Presentation (CTI)

OBJECTIVES: Understanding trends in out-of-pocket (OOP) spending for diabetes care is essential for evaluating healthcare policies such as the Affordable Care Act (ACA) and Inflation Reduction Act (IRA). Despite rising drug prices, little is known about how OOP spending has changed over time or whether trends differ by insurance coverage and income.
METHODS: We used data from the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the U.S. civilian noninstitutionalized population. Annual total OOP spending among individuals with diabetes was measured in inflation-adjusted 2023 U.S. dollars. Survey-weighted generalized linear models were used to estimate linear trends in OOP spending over time, with calendar year specified as a continuous variable. Effect modification by insurance coverage (private, public, uninsured) and income category was assessed using interaction terms. All analyses accounted for the complex MEPS survey design.
RESULTS: Among individuals with diabetes, mean annual OOP spending declined substantially over the study period, from $814 (95% CI: $740-$887) in 2013 to $424 (95% CI: $368-$480) in 2023, corresponding to an average annual decrease of $38 (95% CI: −$44 to −$32). OOP spending declined significantly among privately insured ($44 per year; 95% CI: −$52 to −$37) and publicly insured individuals ($28 per year; 95% CI: −$36 to −$21). In contrast, no statistically significant trend was observed among uninsured individuals (annual change: $16; 95% CI: −$53 to $85). Declines in OOP spending were observed across all income categories.
CONCLUSIONS: Despite rising prices for newer diabetes therapies, average OOP spending among individuals with diabetes has declined substantially over time, driven primarily by reductions among privately and publicly insured populations. Uninsured individuals did not experience similar improvements, highlighting persistent disparities in financial burden.