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Can Insulin Therapy Reduce ED Visits?

May 09, 2016

Although the costs associated with insulin therapy have significantly increased, better glycemic control with insulin therapy is associated with fewer hypoglycemia-related emergency department (ED) visits, according to two studies conducted by pharmacy benefit manager (PBM) Prime Therapeutics LLC. The studies were presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016 (April 19-22, 2016; San Francisco, CA).

The Centers for Disease Control and Prevention reports that more than 9% of Americans are living with diabetes, and, for most insured populations, insulin therapy for diabetes treatment is the leading driver of pharmacy costs.

The studies were conducted using data from January 2011 to June 2015 and included nearly 4 million members with type 1 or type 2 diabetes (mean age, 39.4 years). In the first study, researchers estimated the prevalence and trends in cost associated with insulin therapy. The researchers found a 50% increase in the use of insulin and an 80% increase in the cost of insulin among its commercially-insured members over a 4.5-year period. Overall, the cost for all diabetes drugs increased by 168% in the insured population. In June 2011, diabetes drugs accounted for 6.7% of all pharmacy benefits costs; these costs rose by 4–10.7% by June 2015. During the same timeframe, the cost of insulin rose 200%, from 3% of all pharmacy benefit costs in January 2011 to 5.4% in June 2015.

The second study tracked members’ ED visits related to hypoglycemia by the type of therapy they were receiving. ED visits for hypoglycemia are an indicator for severe hypoglycemia events that may result in injury or death. Nearly 4 million members had a total of 4128 ED visits coded for hypoglycemia over a period of longer than 4 years. Such visits occurred at a rate of about 15 per 1000 patient-years among members treated with insulin. The rate of hypoglycemia-related ED visits was highest for members with type 1 diabetes. Among members with type 2 diabetes, the rate of ED visits was higher for those using both long- and short-acting insulin (basal/bolus therapy) than for those using only long-acting insulin the more common therapy regimen.

“With new diabetes drugs coming to market that may be able to lower the risk of hypoglycemia events for some patients, health plans and employers should carefully weigh the benefits compared with lower cost drugs currently available,” said Kevin Bowen, MD, MBA, principal health outcomes researcher at Prime, said in a press statement. “Seeing the full picture can help members manage their diabetes so they can get the medicine they need to feel better and live well.”



Bowen KL, Gleason PP. Diabetes mellitus (DM) prevalence, incidence, drug regimens and insulin therapy cost by type among four million commercially insured members continuously enrolled for 4.5 years. Poster presented at: AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016; April 19-22, 2016; San Francisco, CA. Accessed May 9, 2016.

Bowen KL, Gleason PP. Incidence rate of emergency department visits for hypoglycemia by diabetes drug regimen in a four million member commercially insured population. Poster presented at: AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016; April 19-22, 2016; San Francisco, CA. Accessed May 9, 2016.



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