{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T16:03:33Z","timestamp":1784649813442,"version":"3.55.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK141666"],"award-info":[{"award-number":["R01DK141666"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007184","name":"Yale School of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007184","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Maryland-Institute for Health Computing"},{"DOI":"10.13039\/100024377","name":"Montgomery County","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100024377","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008510","name":"University of Maryland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008510","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007744","name":"University of Maryland, College Park","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007744","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019823","name":"University of Maryland, Baltimore","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019823","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Maryland Institute for Health Computing"},{"DOI":"10.13039\/501100012264","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012264","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Inflation Reduction Act (IRA) capped out-of-pocket (OOP) insulin spending at $35 for Medicare Part D beneficiaries in 2023. Studies have shown lower per-prescription insulin spending after the IRA but less is known about annual OOP insulin spending. We examined whether beneficiaries' annual insulin spending fell below $420 (ie, $35\/month) and whether savings differed across demographic subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using nationally representative data from the Medical Expenditures Panel Survey, we estimated survey-weighted two-part models comparing annual per-person OOP insulin spending in 2022 and 2023 overall, and by sex, race and ethnicity, income, education, insurance type, and number and type of insulin prescriptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Annual per-person OOP spending on insulin decreased from $359.95 in 2022 to $214.11 in 2023 (P = 0.016). However, 13.2% of Part D beneficiaries spent more than $420 in 2023, and rates of cost-related medication nonadherence were unchanged. Reductions in spending were consistent across demographic subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The IRA's universal cap on insulin for Medicare beneficiaries was associated with reductions in annual OOP spending across demographic subgroups, highlighting its potential to improve equitable access to insulin. However, persistent spending above the annualized cap for 1 in 7 patients suggests gaps in protection and the need for additional solutions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag165","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:21:50Z","timestamp":1783336910000},"source":"Crossref","is-referenced-by-count":0,"title":["Out-of-pocket insulin spending before and after the Inflation Reduction Act across demographic subgroups"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9360-5049","authenticated-orcid":false,"given":"Caroline G","family":"Borden","sequence":"first","affiliation":[{"name":"Yale School of Medicine , New Haven, CT 06510 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4979-5321","authenticated-orcid":false,"given":"Renhao","family":"Wang","sequence":"additional","affiliation":[{"name":"University of Maryland Institute for Health Computing , North Bethesda, MD 20852 ,","place":["USA"]},{"name":"Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine , Baltimore, MD 21201 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5192-6557","authenticated-orcid":false,"given":"Alexander O","family":"Everhart","sequence":"additional","affiliation":[{"name":"Division of General Medicine & Geriatrics, John T. Milliken Department of Medicine, Washington University School of Medicine in St.Louis , St. Louis, MO 63110 ,","place":["USA"]},{"name":"Center for Advancing Health Services, Policy & Economics Research, Washington University , St.Louis, MO 63110 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6682-1982","authenticated-orcid":false,"given":"Pinar","family":"Karaca-Mandic","sequence":"additional","affiliation":[{"name":"Department of Finance, Carlson School of Management, University of Minnesota , Minneapolis, MN 55455 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3907-9196","authenticated-orcid":false,"given":"Stacie B","family":"Dusetzina","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Vanderbilt University Medical Center , Nashville, TN 37203 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