Insulin Rationing Persists Despite Policy Changes: Repeated Cross-Sectional Studies, 2017 vs 2024.
cross_sectional · Level IV
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- Record sourced from PubMed, PMID 41193794.
- Also identified by DOI 10.1007/s11606-025-09886-9 and PMC identifier 12895931.
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Abstract
Insulin is a life-saving medication for people with diabetes, but access barriers, such as high costs, can result in rationing. Multiple policies have been introduced to limit insulin out-of-pocket costs over the past 5 years. To compare rates of cost-related insulin rationing among patients prescribed insulin in 2024 vs. 2017, and to examine broader insulin rationing due to cost-related barriers, insurance delays, or pharmacy shortage DESIGN: A 22-item cross-sectional survey conducted from April to July 2024 compared with a survey conducted from June to August 2017. Yale Diabetes Center PARTICIPANTS: Adults with type 1 or type 2 diabetes prescribed insulin, with 199 (60.1%) completing the survey in 2024 and 199 (56.2%) in 2017. Rates of cost-related insulin rationing and broader rationing due to access barriers, including cost, insurance delays, and pharmacy shortages. In 2024, among 199 respondents (mean age of 52.4 years, 47.7% female, 58.3% white, and 47.2% type 1 diabetes), 48 (24.1%) reported cost-related insulin rationing compared to 51 (25.5%) of 199 respondents in 2017 (p = 0.41). Characteristics of participants who reported cost-related insulin rationing were similar between 2024 and 2017, but with a higher proportion of adults with type 1 diabetes in 2024 (63.0%) compared to 2017 (43.1%, p = 0.05). In 2024, 75 participants (37.7%) reported insulin rationing due to cost, insurance delays, or pharmacy shortages. In a multivariable model, age, sex, race, ethnicity, income, and insurance coverage were not significantly associated with rationing, but patients with type 2 diabetes had lower odds (OR 0.34, 95%CI 0.13-0.87) compared with type 1 diabetes patients. Despite new policies addressing insulin costs since 2017, one in four patients at Yale Diabetes Center rationed insulin due to cost in 2024, unchanged from 2017. Over one-third reported rationing due to broader access barriers. These findings highlight the ongoing need to comprehensively address insulin affordability and access.