Impact of pen utilization on insulin cost reduction in long-term care facilities.

OBJECTIVE

To determine the impact on insulin acquisition cost of a pharmacy program to convert insulin utilization from multidose vials to pen-delivery systems for long-term care residents covered by Medicare Part A, and managed care plans.

DESIGN

Retrospective cost comparison.

SETTING

Long-term care facilities.

PATIENTS

Residents covered by Medicare Part A and managed care plans.

INTERVENTIONS

Policy to replace insulin vials with pen devices, effective July 2009.

MAIN OUTCOME MEASURES

Mean insulin cost-per-patient day (total insulin purchases divided by patient admission days) and pen utilization (pen purchases as a percent of total insulin purchases).

RESULTS

Insulin purchase data covered 2,405 admissions in 75 facilities over the 12-month period ending June 2010. Pen device purchases increased from less than 1% to almost 35% of total insulin purchases over the study period during which insulin cost per patient-day declined from $10.29 to $4.08. For Medicare Part A patients with admissions of 30 days or fewer, the most frequent visit type, mean cost per patient-day decreased from $13.73 to $9.19 as pen purchases increased from less than 1% to about 32%. For these same patients, mean cost per patient-day for admissions using only pen devices was $7.04, compared with $11.79 for admissions using only vials (P < 0.001). Significant differences in mean cost per patient-day were also found for residents covered by managed care and for longer admissions.

CONCLUSION

Total insulin costs can be reduced through higher utilization of pen devices by patients in long-term care facilities.