National Trends in Out-of-Pocket Cost for Glucose-Lowering Drugs Among U.S. Adults With Diabetes, 2000–2022

OBJECTIVE: To examine national trends in out-of-pocket (OOP) costs for glucose-lowering medications among U.S. adults with diabetes from 2000 to 2022. RESEARCH DESIGN AND METHODS: We analyzed Medical Expenditure Panel Survey data, linked to pharmacy-verified records, for adults with self-reported diabetes. OOP costs were evaluated per user by medication category and at the population level. Trends were assessed using inflation-adjusted annual estimates and joinpoint regression, with subgroup analyses by income, race/ethnicity, age, insurance, insulin use, and cardiovascular disease status. RESULTS: Population-average OOP costs declined 46%, driven by sharp per-user OOP cost reductions for older oral agents and decreasing use of human insulin. OOP costs for newer agents and analog insulin remained higher, with surging uptake. Declines occurred across all subgroups, but differences between subgroups were still observed. CONCLUSIONS: Despite substantial reductions in overall OOP costs, high-cost newer therapies continue to impose financial burdens that may limit equitable access.