Insulin-Requiring Diabetes Coverage, Affordability, and Access in State-Regulated Private Health Insurance

Nationwide, nearly 30 million people have been diagnosed with diabetes. Approximately 2 million individuals have Type 1 diabetes, an autoimmune disease that prevents the pancreas from making insulin and requires constant insulin treatment for survival, while around 6 million people with Type 2 diabetes also use insulin to manage their blood sugar levels. To maintain optimal health and avoid life-threatening complications, people living with insulin-requiring diabetes (IRD) must have access to a comprehensive range of care that extends beyond insulin alone.

With funding from The Leona M. and Harry B. Helmsley Charitable Trust, CHIR experts conducted a literature review and informant interviews across five states plus the District of Columbia (“study states”) to assess the health insurance policy landscape for IRD in the state private health insurance market. They found that people with IRD frequently face gaps in the diabetes services their plans cover, quickly accumulate high out-of-pocket costs for needed diabetes care, and regularly must overcome burdensome prior authorization requirements to access clinically appropriate care. This issue brief series highlights the levers available to state policymakers to address IRD-related challenges in this market, including state coverage mandates, cost-sharing protections, and prior authorization reforms.

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