Impact of type 2 diabetes medication cost sharing on patient outcomes and health plan costs

Am J Manag Care. 2016 Jun;22(6):433-40.


Objectives: To study the association between cost sharing for diabetes medications, adherence, hospitalization rates, and healthcare costs, with relationship to patient risk.

Study design: A retrospective claims analysis of data from 35 large, private, self-insured employers (2004 to 2012).

Methods: We examined outcomes for 92,410 patients aged 18 to 64 years with a type 2 diabetes (T2D) diagnosis who filled at least 1 T2D prescription. First, we examined the relationship between adherence, measured as the proportion of days covered, and cost sharing, measured as the out-of-pocket cost to purchase a pre-specified bundle of T2D prescriptions. We then examined the association between adherence and hospital days. Simulations showed the effect of increased cost sharing on adherence and inpatient utilization.

Results: A $10 increase in out-of-pocket cost was associated with a 1.9% reduction in adherence (P < .01). In turn, a 10% reduction in adherence was associated with a 15% increase in per-patient hospital days (0.17 days; P < .01). For the average plan, switching from low to high cost sharing reduced per-patient medication costs by $242 and increased per-patient hospitalization costs by $342, for a net increase of $100 in plan costs. Increases in per-patient costs were greater for high-risk patients, such as those with heart failure ($1328).

Conclusions: Increased cost sharing for T2D medication was associated with reductions in pharmacy costs, but higher total costs for patients with T2D. This problem is particularly acute for patients with 1 or more cardiovascular comorbidities. The results suggest that increased diabetes cost sharing may hamper efforts to lower the total cost of diabetes care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Cost Sharing / trends*
  • Databases, Factual
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / economics
  • Drug Costs*
  • Female
  • Health Care Costs*
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Insurance Claim Review
  • Insurance, Health / economics*
  • Insurance, Pharmaceutical Services / economics*
  • Linear Models
  • Male
  • Middle Aged
  • Retrospective Studies
  • United States