The Runaway Cost of Diabetes

Oct 15, 2012
In 2011, for the first time, the United States spent more on medications to treat diabetes than for medication for any other disease.
  • Diabetes

Last year, for the first time, the United States spent more on medications to treat diabetes than for medication for any other disease. We forecast that diabetes drug spend will maintain this top ranking for the foreseeable future.

With an aging population and increased prevalence of obesity, this may not be surprising. However, when 10% of total drug spend goes to treat a single disease, it’s an issue that requires immediate attention, and it is being discussed this week at the American Diabetes Association 72nd Scientific Sessions in Philadelphia.

Nearly 26 million Americans – more than 8% of the population – are estimated to have diabetes, although approximately 7 million go undiagnosed and therefore untreated. Additionally, 79 million others may have pre-diabetes.

For the commercially insured population Express Scripts serves, $81.12 was spent per member in 2011 on diabetes medications. NOTE: this isn’t $81.12 per diabetes patient; it’s $81.12 per member, which includes those who are not diabetic. For example, if a company has 100,000 employees and beneficiaries on its health plan, the total bill (including both employer cost and patient copays) just for diabetes medications was likely more than $8.1 million.

Outside of drug spend, diabetes is one of the costliest chronic conditions to treat when you consider medical claims for specialists and hospitalizations from devastating and costly complication and comorbidities, including heart disease, hypertension, and renal failure. In fact, the Centers for Disease Control and Prevention estimates direct medical spending on diabetes is $116 billion annually, and that amount is expected to triple by the end of the decade.

Understanding Patient Behavior

Diabetes patients can successfully manage their condition, and in many instances prevent diabetes, through lifestyle modifications, maintaining a healthy diet and exercise program.

Improving medication adherence is another critical factor in reigning in costs to treat diabetes. Currently, 41% of diabetes patients are nonadherent to their medication. We estimate that nonadherence to medications for diabetes, high cholesterol, and high blood pressure – three highly correlated diseases – increases the country’s medical bills by $105.8 billion each year.

Looking for an Answer

As utilization for drugs to treat diabetes continues to rise, implementing appropriate strategies control cost trend while maximizing patient outcomes is critical for successful long-term management.

ScreenRx predicts which diabetes patients are going to stop taking their medication within the next year – with a 98% accuracy rate – and intervenes with an appropriate solution that’s tailored to the specific adherence obstacle that the individual patient is likely to encounter.

The Express Scripts Diabetes Therapeutic Resource Center (TRC) has a robust team of pharmacists who specialize in the treatment of diabetes and provide clinical and behavioral counsel to help patients more effectively manage their condition.

By combining our data expertise with our pharmacist consultation services, ExpressAlliance delivers more highly coordinated care for diabetes patients. Gaps in care are closed, duplication of health services is prevented, and health outcomes are improved.

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Lab Staff
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