical spending, particularly among individuals with high levels of spending, and a greater chance of incurring catastrophic medical spending compared with otherwise similar individuals without diabetes,” Li said.

Although older medications are now inexpensive, lab tests, medical follow-up and supplies remain costly, Rushakoff said.

Generic prescription medications can be filled for as little as $4 per month at Walmart or similar stores, he said. Test strips are a bigger expense, but people who are not on insulin don’t need to use as many, and insurance generally covers them.

The Affordable Care Act may help continue to bring expenses down, in that more people will have insurance, Rushakoff said.

For patients, the best way to keep expenses down is to use generic medications or look into discount cards which are available for many newer medications and reduce the co-pay, he said. They can also make sure the test strips they select are covered by their insurance plan.

SOURCE: Diabetes Care, online March 25, 2014.