About 1 in 10 U.S. adults are diagnosed with diabetes and more than 13% of them did not take their medications as prescribed because of high drug costs, according to federal health researchers.

“Compared with those without diabetes, adults with diagnosed diabetes experience higher out-of-pocket costs for prescription medications and cost-related medication nonadherence behaviors,” the Centers for Disease Control and Prevention said in a data brief published Wednesday.

The higher prescription costs have led some adults with diabetes to ask their doctors for lower-cost medications, skip doses, delay filling a prescription or take less medicine to save money.

From 2017 to 2018, more than 24% of adults diagnosed with diabetes asked a doctor for a lower-cost medications, reads the CDC data brief.

The CDC said outpatient medications to treat diabetes cost almost $5,000 per person annually in 2017. Last year, diabetes medications ranked sixth of the top 20 therapeutic classes of dispensed prescriptions, making up 214 million prescriptions.

Diabetes was estimated to be the most expensive chronic illness in the U.S. in 2017, with a total cost exceeding $327 billion each year, including $15 billion for insulin, according to the American Diabetes Association.

The ADA says the average price of insulin, a life-sustaining medication for which there is no substitute, nearly tripled between 2002 and 2013.

The cost of insulin today could range from $144 to $1,037, according to GoodRx.

“Insulin is not a luxury, it is a matter of life and death for more than 7.5 million Americans with diabetes,” said LaShawn McIver, senior vice president of government affairs and advocacy for the ADA. “Action to reduce the high out-of-pocket costs that endanger their lives is critical and urgently needed.”

The CDC also found that the percentage of adults who didn’t take their medications as prescribed to reduce costs were the highest among women (14.9%) and adults under age 65 (17.9%). Uninsured adults between 18-64 years were more likely (35.7%) than those with private insurance or Medicaid to not take drugs as prescribed or to ask their doctors for cheaper medications.

Dr. Diana Isaacs, a clinical pharmacy specialist for the Cleveland Clinic Diabetes Center, said many of the recommended medications to treat diabetes are not available as generics, and therefore, drive up drug costs.

She added that multiple medications are often needed to reach desired glucose goals, noting insulin is especially expensive and required for those with Type 1 diabetes and for many with Type 2 diabetes. And not taking medications as prescribed can pose serious health risks for those with diabetes.

“They will likely have erratic blood sugar readings causing blood sugars to be high sometimes and lower at other times,” Dr. Isaacs said. “If the health care team does not know the person is skipping their medication, it may lead to increased doses. Then when the person finally does take all the medication as directed, it can cause the blood glucose to go too low [hypoglycemia], which can be dangerous.”

An estimated 30 million Americans have diabetes, with obesity as a major risk factor for developing the disease, specifically Type 2 diabetes, which makes up 90% to 95% of cases.

Melissa Young, a spokeswoman for the American Association of Diabetes Educators and a clinical pharmacy specialist, said, “Largely due to the prevalence of obesity doubling in the past two decades, diabetes is one of the largest health threats in the 21st century.” She said the number of Americans with diabetes is expected to rise to 55 million over the next decade.

For those with diabetes looking for cheaper options, Dr. Young recommended asking for generics and to speak with a diabetes educator, checking on coupon savings on brand name medications, connecting with patient assistance plans and shopping around different pharmacies for internal discount plans.

Dr. Isaacs said for people with commercial insurance, co-pay cards may help reduce the cost. She also mentioned that cheaper insulin alternatives like Novolin R and older oral agents that are available as less expensive generics.

CDC researchers noted there has been a shift toward using lower-cost options as the first line of therapy to manage diabetes.

“However, the burden associated with high prescription drug costs remains a public health concern for adults with diagnosed diabetes,” the CDC data brief says.

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