Type 1 diabetes (T1D) is a chronic disease that affects 2 million people in the United States. We recently conducted an analysis of the size of the T1D population benefitting from insulin out-of-pocket (OOP) cost caps and those still vulnerable to high-cost exposure. Breakthrough T1D, a research and advocacy organization, commissioned Milliman to analyze insulin product utilization and costs using administrative claims and enrollment data from four major sources of health insurance coverage in 2022 (Medicare fee-for-service, Medicare Advantage, Medicaid, and commercial insurance).

T1D works by attacking the body’s insulin-producing cells. Insulin is a hormone critical to the body’s functioning because it is a key component of the mechanism that helps the body convert food into energy. Individuals living with this condition depend on prescription insulin–without it, glucose builds up in the bloodstream, resulting in serious health complications. As a result, people diagnosed with T1D must use prescription insulin for the rest of their lives. Insulin affordability is especially important for individuals with T1D, as financially strained users exposed to high OOP insulin costs may engage in cost-saving behaviors with potentially dire health consequences. We estimate that 45% of people with T1D in the United States are covered by either a state or federal insulin OOP cost cap. Despite the existence of these caps nationally, many people with the disease may still be vulnerable to high OOP insulin costs.

This report was commissioned by Breakthrough T1D.