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Research Letter
April 5, 2016

Expenditures and Prices of Antihyperglycemic Medications in the United States: 2002-2013

Author Affiliations
  • 1School of Population and Global Health, University of Melbourne, Victoria, Australia
  • 2Department of Medicine, University of Chicago, Chicago, Illinois
  • 3School of Public Health, University of Michigan, Ann Arbor
JAMA. 2016;315(13):1400-1402. doi:10.1001/jama.2016.0126

A recent study demonstrated widespread substitution of analog for human insulin and rising out-of-pocket costs in privately insured people with type 2 diabetes in the United States.1 Medicaid reimbursements have increased for both human insulin and more costly analog insulins.2 Although studies have described per-person changes in excess medical spending of US adults with diabetes on prescription medications,3 they have not reported trends in expenditures for different classes of antihyperglycemic medications that simultaneously consider changes in use and price.

We analyzed individual and prescription-level data from the Medical Expenditure Panel Survey (MEPS) to describe and compare trends in expenditure and price of antihyperglycemic medications in the United States from 2002 through 2013. The MEPS involves deidentified, publicly available data of a nationally representative household survey of noninstitutionalized residents.4 The in-person interview response rate ranged from 69.2% to 58.0%. We first described the prevalence of treated patients with diabetes, their characteristics, and use of antihyperglycemic medications. We then estimated inflation-adjusted expenditures per patient for insulin (combining both human and analog) compared with other classes of antihyperglycemic medications. Medications were identified using Multum Lexicon therapeutic class codes. Drug expenditures from all sources (including patient co-payments) and quantity used came from household surveys, with data verified by pharmacies. Relative and absolute mean drug prices were calculated by dividing expenditure per prescription by quantity. All analyses were conducted in Stata (StataCorp), version 13.1, accounting for MEPS sampling weights and the complex survey design. The 95% confidence intervals were calculated and compared to determine statistically significant differences.

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