January 24, 2023
HP-2023-02

Insulin Affordability and the Inflation Reduction Act:
Medicare Beneficiary Savings by State and
Demographics
Under the Inflation Reduction Act, out-of-pocket costs for insulin in Medicare are
now capped at $35 per monthly prescription for Part D, as of January 1, 2023, with asimilar cap taking effect in Part B on July 1, 2023. Medicare beneficiaries who use
insulin would have saved $734 million in Part D and $27 million in Part B if these caps
had been in effect in 2020.
Bisma A. Sayed, Kenneth Finegold, T. Anders Olsen, Nancy De Lew, Steve Sheingold, Kaavya Ashok,
and Benjamin D. Sommers

KEY POINTS
•

•

•

•

•

The Inflation Reduction Act (IRA) caps insulin out-of-pocket spending at $35 per month’s supply ofeach insulin product covered under a Medicare Part D plan, with similar limits for out-of-pocket
costs for insulin supplied under Part B, and reduces out-of-pocket drug spending in Medicare inother ways. These provisions will make insulin more affordable for people covered by Medicare.
We examined out-of-pocket spending on insulin using 2019 survey data for individuals with
Medicare, Medicaid, or private insurance, and for those without health coverage. We thenestimated the potential effects of the IRA’s insulin cap provisions on out-of-pocket spending forinsulin among Medicare beneficiaries using 2020 Medicare claims data.
Nationally, the average out-of-pocket cost was $58 per insulin fill, typically for a 30-day supply.
The average cost per fill among people who were uninsured for the entire year was $123, morethan double the national average. Patients with private insurance or Medicare paid about $63 per
fill on average.
About 37 percent of insulin fills for Medicare enrollees (Part B and Part D) required cost-sharing
exceeding $35 per fill, including 24 percent that exceeded $70 per fill. About 36 percent of insulin
fills for people without insurance and 35 percent for people with private insurance had cost
sharing above $35 per fill. These estimates are only for enrollees who filled an insulin prescription
and do not include potential costs for patients who did not fill their insulin due to cost or otherreasons.
We estimate that 1.5 million Medicare beneficiaries would have benefited from the new IRA
insulin cost-sharing limits if they had been in effect in 2020, with savings to those beneficiaries ofabout $734 million in Part D and $27 million in Part B – or approximately $500 in average annual
savings per person among those benefiting from the provision.

1

BACKGROUND
An estimated 37 million Americans, representing about 11.3 percent of the U.S. population, have diabetes. 1
Diabetes is characterized by insulin dysfunction that occurs when the pancreas does not produce enoughinsulin (type 1 diabetes), or when the body does not respond to insulin properly and/or have enough insulin
production to overcome this deficit (type 2 diabetes). 2, 3 More than 7 million individuals with diabetes,
including all individuals with type 1 diabetes and a substantial number of those with type 2 diabetes, need touse insulin daily to manage their blood sugars and prevent the adverse consequences associated withuncontrolled diabetes. 4
Although insulin is critical for the patients who require it to manage their illness, it can be expensive. List
prices have increased over time, nearly doubling between 2012 and 2016, 5 before stabilizing somewhat inrecent years. High insulin prices can contribute to challenges with adherence to prescribed insulin regimens,
which can, in turn, lead to complications including ketoacidosis, * kidney disease, vision loss, and others. 6
These complications are expensive to treat, severely impact patients’ quality of life, and may lead tohospitalizations, amputations, and death. 7
Recognizing the importance of insulin affordability, † the Inflation Reduction Act (IRA) of 2022 includes
provisions to limit out-of-pocket costs of insulin for people with Medicare, a population with higher prevalenceof diabetes (nearly 30 percent) than the general population (about 11 percent). 8, 9 Most people with Medicare
coverage access insulin through Medicare Part D, which covers injectable insulin, inhaled insulin, anddisposable “patch” pumps. 10 Cost sharing for insulin in Part D varies depending on whether the enrollee
qualifies for the Low-Income Subsidy (LIS) and, prior to the IRA, the Part D coverage phase of the enrollee atthe time that they obtained insulin. ‡Medicare Part B provides coverage for insulin when it is medically required to be administered through nondisposable insulin pumps. 11 Prior to the IRA, under Medicare Part B, beneficiaries were responsible for 20
percent of the cost after they met the Part B deductible, which may have been covered for some beneficiaries
by supplemental coverage.
The IRA includes several provisions that limit out-of-pocket spending on insulin for Medicare Part D and Part B
enrollees: 12•

Effective January 1, 2023, people enrolled in a Medicare Part D prescription drug plan (PDP) or a
Medicare Advantage plan with a prescription drug coverage (MA-PD) have no deductible for covered
insulin products and have a copayment cap of $35 per month supply of each covered insulin product. §_______________________
Ketoacidosis occurs when the body does not have enough insulin to use glucose, the body’s normal source of energy,
and this condition produces life-threatening metabolic disturbances that can lead to coma and death.
*

Recognizing insulin affordability as a key priority, even prior to the IRA, the Centers for Medicare and Medicaid Services
launched the Part D Senior Savings Model (PDSS), which tested changes to the Part D benefit design including
requirements that enrollees of participating plans would not need to pay more than $35 for a monthly supply of insulin.
Details about the PDSS Model are available here: https://innovation.cms.gov/innovation-models/part-d-savings-model.
†

For eligible enrollees whose income and resources are limited, the Medicare Prescription Drug, Improvement andModernization Act of 2003 established extra help (a subsidy) for prescription drugs, referred to as the Low-Income
Subsidy (LIS). Subsidies are paid by the Federal government to drug plans and provide assistance with premiums,
deductibles, and co-payments.
‡

Many patients with diabetes requiring insulin therapy have complex insulin regimens that may include a combination oftherapies, including insulin with other oral medications or multiple different types of insulin to manage diabetes andreduce risk of serious health effects.
§

January 2023

DATA POINT

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•

•

Effective July 1, 2023, Medicare Part B beneficiaries or those enrolled in a Medicare Advantage plan
who use an insulin pump furnished via durable medical equipment will no longer have to pay a
deductible for insulin and will have a copayment cap of $35 per month supply for their Part B covered
insulin.
Effective January 1, 2024, one year after the $35 cap, eligibility for the Part D LIS will expand. The IRA
raises the income limit for certain people covered by Medicare for the full LIS from 135 percent of theFederal Poverty Level (FPL) to 150 percent of FPL, which will allow these enrollees to further reduce
their out-of-pocket costs for insulin and other medications.

In this Data Point, we examine out-of-pocket costs of insulin and the average cost per insulin prescription fill byhealth insurance coverage type. We then examine what would have happened to out-of-pocket spending on
insulin among Medicare beneficiaries if the IRA’s monthly copayment cap of $35 for a one-month supply of acovered insulin product had been in effect in 2020. For more information about this research, see ourrecently released Report to Congress. ** 13

METHODS
We used the 2019 Medicare Expenditure Panel Survey Household Component (MEPS HC) to examine out-ofpocket cost per insulin fill, which was most commonly a 30-day supply of insulin. We also examined theaverage cost per fill of insulin by the type of health coverage.
Next, we focused specifically on the Medicare population to examine the IRA insulin provisions that aim to
reduce out-of-pocket spending and improve affordability of insulin for Medicare enrollees. We used the
Medicare Prescription Drug Event, Enrollment, and Part B data files to calculate the total amount enrollees
spent on insulin per month. Then for each enrollee, we computed the total amount spent above the IRA’slimits on cost sharing for insulin. This allowed us to estimate how much people with Medicare Part D and Part
B would have saved in out-of-pocket costs if the IRA insulin out-of-pocket cap had been in effect in 2020. We
identified the number of enrollees who would have had lower out-of-pocket costs for insulin and their totalsavings compared with what they actually paid in 2020, if the insulin cap had been in effect in 2020. Theseestimates are based on the number of Medicare Part D enrollees who spent more than $35 in any month of2020 on insulin in Part D and Part B combined.
We did not model other provisions of the IRA that may impact Medicare enrollees’ out-of-pocket spending forinsulin, such as the additional effect of LIS expansion, which will be implemented in 2024, or the potential
effects of negotiation on prices for selected prescription drugs, which will begin in 2026. Moreover, theestimates presented are based on Medicare enrollees who filled an insulin prescription in 2020 and do nottake into account individuals who did not fill their insulin prescription. For Part D, our estimates include both
Medicare Advantage prescription drug plans (MA-PD) and prescription drug plans (PDP) enrollees. Except as
noted, Part B estimates are only for individuals covered by fee-for-service Medicare.

FINDINGS
Out-of-Pocket Spending for Insulin
Table 1 indicates that the overall mean out-of-pocket cost for insulin obtained from retail, mail, and online
pharmacies in 2019 was $58 per fill. Among the prescriptions with reported days supplied, 30 days was the_______________________
This Data Point includes selected findings from the Insulin Affordability Report to Congress: Office of the Assistant
Secretary for Planning and Evaluation, U.S. Department of Health & Human Services. Report on the Affordability of
Insulin. December 16, 2022. https://aspe.hhs.gov/reports/insulin-affordability-rtc**

January 2023

DATA POINT

3

mode and median number of days, indicating that fills typically represent an approximate 30-day supply of
insulin. These estimates are only for individuals who filled an insulin prescription in 2019 and do not include
estimates for those who did not fill an insulin prescription because of cost or other reasons.
The estimates in Table 1 demonstrate wide variation in the amounts paid in out-of-pocket costs for insulin bytype of coverage for prescription drugs. Among people uninsured for the entire year, the average out-ofpocket cost per fill was $123, more than double the overall average. Patients with private insurance or
Medicare both paid $63 per fill on average. The median overall out-of-pocket payment was substantially lower
than the mean at $9, meaning that half of fills were for that amount or less. The large difference between themean and median estimates indicates variability in the data and suggests that a subset of patients have ahigher out-of-pocket cost burden than the mean or median estimates.
Out-of-pocket costs for uninsured patients would likely have been greater if not for charity care, safety net
providers, patient assistance programs, free or sliding scale access through federally qualified health centersand safety net providers, and coupons. †† Availability of some types of insulin at low cost from certain
commercial retailers and authorized generic products from manufacturers with no rebates may contribute to
reduced costs of insulin for patients who do not have insurance. Similarly, out-of-pocket costs for patientswith private insurance would likely have been greater if not for patient assistance programs and coupons. In
addition, many patients covered through Marketplace with low incomes qualify for cost-sharing reductions,which reduce their out-of-pocket costs.

Table 1. Median and Mean Out-of-Pocket Cost Per Insulin Fill, by Type of Coverage, 2019
Type of Coverage
Overall
PrivateMedicare
Medicaid
Uninsured b

Mean
$58
$63
$63
$6 ** a$123 **Median$9$25 **$10 a$0 ** a$12

Source: Medical Expenditure Panel Survey (MEPS), 2019. Civilian noninstitutionalized population.
Notes: The insurance categories are treated as mutually exclusive according to the following hierarchy: Medicare (with orwithout Part D drug coverage, including Medicare only, Medicare and Medicaid, and Medicare and private insurance),
private insurance (including private insurance only and Marketplace any time during the year), Medicaid (includes
Medicaid only or Medicaid and other government programs), other government programs only, and uninsured (lacked
insurance from any source for the entire calendar year). “Medicare” includes fills under Part D (MA-PDP and PDP) andPart B (Fee for Service and Medicare Advantage). “Overall” also includes adults who had insurance through othergovernment programs.
* Statistically significantly different from overall at the .05 level.
** Statistically significantly different from overall at the .01 level.
a Estimates are imprecise due to small sample sizes.
b For the uninsured population, annual average estimates are from the MEPS, 2014-2019 due to small sample sizes in
2019. Out-of-pocket expenditures on insulin for 2014 to 2018 are inflated to 2019 dollars using the Consumer Price Index
for prescription drugs. For overall, private, Medicare, and Medicaid coverage categories, we used the 2019 MEPS data.

Figure 1 presents the shares of insulin prescription fills, by type of coverage, for which there was any out-ofpocket spending. Overall, 63 percent of insulin fills required some cost-sharing, with 32 percent of fills_______________________
Manufacturer programs and coupons are treated like other discounts and are not counted as expenditures by thepatient or other payers.
††

January 2023

DATA POINT

4

requiring more than $35, and 20 percent requiring more than $70. Fills for privately insured and uninsured
patients were significantly more likely to require cost-sharing than other coverage groups, while mostMedicaid beneficiaries with insulin fills had no cost-sharing at all. Among Medicare patients, 68.5 percent hadout-of-pocket costs, with 37 percent paying more than $35 per prescription fill – including nearly a quarter
who paid more than $70 per fill.
While 30 days was the most common prescription length in the dataset, 32 percent of prescriptions lacked
information on the number of days supplied, and smaller numbers of prescriptions may represent more or lessthan a 30-day supply; these factors introduce some uncertainty into our estimates of the proportion of insulin
users paying more than $35 per 30-day supply.

Figure 1. Share of Insulin Prescription Fills with Cost Sharing Per Fill, by Type of Coverage, 20190%20%

Overall
PrivateMedicare

40%

80%

40%

25%

31%

32%

20%

16%

19%

13%

9%

43%
$0

>$0 to $35

24%
14%

84%
21%

100%

12%

32%

37%

Medicaid
Uninsured

60%>$35 to $70

3%

27%

>$70

Source: Medical Expenditure Panel Survey (MEPS), 2019. Civilian noninstitutionalized population.
Notes: The insurance categories are hierarchical (see Notes to Table 1). “Medicare” includes fills under Part D (MA-PDP
and PDP) and Part B (Fee for Service and Medicare Advantage). “Overall” also includes adults who had insurance throughother government programs. For overall, private, Medicare, and Medicaid coverage categories, we used the 2019 MEPS
data. For the uninsured population, annual average estimates are from the MEPS, 2014-2019 due to small sample sizes in
2019. Out-of-pocket expenditures on insulin for 2014 to 2018 are inflated to 2019 dollars using the Consumer Price Index
for prescription drugs.

Effects of IRA Insulin Provisions on Out-Of-Pocket Spending for Medicare Enrollees
Our analyses of the impact of the IRA’s out-of-pocket insulin cap estimated how much individuals with
Medicare Part D and Part B would have saved if these provisions had been in effect in 2020. Table 2 showsthat nearly 1,518,000 Part D enrollees would have benefited, saving $734 million, if the IRA insulin provisions
had been in effect in 2020. ‡‡ Most of the savings would have accrued to enrollees who do not qualify for LIS,
which reduces out-of-pocket costs for Part D enrollees who meet income and resource limits.

_______________________
Our estimate of 1.5 million Part D enrollees who would have had lower out-of-pocket costs for insulin if the IRA
provisions had been in effect in 2020 is slightly different from the CMS estimate of 1.4 million(https://www.cms.gov/newsroom/fact-sheets/inflation-reduction-act-lowers-health-care-costs-millions-americans).
‡‡January 2023

DATA POINT

5

Table 2 also shows that the IRA’s Part B insulin out-of-pocket cap would
have produced additional savings of $27 million for about 31,000 Part B
beneficiaries, or about $866 per beneficiary in 2020.

1.5 million

Medicare beneficiaries
would have saved moneyin Part D, Part B, or bothunder the IRA’s $35
insulin cap provisions.

There is some overlap between the Part D and Part B insulin users who
benefit from the out-of-pocket cap, but some Part B beneficiaries do nothave Part D coverage. Overall, about 1.52 million Medicare enrollees
would have saved money in Part D, Part B, or both under the IRA’s $35
insulin cap provisions. Combining the estimated Part D and Part B savings,
total savings in 2020 would have been $761 million, or just over $500 per
beneficiary with savings.

Table 2. Estimated Out-of-Pocket Savings If Inflation Reduction Act $35/month Out-of-Pocket
Insulin Cap Had Been in Effect in 2020
Outcome
Total IRA Savings ($millions)
Number of Insulin
Users with Savings
Average Savings
per Insulin User
with Savings ($)

Non-LIS$723.2

Part D
LIS
$10.8

Total
$734.0Part B
Total
$27.2

Total
(Combined Part B and D)$761.16

1,477,327

76,503

1,517,817

31,376

1,519,856

$490

$141

$484

$866

$501

Source: ASPE analysis of CMS Medicare Part D 2020 Prescription Drug Event (PDE), Enrollment, and Part B data files.
LIS = Low-Income Subsidy

Table 3 shows the distribution of savings by gender, race, ethnicity, and age. The estimates indicate that
substantial numbers of beneficiaries would benefit from the policy across all demographic groups analyzed.
Part D LIS enrollees who benefit from the cap are more likely than Part D non-LIS enrollees or Part B
beneficiaries to be women, Black, or below the age of 65 (indicating eligibility for Medicare on the basis of
disability or End-Stage Renal Disease). Overall, about 1.25 million White beneficiaries, 160,000 Black
beneficiaries, 28,000 Latino beneficiaries, 20,000 Asian beneficiaries, and 7,000 American Indian / Alaska
Native beneficiaries will benefit from the new provision.

January 2023

DATA POINT

6

Table 3. Demographic Characteristics of Medicare Enrollees with Out-of-Pocket Savings If Inflation
Reduction Act Insulin Provisions Had Been in Effect in 2020
Category

Non-LIS(n)Part D
%

LIS
(n)

%

Part B
Total
(n)

Total
%

(n)

%

GenderFemale708,281 47.9% 43,862
57.3%
16,46552.5%
732,729
48.2%
Male or Unknown
769,046 52.1% 32,641
42.7%
14,911
47.5%
787,127
51.8%
Race and Ethnicity
White
1,217,545 82.4% 55,424
72.4%
29,00592.4%
1,248,912
82.2%
Black
154,311 10.4% 14,093
18.4%
922
2.9%
161,810
10.7%
Latino25,901 1.8%
3,512
4.6%
137
0.4%
27,788
1.8%
Asian
19,795 1.3%
1,146
1.5%
128
0.4%
20,344
1.3%
AI/AN
6,705 0.5%
525
0.7%
47
0.2%
6,961
0.5%
Other
53,070 3.6%
1,803
2.4%
1,137
3.6%
54,041
3.6%
Age
Under 65
115,104 7.8% 20,366
26.6%
4,674
14.9%
128,6348.5%
65-69
284,559 19.3% 14,413
18.8%
7,722
24.6%
292,603
19.3%
70-74
420,654 28.5% 15,092
19.7%
10,15332.4%
428,893
28.2%
75-79
319,859 21.7% 11,566
15.1%
5,618
17.9%
325,856
21.4%
80-84
196,240 13.3% 8,281
10.8%
2,356
7.5%
200,283
13.2%
85-89
95,927 6.5%
4,454
5.8%
700
2.2%
97,838
6.4%
90 or Older
44,984 3.0%
2,331
3.0%
153
0.5%
45,7493.0%
Source: ASPE analysis of CMS Medicare Part D 2020 Prescription Drug Event (PDE), Enrollment, and Part B data files.
LIS = Low-Income Subsidy
AI/AN = American Indian and Alaskan Native

Effects of IRA Insulin Provisions on Out-Of-Pocket Spending by StateWe also examined the effects of the IRA insulin cap on out-of-pocket spending for people with Medicare
coverage in each state. Table 4 shows that across both Medicare Part D and B, 114,000 beneficiaries in Texas,
108,000 in California, and 90,000 in Florida are projected to have the highest number of enrollees that will
benefit from the new IRA provision. Among those projected to have out-of-pocket savings, Texas($50,395,627), Pennsylvania ($43,565,423), and Florida ($42,920,606) have the highest projected savings fromthe IRA’s $35 insulin caps. North Dakota ($805), Iowa ($725), and South Dakota ($725) have the highest
average annual out-of-pocket savings per individual among those with savings. Separate estimates for
Medicare Part D and Part B are presented in Appendix Tables A1 and A2.

January 2023

DATA POINT

7

Table 4. Estimated Out-of-Pocket Savings If Inflation Reduction Act $35 Out-of-Pocket Insulin Cap
Had Been in Effect in 2020, by State
State
Alabama
AlaskaArizona
Arkansas
California
Colorado
Connecticut
DelawareDistrict of Columbia
FloridaGeorgia
Hawaii
Idaho
Illinois
Indiana
Iowa
KansasKentuckyLouisiana
Maine
Maryland
Massachusetts
MichiganMinnesota
Mississippi
MissouriMontana
Nebraska
NevadaNew Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
OregonPennsylvania
Rhode Island
South Carolina
January 2023

Total Number of Enrollees in Part
D and B Who Would Experience
Savings
29,127
1,026
28,124
15,559108,164
16,085
11,4446,066
650
90,181
45,625
3,703
7,927
59,71842,31018,834
15,657
27,79722,071
5,976
21,052
26,28766,72627,12815,36634,881
4,835
9,716
10,7696,586
39,641
8,716
75,601
56,921
4,527
72,854
19,556
17,91580,197
4,678
31,235DATA POINT

Projected IRA
Savings ($)$12,800,687$613,867$14,545,058$8,395,598$36,622,758$8,288,613$6,749,195$2,707,378$262,462$42,920,606$21,764,218$1,440,292$4,801,119$30,975,919$22,876,374$13,648,044$10,170,650$12,590,086$9,095,485$3,169,201$9,868,664$13,248,195$26,908,214$18,232,052$8,344,497$18,256,529$2,913,023$6,576,898$4,725,569$3,533,326$20,239,433$3,856,841$36,526,747$25,580,364$3,642,152$36,536,703$10,417,603$10,586,279$43,565,423$2,269,088$14,896,443

Mean Annual Out-of-Pocket
Savings Per Enrollee with
Savings ($)
$439
$598
$517
$540
$339
$515
$590
$446
$404
$476
$477
$389
$606
$519
$541
$725
$650
$453
$412
$530
$469
$504
$403
$672
$543
$523
$602
$677
$439
$536
$511
$443
$483
$449
$805
$502
$533
$591
$543
$485
$477
8

South Dakota
4,568$3,313,226$725
Tennessee
39,562$19,534,028
$494
Texas
114,242$50,395,627
$441
Utah
11,393$7,110,735$624
Vermont
3,118$2,153,816$691
Virginia
36,461$18,597,268$510
Washington
28,063$16,917,285$603
West Virginia
12,656$5,706,666$451
Wisconsin
31,935$20,064,260$628
Wyoming
2,469$1,597,721$647
Source: ASPE analysis of CMS Medicare Part D 2020 Prescription Drug Event (PDE), Enrollment, and Part B data files.

CONCLUSION

Patient out-of-pocket costs impact adherence to insulin, and non-adherence can worsen the rates of diabetesrelated complications. 14, 15 High out-of-pocket health care costs can also contribute to financial hardships that
impact an individuals’ overall health and wellbeing as individuals may have to make tradeoffs between healthspending and other basic living necessities. 16 Our analysis of survey and administrative data on insulin costs
indicate that 1.5 million Medicare beneficiaries using insulin will experience savings under the IRA’s new outof-pocket spending cap that took effect on January 1, 2023. In addition, the IRA insulin cap may allow
increased access to insulin for patients who were previously unable to fill their insulin prescription due to cost.
Based on the research evidence on the role of medication adherence in improving outcomes for patients withdiabetes, these changes may produce downstream health benefits as well. Future research should monitor
the impacts of these new provisions.

January 2023

DATA POINT

9APPENDIX
Table A1. Estimated Medicare Part D Annual Out-of-Pocket Savings If Inflation Reduction Act$35/month Out-of-Pocket Insulin Cap Had Been in Effect in 2020, by LIS Status and State
State

Alabama
AlaskaArizona
Arkansas
California
Colorado
Connecticut
DelawareDistrict of Columbia
FloridaGeorgia
Hawaii
Idaho
Illinois
Indiana
Iowa
KansasKentuckyLouisiana
Maine
Maryland
Massachusetts
MichiganMinnesota
Mississippi
MissouriMontana
Nebraska
NevadaNew Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
January 2023

Non-LIS

LIS

Numberwith Savings

Total Savings($)

Number
with
Savings

28,003990
27,455
14,841
106,345
15,64911,253
5,933
619
87,48643,873
3,629
7,717
58,32941,38918,35815,15026,531
21,378
5,851
20,28525,79065,305
26,57014,76533,782
4,692
9,466
10,4996,398
38,813
8,452
73,73954,677
4,443
71,057$11,815,018$582,152$13,830,586$7,805,379$35,250,745$7,860,192$6,540,640$2,536,364$252,990$40,173,151$20,475,237$1,410,522$4,623,058$29,231,359$21,695,855$13,062,005$9,692,101$11,747,790$8,713,930$2,925,752$9,209,453$12,695,158$25,804,236$17,248,122$7,668,044$17,205,616$2,744,380$6,197,689$4,554,867$3,327,493$19,425,572$3,692,046$35,101,368$23,913,854$3,519,944$35,024,530

1,775
58
1,109
1,132
4,022
746
520
243
64
4,646
2,982
137
338
2,810
1,896
790
836
2,976
1,393
388
1,155
961
2,540
1,025
935
1,874
218
440
429
333
1,630
473
4,280
3,637
165
3,382

DATA POINT

Total Part D
Total
Savings($)

Number
with
Savings

Total
Savings ($)$268,778$5,802$166,823$177,075$358,146$103,227$18,080$30,213$950$521,412$362,556$20,251$52,263$330,467$179,074$107,007$113,857$286,489$148,732$6,293$189,666$121,436$388,152$156,585$138,816$252,922$34,469$57,578$61,393$49,725$263,276$58,173$481,505$554,791$28,390$472,564

29,066
1,023
28,075
15,521
108,092
16,062
11,4336,060
647
90,00345,532
3,701
7,909
59,64242,253
18,783
15,63027,75022,038
5,967
20,996
26,264
66,67427,083
15,33634,817
4,829
9,702
10,755
6,572
39,612
8,702
75,526
56,848
4,522
72,798$12,083,796$587,953$13,997,410$7,982,454$35,608,891$7,963,419$6,558,720$2,566,577$253,940$40,694,563$20,837,793$1,430,774$4,675,321$29,561,826$21,874,929$13,169,011$9,805,958$12,034,278$8,862,661$2,932,045$9,399,119$12,816,594$26,192,388$17,404,707$7,806,860$17,458,538$2,778,849$6,255,267$4,616,260$3,377,218$19,688,849$3,750,219$35,582,873$24,468,645$3,548,334$35,497,094

Mean Annual
OOP Savings
Per Enrollee
with Savings($)$415.74$574.73$498.57$514.30$329.43$495.79$573.67$423.53$392.49$452.15$457.65$386.59$591.14$495.65$517.71$701.11$627.38$433.67$402.15$491.38$447.66$487.99$392.84$642.64$509.05$501.44$575.45$644.74$429.22$513.88$497.04$430.96$471.13$430.42$784.68$487.6110

Oklahoma
18,972$9,959,808
980 $142,137 19,524 $10,101,945
Oregon17,408 $10,181,803
816 $125,532 17,891 $10,307,335
Pennsylvania
77,935 $41,238,148
4,028 $662,135 80,108 $41,900,282
Rhode Island
4,522$2,146,243
273$37,724
4,675 $2,183,967
South Carolina
30,164 $14,015,620
1,820 $301,840 31,179 $14,317,459
South Dakota
4,450$3,175,345
198$29,276
4,558 $3,204,621
Tennessee
38,074 $18,055,834
2,403 $375,905 39,494 $18,431,739
Texas
110,446 $48,013,573
6,511 $955,289 114,122 $48,968,862
Utah
11,183$6,850,762
349$60,050 11,378 $6,910,811
Vermont
2,981$2,030,768
244$49,463
3,117 $2,080,231
Virginia
35,343 $17,595,051
1,876 $267,486 36,405 $17,862,537
Washington
27,253 $16,147,677
1,305 $198,890 27,985 $16,346,568
West Virginia
12,133$5,411,873
843 $149,416 12,642 $5,561,289
Wisconsin
31,439 $19,348,080
1,121 $111,812 31,895 $19,459,892
Wyoming
2,410$1,511,413
108$10,092
2,464 $1,521,505
Source: ASPE analysis of CMS Medicare Part D 2020 Prescription Drug Event (PDE) and Enrollment data files.
OOP = Out-of-Pocket$517.41$576.12$523.05$467.16$459.20$703.08$466.70$429.09$607.38$667.38$490.66$584.12$439.91$610.12$617.49

January 2023

11

DATA POINT

Table A2. Estimated Medicare Part B Annual Out-of-Pocket Savings If Inflation Reduction Act$35/month Out-of-Pocket Insulin Cap Had Been in Effect in 2020, by State
State

Number with Savings

Alabama
AlaskaArizona
Arkansas
California
Colorado
Connecticut
DelawareDistrict of Columbia
FloridaGeorgia
Hawaii
Idaho
Illinois
Indiana
Iowa
KansasKentuckyLouisiana
Maine
Maryland
Massachusetts
MichiganMinnesota
Mississippi
MissouriMontana
Nebraska
NevadaNew Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
OregonPennsylvania
Rhode Island
South Carolina

679
41
727
459
1,332
450
205
159
12
2,433
1,052
15
195
1,559
1,170
754
583
558
279
273
543
518
843
945
604
880
177
454
146
180
585
148
989
1,239
108
1,154
361
396
1,651
95
664

January 2023

DATA POINT

Total Savings ($)$716,891$25,913$547,648$413,144$1,013,795$324,247$190,475$140,386$8,522$2,225,736$926,236$9,518$125,798$1,412,609$1,000,730$474,335$363,689$555,808$232,811$237,156$469,439$431,601$715,826$793,885$537,637$797,746$134,174$320,834$109,309$156,109$550,309$106,622$943,874$1,111,681$79,880$1,038,659$315,658$278,944$1,665,126$85,121$578,953

Mean Annual OOP Savings Per
Enrollee with Savings$1,056
$632
$753
$900
$761
$721
$929
$883
$710
$915
$880
$635
$645
$906
$855
$629
$624
$996
$834
$869
$865
$833
$849
$840
$890
$907
$758
$707
$749
$867
$941
$720
$954
$897
$740
$900
$874
$704
$1,009
$896
$872
12

South Dakota
155$99,248
Tennessee
1,071$1,101,514
Texas
1,645
$1,425,196
Utah
240$199,924
Vermont
94$73,584
Virginia
802$734,731
Washington
751$570,156
West Virginia
192$145,377
Wisconsin
698$576,426
Wyoming
104$76,216
Source: ASPE analysis of CMS Medicare Enrollment and Part B data files.
OOP = Out-of-Pocket

January 2023

DATA POINT$640$1,028
$866
$833
$783
$916
$759
$757
$826
$733

13

REFERENCES
Centers for Disease Control and Prevention. (2022, June 29). National Diabetes Statistics Report. Centers for Disease
Control and Prevention. Retrieved November 28, 2022, from https://www.cdc.gov/diabetes/data/statisticsreport/index.html
1

Martinez, R. (Ed.). (2022, January 24). Pancreas hormones. Endocrine Society. Retrieved November 28, 2022, fromhttps://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/pancreashormones
2

American Diabetes Association. (2022). Insulin and Other Injectables. Insulin Basics. Retrieved November 28, 2022,
from https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics
3

Cefalu, W. T., Dawes, D. E., Gavlak, G., Goldman, D., Herman, W. H., Van Nuys, K., Powers, A. C., Taylor, S. I., Yatvin, A. L.
(2018, May 11). Insulin access and affordability working group: Conclusions and recommendations. American Diabetes
Association. Retrieved January 23, 2023, from https://diabetesjournals.org/care/article/41/6/1299/36487/Insulin-Accessand-Affordability-Working-Group
4

Cefalu, W. T., Dawes, D. E., Gavlak, G., Goldman, D., Herman, W. H., Van Nuys, K., Powers, A. C., Taylor, S. I., Yatvin, A. L.
(2018, May 11). Insulin access and affordability working group: Conclusions and recommendations. American Diabetes
Association. Retrieved January 23, 2023, from https://diabetesjournals.org/care/article/41/6/1299/36487/Insulin-Accessand-Affordability-Working-Group5

Gafney, A, Himmelstein, D, & Woolhandler, S. (2022) Prevalence and correlates of patient rationing of insulin in the
United States: A National Survey. Annals of Internal Medicine Letters, 175(11), 1623-1626
6

Stanley, T. (2019, January 7). What happens when a lifesaving drug becomes intolerably expensive? The Washington
Post. Retrieved November 28, 2022, fromhttps://www.washingtonpost.com/news/magazine/wp/2019/01/07/feature/insulin-is-a-lifesaving-drug-but-it-hasbecome-intolerably-expensive-and-the-consequences-can-be-tragic/
7

Centers for Medicare and Medicaid Services. (2020). “Diabetes period prevalence by state, 2020.” Retrieved from: b2diabetes-state-current-year.jpg (1536×600) (ccwdata.org)
8

Centers for Medicare and Medicaid Services. “Diabetes disparities in Medicare fee-for-service beneficiaries. Retrieved
from: Diabetes Disparities in Medicare (cms.gov)
9

Centers for Medicare and Medicaid Services. “Your Medicare Coverage: Insulin.” Retrieved from:https://www.medicare.gov/coverage/insulin
10

Centers for Medicare and Medicaid Services. “Your Medicare Coverage: Insulin.” Retrieved from:https://www.medicare.gov/coverage/insulin
11

United States Congress. (2022, August 16). Text - H.R.5376 - 117th Congress (2021-2022): Inflation reduction act.
Congress.gov. Retrieved January 23, 2022, from https://www.congress.gov/bill/117th-congress/house-bill/5376/text
12

Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health & Human Services. Report on
the Affordability of Insulin. December 16, 2022. https://aspe.hhs.gov/reports/insulin-affordability-rtc
13

McAdam-Marx, C., Ruiz-Negron, N., Sullivan, J. M., & Tucker, J. M. (2022). The effects of patient out-of-pocket costs forinsulin on medication adherence and health care utilization in patients with commercial insurance; 2007-2018. Journal ofManaged Care & Specialty Pharmacy, 28(5), 494–506 . https://doi.org/10.18553/jmcp.2022.21481
14

Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health & Human Services. Report on
the Affordability of Insulin. December 16, 2022. https://aspe.hhs.gov/reports/insulin-affordability-rtc
15

Stanley, T. (2019). “Insulin is a lifesaving drug, but it has become intolerably expensive. And the consequences can betragic.” Washington Post, January 7. https://www.washingtonpost.com/news/magazine/wp/2019/01/07/feature/insulinis-a-lifesaving-drug-but-it-has-become-intolerably-expensive-and-the-consequences-can-be-tragic/
16

January 2023

DATA POINT

14

HP-2023-02

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Assistant Secretary for Planning and Evaluation

200 Independence Avenue SW, Mailstop 447D
Washington, D.C. 20201
For more ASPE briefs and other publications, visit:
aspe.hhs.gov/reports

ABOUT THE AUTHORS
Bisma A. Sayed is an Economist in the Office of Health Policy in ASPE.
Kenneth Finegold is a Senior Social Science Analyst in the Office of Health Policy in
ASPE.
T. Anders Olsen is an Oak Ridge Institute for Science and Education (ORISE) Fellow in the
Office of Health Policy in ASPE.
Nancy De Lew is the Acting Deputy Assistant Secretary for Health Policy in ASPE.
Steven Sheingold is the Director of the Division of Health Care Financing Policy for the
Office of Health Policy in ASPE.
Kaavya Ashok is a graduate intern in the Office of Health Policy in ASPE.
Benjamin D. Sommers is Senior Counselor, ASPE.
The authors are grateful for the contributions of Acumen, LLC staff to analysis of CMS
Medicare data. The statements expressed in this Data Point do not necessarily reflect
the views of Acumen, LLC.
SUGGESTED CITATION
Sayed, BA, Finegold, K, Olsen, TA, De Lew, N, Sheingold, S, Ashok, K, Sommers, BD.
Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings byState and Demographics. (Issue Brief No. HP-2023-02). Office of the Assistant Secretaryfor Planning and Evaluation, U.S. Department of Health and Human Services. January
2023.
COPYRIGHT INFORMATION
All material appearing in this report is in the public domain and may be reproduced or
copied without permission; citation as to source, however, is appreciated.
DISCLOSURE
This communication was printed, published, or produced and disseminated at U.S.
taxpayer expense.
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January 2023

DATA POINT

15