By Shefali
Luthra APRIL 29, 2019
“One out of 4 diabetes patients in our country cannot afford
their insulin.”
Kamala Harris on Monday,
April 22, 2019, in a CNN town hall
event
High
prescription drug prices are fast becoming a leading political topic, with
medications like insulin emerging as a poster child for the issue. Nearly
doubling in price from 2012 to 2016, the diabetes medication has
commanded bipartisan attention on
Capitol Hill and even a shoutout in a recent Netflix comedy special.
This
fact check was produced in partnership with PolitiFact.
Voters
say curbing such prices should be a top priority for
lawmakers — and Democratic presidential candidates are paying attention.
At
an April 22 CNN town hall,
Sen. Kamala Harris (D-Calif.), among the field of Democrats vying for the 2020
nomination, responded to a health care question by spotlighting insulin’s
spiraling price tag.
“One
out of 4 diabetes patients in our country cannot afford their insulin,” she
said.
That
would be a shockingly high number, researchers point out, and could become a
talking point Democrats return to throughout the campaign season. The cost of
insulin particularly resonates given diabetes’ incidence rates.
According
to the American Diabetes Association, about 1.25 millionAmericans have Type 1 diabetes
—less common than Type 2 — and cannot live without insulin.
With
that in mind, we decided to dig in to see if Harris’ statement checks out.
Three
Different Datasets Back Harris’ claim
When
asked about this particular statement, Harris’ campaign first cited a peer-reviewed study published
in December, which looked at people with diabetes being treated at the Yale
Diabetes Center in New Haven, Conn. Of 199 participants, 51 people — just over
25% — reported they either reduced or stopped taking insulin because of the
cost.
The
study is small and limited to one metropolitan area. But it likely paints a
more-or-less accurate picture nationally, three health care academic
researchers said.
“The
characteristics of the people that were included look reasonably
well-distributed across measures we’d be thinking about, like age, insurance
type, race, ethnicity,” said Stacie Dusetzina, an associate professor of health
policy at Vanderbilt University. “They probably are pretty much on target.”
The
study also corresponds with other surveys, though they too have limitations.
One,
commissioned by the American Diabetes Association and
made public last May, polled about 530 people online whose demographics
corresponded to the national data of people with the illness. About 27% of
respondents suggested the price of insulin had “affected their past year
purchase or use of insulin.”
SOURCES:
Kamala Harris, comments on CNN, April 22, 2019.
Kaiser Family Foundation, “Public Opinion on Prescription Drugs and Their Prices,” March
1, 2019.
Health Care Cost Institute, “Spending on Individuals with Type 1 Diabetes and the Role of
Rapidly Increasing Insulin Prices,” Jan. 21, 2019.
Kaiser Health News, “The Blame Game: Everyone And No One Is Raising Insulin Prices,” April
10, 2019.
The Patriot Act With Hasan Minhaj, “Drug Pricing,” Feb.
17, 2019.
The Centers for Disease Control and Prevention, “National Diabetes Statistics Report, 2017.”
JAMA Internal Medicine, “Cost-Related Insulin Underuse Among Patients With Diabetes,” January
2019.
American Diabetes Association, “Insulin Affordability Survey, 2018.”
T1 International, “Access to Insulin and Supplies Survey.”
Telephone interview with Stacie Dusetzina, an associate
professor of health policy at Vanderbilt University, April 23.
Telephone interview with Dr. Jing Luo, an instructor at Harvard
Medical School, April 23.
Telephone interview with Dr. Kasia Lipska, an assistant
professor of endocrinology at Yale School of Medicine, April 24.
Email interview with James Elliott, T1 International trustee,
April 23.
Email interview with Elizabeth Feister, T1 International
executive director, April 24.
Email interview with Michelle Kirkwood, American Diabetes
Association vice president of scientific, medical and mission communications,
April 23.
There
is also an online opt-in survey administered by T1 International, an advocacy
group for people with diabetes. Its 2018 results and methodology are undergoing
peer review and have not yet been published in full, said James Elliott, one of
the organization’s trustees. He suggested it would likely ultimately support
Harris’ “1 out of 4” talking point.
There’s
Some Extrapolation, But The Point Is ‘More True Than Not’
The
caveat is that Harris’ comment is based on limited data, and only one of the
papers has been peer-reviewed.
Though
insulin’s price has skyrocketed in recent years, no sizable national survey or
study has tracked insulin affordability, said Dr. Jing Luo, an instructor at
Harvard Medical School who was involved with the Yale study and has researched
insulin pricing more generally.
That
perhaps limits any effort to make an argument about insulin access nationwide,
or at the very least requires some extrapolation.
That
said, the 1-in-4 figure is “more true than not,” Luo said.
“It’s
as accurate as the data available allows,” Luo said. “It’s a reasonable
estimate. Really, there’s no data to suggest otherwise.”
We also
asked about Harris’ specific word choice: “cannot afford their insulin.” All
the research examining this issue doesn’t ask that precise question, but rather,
asks if the cost has resulted in a patient’s purchasing or using less
medication.
That,
analysts said, is, in fact, a good proxy for whether people can’t afford
insulin. And it may understate the problem, said Dr. Kasia Lipska, the
endocrinologist who led the Yale study, since it doesn’t account for people who
keep buying medication but skimp on groceries or other necessities as a result.
Our
Ruling
The
lack of a national study is an issue, for sure, and to some extent limits the
extent to which we can put stock in Harris’ 1-in-4 figure. It’s also important
to remember that it refers to a narrower group — only patients with Type 1 —
rather than all people with diabetes.
But
experts broadly suggested that the findings in the three reports referenced —
one peer-reviewed academic paper and two surveys — amply support her claim. And
the broad meaning of the phrase “cannot afford” means the problem could be more
significant than these datasets suggest since they measure only people going
without medication, not those for whom insulin prices maybe create other
financial issues.
This
statement is accurate but needs some additional information. We rate this
claim Mostly True.
A
related story from our PolitiFact partners: “Does Half the U.S. Population Have
Diabetes or Prediabetes, as Tim Ryan Claimed?” PolitiFact
National (Valverde, April 29).
Shefali
Luthra: ShefaliL@kff.org,
@Shefalil
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