Health Equity Considerations for Children With Type 1 Diabetes Who Utilize Insulin Cost-Sharing Cap Programs

The cost associated with type 1 diabetes care is considerable and the rising price of insulin has further amplified this financial burden. To curb insulin costs, numerous policies have been enacted in the past five years, both by pharmaceutical companies and their intermediaries, as well as federal and state legislatures. The most notable example is implementation of insulin cost-sharing cap laws, which place limits on out-of-pocket expenses for insulin, and in some cases, diabetes technology. Although insulin cost-sharing cap laws have the potential to mitigate the financial burden associated with routine diabetes care, these policies have largely benefitted adults living with type 1 diabetes, while children, especially those from racial and ethnic underrepresented groups, appear to have derived limited advantage. We describe the current state of insulin cost-sharing cap laws and utilization among children and adolescents with type 1 diabetes, with a focus on the limitations of current insulin laws, the importance of measuring health outcomes for children who utilize such programs, and the impact on health equity. We provide a call to action for policymakers and provide recommendations for future research in this area.