{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:36:02Z","timestamp":1792787762339,"version":"4.5.0"},"reference-count":58,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"MannKind Corporation","id":[{"id":"https:\/\/ror.org\/02vbfm330","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"abstract":"<jats:p>\n                    Inhaled insulin provides a unique prandial insulin option, offering an alternative, with a more rapid onset of effect, to subcutaneous rapid-acting analog insulin. Clinical studies with inhaled insulin have demonstrated its efficacy and safety, with glycemic outcomes comparable to or in some cases better than those of contemporary insulin delivery approaches. However, the use of inhaled insulin for diabetes therapy in daily life remains limited due to payer restrictions, prior authorization requirements, formulary exclusions, clinician knowledge gaps, clinician time constraints, persistent misconceptions regarding safety, and inadequate patient awareness. A panel of clinical experts in diabetes management met in June 2026 to review the safety and efficacy of Technosphere\n                    <jats:sup>\u00ae<\/jats:sup>\n                    inhaled (TI) insulin, discuss the current obstacles that limit access for people with diabetes (PwD) to TI, identify practical strategies to overcome these obstacles, and issue a call-to-action for payers, clinicians, policymakers, professional organizations, and patient advocacy groups. This article summarizes those discussions and proposes strategies to increase access and choice for PwD.\n                  <\/jats:p>","DOI":"10.1177\/15209156261500243","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:18:26Z","timestamp":1792477106000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanding Patient Choice in Diabetes Care: Reducing Access Barriers to Inhaled Insulin"],"prefix":"10.1177","author":[{"given":"Thomas C.","family":"Blevins","sequence":"first","affiliation":[{"name":"Texas Diabetes and Endocrinology, Austin, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6838-5355","authenticated-orcid":false,"given":"Christopher G.","family":"Parkin","sequence":"additional","affiliation":[{"name":"CGParkin Communications, Inc., Henderson, Nevada, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5194-8446","authenticated-orcid":false,"given":"Roy W.","family":"Beck","sequence":"additional","affiliation":[{"name":"JAEB Center for Health Research Foundation, Inc., Tampa, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Aleppo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eda","family":"Cengiz","sequence":"additional","affiliation":[{"name":"University of California, San Francisco (UCSF), San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Cher\u00f1avvsky","sequence":"additional","affiliation":[{"name":"University of Virginia School of Medicine, Charlottesville, Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Close","sequence":"additional","affiliation":[{"name":"Close Concerns, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve V.","family":"Edelman","sequence":"additional","affiliation":[{"name":"University of California San Diego, San Diego, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Grunberger","sequence":"additional","affiliation":[{"name":"Grunberger Diabetes and Endocrinology, Bloomfield Hills, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutz","family":"Heinemann","sequence":"additional","affiliation":[{"name":"Science Consulting in Diabetes GmbH, D\u00fcsseldorf, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Huntley","sequence":"additional","affiliation":[{"name":"Diabetes Patient Advocacy Coalition, Diabetes Leadership Council, Carmel, Indiana, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davida F.","family":"Kruger","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Bone and Mineral Disease, Henry Ford Health System, New Center One, Detroit, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol J.","family":"Levy","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Metabolism, Icahn School of Medicine at Mount Sinai, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet B.","family":"McGill","sequence":"additional","affiliation":[{"name":"School of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desmond A.","family":"Schatz","sequence":"additional","affiliation":[{"name":"University of Florida College of Medicine, Gainesville, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viral N.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Endocrinology &amp; Metabolism, Indiana University School of Medicine, Indianapolis, Indiana, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irl B.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S007"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.2217\/dmt.15.43"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2025.103190"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2021-002633"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2012.0298"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2012.01636.x"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12128"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-022-01469-w"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/cd19-0008"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0034"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S005"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S009"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000126073"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001431.pub5"},{"key":"e_1_3_3_16_1","unstructured":"15.American College of Physicians. Mitigating the negative impact of step therapy policies and nonmedical switching of prescription drugs on patient safety. A position paper. Available from: https:\/\/www.acponline.org\/sites\/default\/files\/acp-policy-library\/policies\/step_therapy_nonmedical_switching_prescription_drugs_policy_2020.pd [Last accessed: November1 2025]."},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-014-0120-1"},{"key":"e_1_3_3_18_1","unstructured":"17.U.S. Food & Drug Administration. AFREZZA (insulin human) inhalation powder: Prescribing Information. Silver Spring MD: 2026. Available from: https:\/\/afrezza.com\/pdf\/full-prescribing-information [Last accessed: June12 2026]."},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-021-01084-0"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2018.0200"},{"key":"e_1_3_3_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14202"},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-1832"},{"key":"e_1_3_3_23_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2024.0582"},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc25-1994"},{"key":"e_1_3_3_25_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-0838"},{"key":"e_1_3_3_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251387102"},{"key":"e_1_3_3_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251412816"},{"key":"e_1_3_3_28_1","doi-asserted-by":"publisher","DOI":"10.2337\/db26-2333-P"},{"key":"e_1_3_3_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251396118"},{"key":"e_1_3_3_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40261-020-00958-8"},{"key":"e_1_3_3_31_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-0075"},{"key":"e_1_3_3_32_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-0629"},{"key":"e_1_3_3_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-023-01368-7"},{"key":"e_1_3_3_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2025.109108"},{"key":"e_1_3_3_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/19322968251388128"},{"key":"e_1_3_3_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2025.06.010"},{"key":"e_1_3_3_37_1","unstructured":"36.Drug Channels. The top pharmacy benefit managers of 2024: Market share and key industry developments. Available from: https:\/\/www.drugchannels.net\/2025\/03\/the-top-pharmacy-benefit-managers-of.html [Last accessed: November3 2025]."},{"key":"e_1_3_3_38_1","unstructured":"37.American Diabetes Association. Barriers to insulin: Impact of utilization management on access to insulin. Available from: https:\/\/professional.diabetes.org\/sites\/dpro\/files\/2025-06\/ADA-Barriers-to-Insulin-White-Paper-6-20-25.pdf [Last accessed: October29 2025]."},{"key":"e_1_3_3_39_1","unstructured":"38.Federal Trade Commission. Pharmacy benefit managers: The powerful middlemen inflating drug costs and squeezing main street pharmacies. Available from: https:\/\/www.ftc.gov\/reports\/pharmacy-benefit-managers-report [Last accessed: June18 2026]."},{"key":"e_1_3_3_40_1","doi-asserted-by":"publisher","DOI":"10.1017\/jme.2023.147"},{"key":"e_1_3_3_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/1932296816658056"},{"key":"e_1_3_3_42_1","unstructured":"41.American Medical Association. 2025 AMA prior authorization physician survey. Available from: https:\/\/www.ama-assn.org\/practice-management\/prior-authorization\/ama-prior-authorization-physician-survey [Last accessed: August2 2026]."},{"key":"e_1_3_3_43_1","unstructured":"42.American Diabetes Association. Making insulin affordable for people with diabetes: A primer for health care professionals. Available from: https:\/\/professional.diabetes.org\/sites\/dpro\/files\/2024-09\/ADA_WhitePaper_MakingInsulinAffordableForPeopleWithDiabetes.pdf [Last accessed: October30 2025]."},{"key":"e_1_3_3_44_1","doi-asserted-by":"publisher","DOI":"10.7326\/M22-2477"},{"key":"e_1_3_3_45_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251396121"},{"key":"e_1_3_3_46_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042018819844694"},{"key":"e_1_3_3_47_1","doi-asserted-by":"publisher","DOI":"10.2337\/ds19-0029"},{"key":"e_1_3_3_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2012.03605.x"},{"key":"e_1_3_3_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251403562"},{"key":"e_1_3_3_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.13099"},{"key":"e_1_3_3_51_1","unstructured":"50.MannKind Corporation. Highlights of prescribing information. 2026. Available from: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2026\/022472s029lbl.pdf? [Last accessed: June10 2026]."},{"key":"e_1_3_3_52_1","unstructured":"51.American Medical Association. 2022 AMA prior authorization (PA) physician survey. Available from: https:\/\/www.ama-assn.org\/system\/files\/prior-authorization-survey.pdf [Last accessed: February10 2024]."},{"key":"e_1_3_3_53_1","unstructured":"52.Mannkind Corporation. LearnAboutNTM.com. Available from: https:\/\/learnaboutntm.com [Last accessed: July8 2026]."},{"key":"e_1_3_3_54_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251403580"},{"key":"e_1_3_3_55_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2018.0384"},{"key":"e_1_3_3_56_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2024.0581"},{"key":"e_1_3_3_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2026.113401"},{"key":"e_1_3_3_58_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251403591"},{"key":"e_1_3_3_59_1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251408036"}],"container-title":["Diabetes Technology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15209156261500243","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15209156261500243","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15209156261500243","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:47:22Z","timestamp":1792702042000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15209156261500243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":58,"alternative-id":["10.1177\/15209156261500243"],"URL":"https:\/\/doi.org\/10.1177\/15209156261500243","relation":{},"ISSN":["1520-9156","1557-8593"],"issn-type":[{"value":"1520-9156","type":"print"},{"value":"1557-8593","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"article-number":"15209156261500243"}}