Insulin Costs and Coverage in Medicare Part D
| Table 1: Number of Users and Out-of-Pocket Spending on Insulin Products in Medicare Part D, 2007 and 2017 | ||||
| Number of users | Average out-of-pocket spending per prescription by non-LIS enrollees |
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| Insulin products | 2007 | 2017 | 2007 | 2017 |
| All insulin products, average | 1,642,880 | 3,136,240 | $39 | $57 |
| Afrezza | N/A | 775 | N/A | 86 |
| Apidra | 12,260 | 3,355 | 58 | 67 |
| Apidra Solostar | N/A | 7,765 | N/A | 60 |
| Basaglar Kwikpen U-100 | N/A | 24,485 | N/A | 64 |
| Humalog | 205,700 | 270,780 | 48 | 62 |
| Humalog Kwikpen U-100 | N/A | 411,895 | N/A | 62 |
| Humalog Kwikpen U-200 | N/A | 23,640 | N/A | 70 |
| Humalog Mix 50-50 | 3,900 | 1,895 | 73 | 76 |
| Humalog Mix 50-50 Kwikpen | N/A | 5,700 | N/A | 78 |
| Humalog Mix 75-25 | 67,180 | 28,720 | 58 | 77 |
| Humalog Mix 75-25 Kwikpen | N/A | 67,655 | N/A | 78 |
| Humulin 70-30 | 165,640 | 75,070 | 32 | 43 |
| Humulin 70/30 Kwikpen | N/A | 24,860 | N/A | 63 |
| Humulin N | 150,060 | 119,445 | 30 | 20 |
| Humulin N Kwikpen | N/A | 27,335 | N/A | 35 |
| Humulin R | 133,800 | 97,365 | 29 | 23 |
| Humulin R U-500 | N/A | 14,240 | N/A | 128 |
| Humulin R U-500 Kwikpen | N/A | 13,320 | N/A | 95 |
| Lantus | 775,740 | 586,770 | 42 | 60 |
| Lantus Solostar | 28,220 | 1,108,460 | 50 | 54 |
| Levemir | 64,120 | 187,005 | 52 | 67 |
| Levemir Flextouch | N/A | 508,655 | N/A | 59 |
| Novolin 70-30 | 207,440 | 111,895 | 27 | 39 |
| Novolin N | 159,580 | 76,890 | 20 | 37 |
| Novolin R | 254,240 | 90,410 | 20 | 33 |
| Novolog | 247,680 | 286,065 | 47 | 70 |
| Novolog Flexpen | N/A | 543,835 | N/A | 70 |
| Novolog Mix 70-30 | 117,220 | 41,605 | 55 | 75 |
| Novolog Mix 70-30 Flexpen | N/A | 96,425 | N/A | 84 |
| Soliqua 100-33 | N/A | 3,425 | N/A | 68 |
| Toujeo Solostar | N/A | 190,805 | N/A | 63 |
| Tresiba Flextouch U-100 | N/A | 63,500 | N/A | 55 |
| Tresiba Flextouch U-200 | N/A | 89,275 | N/A | 70 |
| Xultophy 100-3.6 | N/A | 1,330 | N/A | 83 |
| NOTE: LIS is low-income subsidy. N/A indicates drug not available in year. SOURCE: KFF analysis of 2007-2017 prescription drug event claims data from a 5% (2007-2016)/20% (2017) sample of Medicare beneficiaries from the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse. |
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| Table 2: Formulary Coverage of Insulin Products in Medicare Part D Plans, 2019 | ||||||||||||||
| Part D plans placing drug on formulary | Part D enrollees with formulary coverage | |||||||||||||
| Drug name | Product type | Number | Share (out of 3,787) |
Number (in millions) |
Share (out of 37.0 million) | Median total cost for 30-day prescription | ||||||||
| Admelog Solostar | Pen injector | 124 | 3% | 1.4 | 4% | $430 | ||||||||
| Admelog | Injectable solution | 124 | 3% | 1.4 | 4% | $225 | ||||||||
| Afrezza (12 units) | Inhalant powder | 98 | 3% | 1.4 | 4% | $937 | ||||||||
| Afrezza (8 units) | Inhalant powder | 98 | 3% | 1.4 | 4% | $626 | ||||||||
| Afrezza (4 units) | Inhalant powder | 98 | 3% | 1.4 | 4% | $314 | ||||||||
| Afrezza Titration Pack | Inhalant powder | 98 | 3% | 1.4 | 4% | $937 | ||||||||
| Afrezza 180 Titration Pack | Inhalant powder | 98 | 3% | 1.4 | 4% | $1,249 | ||||||||
| Apidra Solostar | Pen injector | 223 | 6% | 1.8 | 5% | $530 | ||||||||
| Apidra | Injectable solution | 223 | 6% | 1.8 | 5% | $277 | ||||||||
| Basaglar | Pen injector | 1,241 | 33% | 13.9 | 38% | $334 | ||||||||
| Fiasp Flextouch | Pen injector | 2,004 | 53% | 22.0 | 59% | $592 | ||||||||
| Fiasp | Injectable solution | 2,004 | 53% | 22.0 | 59% | $307 | ||||||||
| Humalog | Injectable solution | 1,932 | 51% | 16.6 | 45% | $87 | ||||||||
| Humalog | Pen injector | 1,923 | 51% | 16.4 | 44% | $561 | ||||||||
| Humalog | Cartridge | 1,918 | 51% | 16.3 | 44% | $540 | ||||||||
| Humalog U-100 Kwikpen | Pen injector | 1,890 | 50% | 16.3 | 44% | $567 | ||||||||
| Humalog U-200 Kwikpen | Pen injector | 1,853 | 49% | 16.2 | 44% | $450 | ||||||||
| Humalog Mix 75/25 | Injectable suspension | 1,932 | 51% | 16.6 | 45% | $301 | ||||||||
| Humalog Mix 50/50 | Injectable suspension | 1,932 | 51% | 16.6 | 45% | $301 | ||||||||
| Humalog Mix 75/25 Kwikpen | Pen injector | 1,923 | 51% | 16.4 | 44% | $562 | ||||||||
| Humalog Mix 50/50 Kwikpen | Pen injector | 1,923 | 51% | 16.4 | 44% | $561 | ||||||||
| Humulin | Pen injector | 1,865 | 49% | 16.3 | 44% | $498 | ||||||||
| Humulin | Injectable suspension | 1,852 | 49% | 16.4 | 44% | $158 | ||||||||
| Humulin N Kwikpen | Pen injector | 1,865 | 49% | 16.3 | 44% | $497 | ||||||||
| Humulin N | Injectable suspension | 1,852 | 49% | 16.4 | 44% | $158 | ||||||||
| Humulin R U-500 | Injectable solution | 3,648 | 96% | 35.6 | 96% | $1,518 | ||||||||
| Humulin R U-500 Kwiken | Pen injector | 3,607 | 95% | 35.3 | 95% | $587 | ||||||||
| Humulin R | Injectable solution | 1,852 | 49% | 16.4 | 44% | $156 | ||||||||
| Lantus | Injectable solution | 2,798 | 74% | 24.9 | 67% | $283 | ||||||||
| Lantus Solostar | Pen injector | 2,793 | 74% | 24.9 | 67% | $425 | ||||||||
| Levemir Flextouch | Pen injector | 3,368 | 89% | 33.3 | 90% | $906 | ||||||||
| Levemir | Injectable solution | 3,368 | 89% | 33.3 | 90% | $604 | ||||||||
| Novolin 70/30 | Injectable suspension | 2,189 | 58% | 22.8 | 62% | $141 | ||||||||
| Novolin N | Injectable suspension | 2,189 | 58% | 22.8 | 62% | $141 | ||||||||
| Novolin R | Injectable solution | 2,189 | 58% | 22.8 | 62% | $141 | ||||||||
| Novolog Flexpen | Pen injector | 2,319 | 61% | 23.1 | 62% | $571 | ||||||||
| Novolog | Cartridge | 2,319 | 61% | 23.1 | 62% | $549 | ||||||||
| Novolog | Injectable solution | 2,319 | 61% | 23.1 | 62% | $296 | ||||||||
| Novolog Mix 70/30 Flexpen | Pen injector | 2,319 | 61% | 23.1 | 62% | $571 | ||||||||
| Novolog Mix 70/30 | Injectable suspension | 2,319 | 61% | 23.1 | 62% | $307 | ||||||||
| Soliqua 100-33 | Pen injector | 2,657 | 70% | 30.7 | 83% | $718 | ||||||||
| Toujeo Solostar | Pen injector | 2,779 | 73% | 24.7 | 67% | $391 | ||||||||
| Toujeo Max Solostar | Pen injector | 2,643 | 70% | 24.5 | 66% | $510 | ||||||||
| Tresiba Flextouch U-200 | Pen injector | 2,953 | 78% | 31.0 | 84% | $609 | ||||||||
| Tresiba Flextouch U-100 | Pen injector | 2,953 | 78% | 31.0 | 84% | $508 | ||||||||
| Xultophy 100-3.6 | Pen injector | 2,168 | 57% | 22.9 | 62% | $1,050 | ||||||||
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NOTE: Analysis includes plans with 5 or 6 tier formulary design (3,787 out of 3,983 plans with a non-standard benefit design in 2019).
SOURCE: KFF analysis of CMS Part D Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files, 2019.
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| Table 3: Typical Formulary Placement of Insulin Products in Medicare Part D Plans, 2019 | ||||||
| Median formulary placement when covered | Cost-sharing amounts | |||||
|
Drug name |
Product type | Tier | Cost-sharing type | Initial coverage phase | Coverage gap phase (based on 25% coinsurance) |
Catastrophic coverage phase (based on 5% coinsurance) |
| Admelog Solostar | Pen injector | 4 | copayment | $100 | $108 | $22 |
| Admelog | Injectable solution | 4 | copayment | $100 | $56 | $11 |
| Afrezza (12 units) | Inhalant powder | 4 | copayment | $100 | $234 | $47 |
| Afrezza (8 units) | Inhalant powder | 4 | copayment | $100 | $157 | $31 |
| Afrezza (4 units) | Inhalant powder | 4 | copayment | $100 | $79 | $16 |
| Afrezza Titration Pack | Inhalant powder | 4 | copayment | $100 | $234 | $47 |
| Afrezza 180 Titration Pack | Inhalant powder | 4 | copayment | $100 | $312 | $62 |
| Apidra Solostar | Pen injector | 4 | copayment | $100 | $132 | $26 |
| Apidra | Injectable solution | 4 | copayment | $100 | $69 | $14 |
| Basaglar | Pen injector | 3 | copayment | $47 | $83 | $17 |
| Fiasp Flextouch | Pen injector | 3 | copayment | $47 | $148 | $30 |
| Fiasp | Injectable solution | 3 | copayment | $47 | $77 | $15 |
| Humalog | Injectable solution | 3 | copayment | $47 | $22 | $4 |
| Humalog | Pen injector | 3 | copayment | $47 | $140 | $28 |
| Humalog | Cartridge | 3 | copayment | $47 | $135 | $27 |
| Humalog U-100 Kwikpen | Pen injector | 3 | copayment | $47 | $142 | $28 |
| Humalog U-200 Kwikpen | Pen injector | 3 | copayment | $47 | $112 | $22 |
| Humalog Mix 75/25 | Injectable suspension | 3 | copayment | $47 | $75 | $15 |
| Humalog Mix 50/50 | Injectable suspension | 3 | copayment | $47 | $75 | $15 |
| Humalog Mix 75/25 Kwikpen | Pen injector | 3 | copayment | $47 | $140 | $28 |
| Humalog Mix 50/50 Kwikpen | Pen injector | 3 | copayment | $47 | $140 | $28 |
| Humulin | Pen injector | 3 | copayment | $47 | $124 | $25 |
| Humulin | Injectable suspension | 3 | copayment | $47 | $39 | $8 |
| Humulin N Kwikpen | Pen injector | 3 | copayment | $47 | $124 | $25 |
| Humulin N | Injectable suspension | 3 | copayment | $47 | $39 | $8 |
| Humulin R U-500 | Injectable solution | 5 | coinsurance | 29% ($440) | $379 | $76 |
| Humulin R U-500 Kwiken | Pen injector | 5 | coinsurance | 29% ($170) | $147 | $29 |
| Humulin R | Injectable solution | 3 | copayment | $47 | $39 | $8 |
| Lantus | Injectable solution | 3 | copayment | $47 | $71 | $14 |
| Lantus Solostar | Pen injector | 3 | copayment | $47 | $106 | $21 |
| Levemir Flextouch | Pen injector | 3 | copayment | $47 | $226 | $45 |
| Levemir | Injectable solution | 3 | copayment | $47 | $151 | $30 |
| Novolin 70/30 | Injectable suspension | 3 | copayment | $47 | $35 | $7 |
| Novolin N | Injectable suspension | 3 | copayment | $47 | $35 | $7 |
| Novolin R | Injectable solution | 3 | copayment | $47 | $35 | $7 |
| Novolog Flexpen | Pen injector | 3 | copayment | $47 | $143 | $29 |
| Novolog | Cartridge | 3 | copayment | $47 | $137 | $27 |
| Novolog | Injectable solution | 3 | copayment | $47 | $74 | $15 |
| Novolog Mix 70/30 Flexpen | Pen injector | 3 | copayment | $47 | $143 | $29 |
| Novolog Mix 70/30 | Injectable suspension | 3 | copayment | $47 | $77 | $15 |
| Soliqua 100-33 | Pen injector | 3 | copayment | $47 | $179 | $36 |
| Toujeo Solostar | Pen injector | 3 | copayment | $47 | $98 | $20 |
| Toujeo Max Solostar | Pen injector | 3 | copayment | $47 | $127 | $25 |
| Tresiba Flextouch U-200 | Pen injector | 3 | copayment | $47 | $152 | $30 |
| Tresiba Flextouch U-100 | Pen injector | 3 | copayment | $47 | $127 | $25 |
| Xultophy 100-3.6 | Pen injector | 3 | copayment | $47 | $262 | $52 |
| NOTE: Analysis includes plans with 5 or 6 tier formulary design (3,787 out of 3,983 plans with a non-standard benefit design in 2019). Typical formulary placement refers to formulary tier, copayment type, and cost-sharing amount most often used by Part D plans that cover given insulin product. Cost-sharing amounts based on coinsurance are calculated based on median total cost for 30-day prescription (see Table 1). SOURCE: KFF analysis of CMS Part D Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files, 2019. |
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| Table 4: Formulary Coverage, Tier Placement, and Cost Sharing of Insulin Products in Medicare Part D Plans, 2019 | |||||||
| Plans charging copayments | Plans charging coinsurance | ||||||
| Formulary tier | Number of insulin products | Percent of plans / enrollees with at least one insulin product covered | Enrollment-weighted median copayment | Number of insulin products | Percent of plans / enrollees with at least one insulin product covered | Enrollment-weighted median copayment | |
| 1 | 32 | 0.4% / 0.2% | $5 | n/a | |||
| 2 | 36 | 7.4% / 17.8% | $20 | 23 | 0.3% / <0.1% | 25% | |
| 3 | 46 | 86.8% / 84.2% | $47 | 39 | 12.3% / 15.0% | 25% | |
| 4 | 46 | 8.9% / 5.9% | $100 | 46 | 7.7% / 4.5% | 48% | |
| 5 | 3 | 0.2% / 0.2% | $0 | 5 | 52.2% / 57.6% | 30% | |
| 6 | 34 | 2.5% / 0.85 | $11 | 21 | 0.1% / <0.1% | 0% | |
| NOTE: Analysis includes plans with 5 or 6 tier formulary design (3,787 out of 3,983 plans with a non-standard benefit design in 2019). SOURCE: KFF analysis of CMS Part D Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files, 2019. |
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