Out-of-Pocket Costs For SGLT-2(Sodium-Glucose Transport Protein-2)Inhibitors in The United States
May 25, 2022
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GLT-2(sodium-glucose transport protein-2) inhibitors are indicated for millions of US individuals with heart disease, diabetes, or kidney dysfunction.12 However, these medications have a high retail price, at over $500 per month ($16 per pill).3 The high costs may contribute to physician inertia to prescribe therapy, impede early initiation, and decrease patient adherence,3A.
Because of these effects, understanding the out-of-pocket costs for SGLT-2 inhibitors is essential. However, estimates for out-of-pocket costs are limited with no nationally representative or multi-payer estimates.3 We aim to address this gap in evidence by providing national estimates of out-of-pocket costs for SGLT-2 inhibitors, stratifying results by major insurance payor types.
The Medical Expenditure Panel Survey (MEPS;2014-2018)is administered to a nationally representative sample of civilian-noninstitutionalized persons in the United States and is designed to estimate cost measures for prescription medications in the United States.5 MEPS collects prescription total expenditures and out-of-pocket costs through pharmacy payment records.
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Outcomes were mean monthly total expenditures per person for SGLT-2 inhibitors and out-of-pocket costs. Results were stratified by insurance type (private, Medicare, Medicaid, dual Medicare/Medicaid, Medicare with supplemental private, and other insurances). Medicare categories only included adults ≥65 years of age, whereas private and only Medicaid categories included only adults <65 years of age. National projections were estimated using MEPS survey weights by accounting for the complex multistage design and participant nonresponse rates, with Cls computed using the Taylor-series linearization method. Subgroup estimations were determined by the use of statistical software accounting for the survey design. Costs were inflation-adjusted to the 2018 Consumer Price Index for prescription medications. Comparisons among different insurance payors were assessed using linear regression, with Medicare-insured adults as the comparator group. The data used in this study are publicly available from the Agency for Healthcare Research and Quality. Analytic methods, as well as study materials, are available to other researchers on request to the authors for purposes of reproducing the results or replicating the procedure. MEPS is Institutional Review Board approved by the Westat Institutional Review Board.
Of 167298 individuals in MEPS, we identified 504 adults prescribed SGLT-2 inhibitors. After applying survey weights to these 504 adults, we estimated that in the United States,1133139(95%Cl,958771-1307507)adults were on SGLT-2 inhibitors. Annually, an estimated 5636828(95%Cl,4619082-6654574)prescriptions for SGLT-2 inhibitors were filled, yielding estimated national total expenditures of $3308539528 (95% Cl,$2722122074-$3894956982). Of these individuals, 58.0% had private insurance, 9.9% had Medicare,7.3% had Medicaid only,4.4% had dual Medi-care/Medicaid, 14.4% had Medicare with private supplemental insurance, and 2.4% had other insurance, and 3.6% had no insurance.
Mean total expenditure for SGLT-2 therapy was $416.12(95%Cl,$405.98-$42627)per person per month, with an average monthly out-of-pocket expense of $46.70 (95% Cl$36.76-$56.64)per person. Com-pared with Medicare-insured individuals($450.15 [95%CI, $424.18-$476.11), total monthl per person costs were less for privately insured individuals($413.42 [95%CI, $400.09-$426.74]difference -$36.73, P-0.020)and uninsured individuals($300.69 [95% CL $201.96-$399.42], difference -$149.46. P-0.005),but similar for the other insurance groups (Table).Out-of-pocket expenses, when compared with Medicare-insured indi-viduals($49.42 95% ClI,$25.41-$73.43])were lowest for Medicaid($5.10 [95% Cl,$034-$9.86] differ-ence-$44.32, P-0.001)and dual Medicare/Medicaid insured adults($3.87 |95% Cl,$1.00-$6.75],difference -$45.54, P-0.001)but similar for the other insurance groups(Table).
Total expenditures for SGLT-2 inhibitors were high-at over $400 per month. However, patients were protected from most of these costs, with average out-of-pocket spending at $47 per month (12% of total expenditures), Out-of-pocket costs were lowest for those covered by Medicaid ($4-$5 per month).
Our findings suggest that insurance coverage for therapy was generally substantial However, out-of-pocket costs for uninsured individuals were high with an estimated average cost of $138 per month, or $5 per day. Strategies to mitigate the high costs for this group of patients, who are already predisposed to haying financial hardship, are necessary. Further, patients with Medicare or private insurance still endured ≈$50 per month in costs, which may be prohibitive for some. especially patients on multiple expensive medications. Private insurances were found to have lower total per-person expenditures for SGLT-2 inhibitors than Medi-care, which may reflect better price negotiation by private insurances. While a prior report estimated higher out-of-pocket costs for Medicare beneficiaries, our study included low-income adults eligible for subsidies that were excluded in the prior report Limitations include the inability to account for health insurance premiums, deductibles, or rebates. Health insurance coverage and plans may have dynamically changed during the study, and we only provide a cross-sectional estimate. We could only identify individuals who received therapy, resulting in the exclusion of individuals who found costs for therapy prohibitive, Additionally. sample size may limit the precision of our estimates.
In conclusion, in the United States, the majority of total expenditures for SGLT-2 inhibitors were not endured by patients, though substantial variation for coverage existed by insurance type. Certain patients may have difficulty affording therapy due to these differences in out-of-pocket costs, especially for adults without insurance.
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