Diabetes Quickly Becoming Most Expensive Chronic Condition To Treat

Diabetes Medication

With an estimated 30 million Americans struggling with diabetes, the disease is one of the nation’s most entrenched chronic conditions. It’s also one of the most expensive.

In California, roughly 55 percent of adults either have diagnosed diabetes or blood-sugar levels that put them at high risk of developing the disease. That includes roughly 1 in every 3 adults ages 18 to 39 – a finding researchers call alarming.

In terms of personal health care spending, diabetes tops the nation’s list of 155 chronic conditions, hitting $101.4 billion in 2013. According to the American Diabetes Association, average medical expenditures for people with diabetes are an estimated 2.3 times higher than for those without it.

The cost of insulin alone has spiked by triple-digit percentages in the past 20 years.

“It’s horrible for patients,” said N. Chesney Hoagland-Fuchs, a registered nurse and chairwoman of the Diabetes Coalition of California, to the Sacramento Bee. She said prices for insulin medications began a slow climb after the recession and started “shooting up” around 2013.

Over the past 20 years, the price of human insulin produced by two major manufacturers – Eli Lilly and Novo Nordisk – rose 450 percent, after accounting for inflation, according to a 2016 Washington Post analysis of data from Michigan-based Truven Health Analytics. A single 10-milliliter vial of Eli Lilly’s Humalog insulin – less than a month’s supply for many adults – was listed at $254.80 last year, compared with $20.82 in 1996, a Truven Health representative said.

Insulin is only one sliver of the cost of living with Type 1 and Type 2 diabetes. Depending on their treatment regimen, diabetics often spend hundreds of dollars annually on medications, syringes, pumps, needles, blood-sugar sensors and monitors, even alcohol swabs for finger stick testing.

It all adds up. On average, those with diagnosed diabetes have annual medical expenses of $13,700, more than half of which is directly attributed to their disease, according to the American Diabetes Association.

The personal cost of managing the disease is daunting. Treating diabetes soaked up $101.4 billion in personal spending in 2013, primarily for pharmaceuticals, according to a study last year by the University of Washington-based Institute for Health Metrics and Evaluation. Diabetes topped the institute’s list of 155 conditions tracked over 18 years, including cancers and heart disease.

In California alone, the cost of treating diabetes was estimated at more than $27 billion in 2012, according to the American Diabetes Association.

Keith Wick, a 31-year-old information technology specialist, was diagnosed with Type 1 diabetes as a teenager. Two years ago, the Sacramento resident was paying about $60 for a 90-day supply of Lantus and Humalog, which covered about five insulin injections a day. Today, even with Kaiser Permanente health insurance, that same dosage costs about $210, roughly a 250 percent increase.

“Diabetes is the cash cow of the pharmaceutical industry,” said Wick, who works for the state Department of General Services. “You have to have (insulin). You have to buy it or you risk losing your life.”

Wick and his wife are squirreling away savings to pay for newer technology to treat his diabetes. Wick wants to buy a continuous glucose-monitoring system, which would cost about $6,000 for an insulin pump and $1,000 for the blood-sugar sensor and monitor. His health plan will cover about 80 percent of the hardware cost, but that doesn’t include the disposable insulin cartridges and the sensor’s batteries, which must be replaced every three months. And he’d still need to test his blood-sugar levels at every meal with finger sticks.

Last year, to cover the anticipated expense, Wick and his wife added money to their health plan’s flexible spending account. “It’s expensive. It’s a lot out of your pocket every year,” said Wick, who’s had Type 1 diabetes for about 18 years.

For Medi-Cal patients, the state covers the full cost of diabetes medications, but price spikes have led to constraints on which medications Medi-Cal doctors can prescribe.

Dr. Gilbert Simon, medical director of Sacramento Family Medical Clinics, which treats about 30,000 Medi-Cal patients in Sacramento County, said doctors are required to start with cheaper, non-insulin solutions that are often not as effective at reducing blood-sugar levels.

“It prolongs the process of getting to the most effective medications,” he said. “The real cost to patients is in delayed treatment.”