Data Published in JAMA from CareMore Health Showcase Approach to Improving Affordability of Insulin for People with Diabetes

Analysis Highlights Outcomes of Switching from Analog to Human Insulin Among Medicare Patients with Type 2 Diabetes

CERRITOS, Calif.--()--CareMore Health today announced the publication of results from one of the first large-scale programs switching Medicare beneficiaries with type 2 diabetes from analog to human insulin in The Journal of the American Medical Association (JAMA). The data demonstrate that this intervention represented a significant cost savings and reduced the Medicare Part D coverage gap, with a minimal increase in average blood sugar levels.

In 2016, Medicare’s outpatient prescription drug program (Part D) spent more than $4 billion on just one long-acting analog insulini. CareMore recognized that since the least expensive versions of human insulin can be obtained at approximately one-tenth the cost of analog insulin, if more patients with type 2 diabetes were switched to human insulin, the resulting savings to patients and the health care system could be substantial.

“At CareMore, we put patients at the center and our goal is to make the right clinical decisions so that they can afford to take the medicines they need,” said CareMore president, Sachin H. Jain, MD. “As commonly used medicines like insulin become more expensive, we explored using older-generation medicines that may have equivalent clinical benefit but in fact cost much less. The analysis of our program demonstrates that this can be done safely and at-scale. Novel medicines are only valuable to the extent that patients can afford to take them.”

The published retrospective analysis was conducted by investigators at Brigham and Women’s Hospital and Harvard Medical School on CareMore Health data from 14,635 older adults who filled 221,866 insulin prescriptions between 2014 and 2016, identified from the CareMore Medicare Advantage and prescription drug plan operating in Arizona, California, Nevada and Virginia (mean age, 73 years; mean baseline HbA1c, 8.46%). In 2015, CareMore began an intervention to switch patients from analog to human insulin after an increase in insulin prices and subsequently partnered with the Brigham and Women’s team to study the effects of the program.

The analysis found:

  • Analog insulin to human insulin usage:
    • Analog insulin usage fell from 89% in 2014 to 30% in 2016. By December 2016, 70% of insulin prescriptions were for human insulin products.
  • Cost savings:
    • Total monthly expenditures for analog insulins decreased from a high of $3,214,437 in December 2014 to $515,875 by December 2016.
    • Monthly human insulin expenditures increased from $160,233 in 2014 to $916,826 by December 2016.
  • Reduction of Part D coverage gap:
    • In 2014, 20.6% of CareMore members reached the Part D coverage gap; in 2016, only 11.1% reached the gap.
  • Clinical outcomes:
    • After the completion of the intervention, changes in the level (+0.08% (95% CI, -0.01% to 0.17%)) and slope (<0.001% (95% CI, -0.008% to 0.010%)) of mean HbA1c were positive, but not statistically significantly different (p=0.09 and 0.81, respectively) compared to the preceding segment (i.e., the 12-month intervention).

Principal Investigator Jing Luo, MD, MPH of the Program on Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA added, “In 2014, most individuals from the study population were using higher-cost insulin analogs, and prices were driving many of these members into the Part D coverage gap, also known as the donut hole. Our objective was to evaluate the impact of this intervention on clinical and economic outcomes.” Senior investigator Aaron S. Kesselheim, MD, JD, MPH, also of the Brigham and Women’s Hospital, added, “based on these results, it might be clinically reasonable for other patients with type 2 diabetes who are struggling with high drug prices to talk with their providers about switching to human insulin.”

To view the full study published in the January 29 issue of JAMA, visit For more information about CareMore, visit For more information about the Program On Regulation, Therapeutics, And Law, visit

The JAMA article includes data from a retrospective cohort study using population-level interrupted times series analysis of members participating in a Medicare Advantage and prescription drug plan operating in four U.S. states. Participants were prescribed insulin between January 1, 2014, and December 31, 2016 (median follow-up, 729 days). The protocol-driven intervention was led by CareMore pharmacists and supported by nurse practitioners, physician assistants, and physicians with experience in chronic disease management at plan care centers. The intervention began in February 2015 in Arizona and was expanded to the entire health plan system by June 2015.

About CareMore Health

CareMore Health is a physician-founded, physician-led integrated care delivery system that harnesses the power of teamwork to treat the whole person. Through a focus on prevention and highly coordinated care, its clinical model and designed-for-purpose approach to managing chronic disease proactively addresses the medical, social and personal health needs of its patients, resulting in clinical outcomes above the national average and ultimately, healthier people and communities. Over the past nine years, CareMore has expanded from one state to ten. And today, the CareMore delivery system provides care for enrollees in Medicare Advantage and Medicaid health plans in Arizona, California, Connecticut, Georgia, Iowa, Nevada, Tennessee, Texas, Virginia, and Washington, DC. CareMore also is participating in a dual demonstration project in parts of Los Angeles County in conjunction with state and federal regulators to coordinate care for people eligible for both Medicare and Medicaid. For more information about CareMore, go to

i Centers for Medicare & Medicaid Services. 2018.


Maryrose Lombardo

Release Summary

Data Published in JAMA from CareMore Health Showcase Approach to Improving Affordability of Insulin for People with Diabetes


Maryrose Lombardo