Insulin Rationing in High-Income Settings: Cost-Related Non-Adherence and Its Clinical Signature
DOI:
https://doi.org/10.5281/zenodo.22260607Keywords:
Insulin rationing, Cost-related non-adherence, Medication access, Glycaemic control, Health policyAbstract
Cost-related insulin underuse is common in wealthy countries and its prevalence has not moved. A survey at a single academic
diabetes centre found that 51 of 199 respondents, 25.5 per cent, had used less insulin than prescribed because of cost in the
previous year, and those who had were three times as likely to have an HbA1c above 9 per cent after adjustment. The same survey
repeated at the same centre seven years later, after a series of policies intended to limit out-of-pocket insulin costs, found 48 of
199 respondents, 24.1 per cent, doing the same thing, a difference that was not significant. Two further findings sharpen the
picture. Counting insurance delays and pharmacy shortages alongside cost raised the figure to 37.7 per cent, so price is not the
whole barrier. And the share of those rationing who had type 1 diabetes rose from 43.1 to 63.0 per cent, concentrating the
behaviour in the group for whom omission is most dangerous. This review sets out what is measured, what it predicts, and why the
policy response has not registered.
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