An estimated 37million Americans, who represent approximately 11.3 percent of the U.S. population or 1 in 9 people, have diabetes. Of these, about 28.5 million people are diagnosed with diabetes and 8.5 million are undiagnosed. Diabetes is more frequently diagnosed among American Indian, Alaska Native, Black, Hispanic, and Asian American individuals, compared to White individuals. Diabetes is also associated with lower incomes and lower levels of education. According to the CDC, diabetes is the most expensive chronic condition in the United States. Insulin is the mainstay of therapy to treat type 1 diabetes and a common treatment for type 2 diabetes as well. More than 7 million individuals with diabetes, including all with type 1 diabetes and substantial numbers of those with type 2 diabetes or other conditions, need to use insulin daily to achieve glycemic control. However, insulin affordability remains a key concern for many reasons, including high out-of-pocket health care costs. Recognizing insulin affordability as a problem, Congress directed the Secretary of Health and Human Services (HHS) to examine the affordability of insulin, including analyzing adherence to insulin prescriptions, rates of diabetic ketoacidosis, downstream impacts of insulin adherence, spending by Federal health programs on acute episodes that could have been averted by adhering to an insulin prescription, and other factors that may be affected by insulin affordability. In this Report to Congress, we examine these topics and describe ongoing policy efforts to improve affordability of and access to insulin, including several provisions in the Inflation Reduction Act of 2022.
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