4.5-year study finds diabetes and related drug costs surging

April 1, 2016

Nearly 1 in 10 Americans have diabetes.1 It’s an epidemic, and it doesn’t appear to be stopping any time soon. By 2050, as many as 1 in 3 adults in the United States will have diabetes.2

The growing diabetic population is having a marked impact on drug use and spend. Coupled with drug price inflation, rising use has led to mounting costs for plan sponsors. To help measure the impact of rising use and costs, the health outcomes team dove deep into Prime’s data to study diabetes prevalence, incidence and drug therapy.

What we studied

Prime’s research team studied nearly 4 million commercial members who were continuously enrolled in a plan for 4.5 years. We used criteria to identify members who had diabetes-related claims, and broke the data down further by diabetes (Type 1 or Type 2) and therapy type.

What we learned

Diabetes drug use and costs are rising quickly. From January 2011 to June 2015:

  • The average cost for all diabetes drugs increased 168 percent.
  • Diabetes drugs, as a category, increased from 6.7 percent to 10.7 percent of total drug spend.
  • Insulin costs increased 200 percent, and use increased 50 percent.
  • Insulin costs rose from 3 percent to 5.4 percent of total drug spend.

What plan sponsors can do

Programs such as step therapy can help plan sponsors encourage the use of generics with known, long-term safety and efficacy, resulting in lower overall drug spend. In addition, programs that help drive adherence by identifying and communicating gaps in care (such as Prime’s GuidedHealth® program) can help improve safety and outcomes, helping members get the medicines they need to live well and lowering the total cost of care.


  1. Statistics about diabetes. American Diabetes Association. (2012.) http://www.diabetes.org/diabetes-basics/statistics/?referrer=https://www.google.com/
  2. Fast facts – data and statistics about diabetes. American Diabetes Association. (2012.) http://professional.diabetes.org/content/fast-facts-data-and-statistics-about-diabetes/?loc=dorg_statistics
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 (Spring 2016)

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