JAMA: Trends in Medicaid Reimbursements for Insulin From 1991 Through 2014

Importance  Insulin is a vital medicine for patients with diabetes mellitus.

Newer, more expensive insulin products and the lack of generic insulins in the United States have increased costs for patients and insurers.

Objective  To examine Medicaid payment trends for insulin products. Cost information is available for all 50 states and has been recorded since the 1990s.

Results  Since 1991, Medicaid reimbursement per unit (1 mL) of insulin dispensed has risen steadily. In the 1990s, Medicaid reimbursed pharmacies between $2.36 and $4.43 per unit. By 2014, reimbursement for short-acting insulins increased to $9.64 per unit; intermediate, $9.22; premixed, $14.79; and long-acting, $19.78. Medicaid reimbursement for rapid-acting insulin analogs rose to $19.81 per unit. The rate of increase in reimbursement was higher for insulins with patent protection ($0.20 per quarter) than without ($0.05 per quarter) (P < .001).Total Medicaid reimbursements peaked at $407.4 million dollars in quarter 2 of 2014. Total volume peaked at 29.9 million units in quarter 4 of 2005 and was 21.2 million units in quarter 2 of 2014.

Jing Luo, MD; Jerry Avorn, MD; Aaron S. Kesselheim, MD, JD, MPH

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