The goal of this study is to help decision makers better understand insulin price sensitivity following out-of-pocket (OOP) increases, and the consequences of cost-related non-adherence. With the dramatic increase in the price of insulin in recent years, patients have experienced a substantial increase in their OOP costs. Approximately 30% of patients require insulin to manage their disease, but prior research identified that patients’ OOP cost for insulin increased 150% between 2000 and 2010, thus becoming unaffordable for many patients. Using OptumLabs data from 2007 – 2018, the researchers will conduct a retrospective cohort study to examine the association between increases in insulin OOP cost and the use of insulin and non-insulin  diabetes medications, as well as the association with other diabetes-related outcomes (e.g. poor blood sugar control, emergency department (ED) visits and hospitalizations). Deliverables will include a project work plan and final narrative report. The researchers will also produce paper(s) suitable for publication and present findings at national research meetings and to other stakeholder audiences as appropriate, including policymakers at the federal, state, and local levels and other key stakeholders, as part of the deliverables for this grant.

Principal Investigators

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Carrie McAdam-Marx, M.S.C.I., Ph.D., R.Ph.

Professor, Department of Pharmacy Practice and Science - University of Nebraska Medical Center

Carrie McAdam-Marx, M.S.C.I., Ph.D., R.Ph. is Professor and Director of the Social and Administrative Pharmacy... Read Bio

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Natalia Ruiz-Negrón, PharmD

Research Assistant Professor - University of Utah College of Pharmacy

Dr. Natalia Ruiz-Negrón, PharmD is a Research Assistant Professor at the University of Utah College of Pharmacy. Read Bio

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John Tilford, Ph.D.

Professor and Chair of Health Policy and Management - University of Arkansas for Medical Sciences

John “Mick” Tilford currently serves as a Professor and Chair of Health Policy and Management, Fay W. Boozman ... Read Bio


Grant: #77105 
Grantee Institution: University of Nebraska Medical Center
Grant Period: 1/1/20 – 12/31/20


The effects of patient out-of-pocket costs on insulin use among people with type 1 and type 2 diabetes with Medicare Advantage insurance-2014-2018
Health Services Research | March 2023

Research Shows Limiting Out-of-Pocket Costs for Insulin Improves Adherence
AcademyHealth | July 2022

The effects of patient out-of-pocket costs for insulin on medication adherence and health care utilization in patients with commercial insurance; 2007-2018
Journal of Managed Care | April 2022