904-P: Trends in Out-of-Pocket Cost for Glucagon 2010–2020

The ADA Standards of Care recommend that all patients with diabetes at risk of hypoglycemia have glucagon available for emergency use. However, glucagon prescriptions are filled by only a small minority of patients with type 1 and type 2 diabetes in the United States each year. While there are multiple barriers to glucagon use, the extent to which out-of-pocket medication costs contributes to low uptake is not clear.

Using administrative claims from Optum’s de-identified Clinformatics® Data Mart Database (2007-2019) for adults with commercial or Medicaid insurance from 2010-2020, we sought to describe the trends in out-of-pocket costs for glucagon over time. Analyzed claims included all fills of glucagon, based on National Drug Codes, from 20through 9/30/2020. Our primary outcome was total out-of-pocket costs defined as the sum of copays and deductibles. Costs were adjusted for inflation based on 2020 dollars and scaled per single-use kit. Insurance type was based on the primary payor at the time of the glucagon fill.

The median (IQR) out-of-pocket cost of unmixed glucagon was $27.42 (15.09-37.98) in 2010, $33.58 (5.60-41.97) in 2015, and $30.42 (15.21-40.56) in 2020 for commercially insured beneficiaries. For Medicare beneficiaries, cost for unmixed glucagon was $0 (0-25.35) in 2010, $0 (0-33.58) in 2015, and $0 (0-40.56) in 2020. After introduction in 2019, the 2020 out-of-pocket cost of intranasal glucagon was $15.21 (7.60-35.49) for commercially insured beneficiaries and $10.14 (0.99-23.83) for Medicare beneficiaries.

Out-of-pocket costs for unmixed glucagon was stable for most commercially insured patients, and $0 for most Medicare beneficiaries from 20through 2020; therefore, cost should not serve as the primary barrier to accessing glucagon for most patients. However, for the subset of patients (4^th quartile) with the highest out-of-pocket costs in both insurance groups, the cost of unmixed glucagon has increased over time. Novel intranasal glucagon had lower out-of-pocket cost compared to unmixed glucagon for most commercially insured patients immediately after introduction.