Diabetes Affordability Is About More Than One Prescription

5 Min read
September 7, 2026

Julia Murray, MSN, RN

Senior Director, Care Guides

Best Practices

Employers can lower the cost of insulin and still leave members with a large diabetes bill.

Insulin affordability matters. But for many people, it is only one part of the cost of managing diabetes.

A member may take several medications. They may use a continuous glucose monitor. Each medication or device can have its own copay, approval process, refill schedule, and coverage rules.

Benefit teams may see separate claims and cost categories.

The member experiences one diabetes regimen.

That is why affordability needs to be evaluated across the full picture.

The cost burden extends beyond insulin

A recent analysis examined 2023 pharmacy claims from more than 400 employer-sponsored plans covering 5.3 million members. Researchers focused on people who consistently filled branded medications from four diabetes drug classes: insulin, GLP-1s, SGLT2 inhibitors, and DPP-4 inhibitors.¹

The median annual out-of-pocket cost for those branded diabetes medications was $643.

GLP-1s accounted for 48% of the branded diabetes prescription claims studied, but approximately 60% of members’ out-of-pocket costs. Fifty-eight percent of the members included in the analysis used medications from more than one branded diabetes drug class.¹

The burden was substantially higher for some people taking several therapies. Among members using three or more branded diabetes drug classes, the highest-spending 10% paid $2,681 a year out of pocket.¹

Those findings do not describe every person with diabetes or every employer plan.

The study did not include diagnoses, individual benefit designs, or the effect of manufacturer copay coupons. It also excluded people treated only with lower-cost generic medications.¹

But the central finding is important:

Diabetes affordability is becoming a whole-regimen issue.

An insulin cap may reduce one significant expense while leaving a member exposed to high costs for other medications. A plan may offer favorable coverage for one therapy without understanding what the person pays across everything needed to manage the condition.

Employers need to see more than the cost of an individual prescription.

They need to understand how the full regimen affects the member.

That view should extend beyond diabetes alone. Diabetes often occurs alongside cardiovascular disease, kidney disease, obesity, and other health needs that affect medication choices, follow-up care, and cost. Looking only at one high-cost drug class can miss the wider burden on the member. ⁴

Diabetes care is also becoming more complex

Medication is only one part of modern diabetes management.

Continuous glucose monitors, commonly called CGMs, give people and their care teams more detailed information about glucose levels throughout the day. These devices have traditionally been associated most closely with people using insulin. New research is examining their role for a broader group of adults with type 2 diabetes.

In June, Dexcom presented results from CONNECT, a company-sponsored randomized controlled trial involving adults with type 2 diabetes who were not using insulin. Participants using the Dexcom G7 experienced an average 1.6 percentage-point reduction in A1C after 26 weeks. That was 0.9 percentage points greater than the reduction in the control group using traditional blood glucose monitoring.²

The trial included participants taking common diabetes medications, including metformin, GLP-1s, and SGLT2 inhibitors.²

The findings are encouraging. They suggest that glucose monitoring may support better glucose control for some people who do not use insulin.

They do not mean every member with type 2 diabetes needs a CGM. The study was sponsored by Dexcom, and the initial results were presented at a scientific meeting. Longer-term data and independent research will help clarify which populations benefit most and how that benefit should influence coverage.

For employers, the larger lesson is already relevant.

As diabetes care changes, the benefit may need to account for combinations of medications, monitoring tools, clinical support, and medical follow-up. Those pieces may be covered through different parts of the health plan, even though they work together in the member’s daily life.

GLP-1s make indication and context essential

GLP-1s add another layer of complexity because the same medication category may be used for different clinical reasons.

Depending on the product and indication, a member may receive a GLP-1 for type 2 diabetes, cardiovascular risk reduction, obesity, or a combination of health needs. They may also take insulin, an SGLT2 inhibitor, or other medications.

At the same time, employers are reconsidering how they cover GLP-1s for weight management. A 2026 Business Group on Health survey found that 67% of participating large employers offered that coverage. Among those employers, 72% said they were likely to continue it in 2027.³

Those decisions are increasing the need to distinguish among populations and indications.

“GLP-1 coverage” is not one simple benefit decision.

An employer needs to understand:

Who is using the medication, and for what clinical reason?

What other therapies are part of the member’s regimen?

What is the member paying across all medications and devices?

Do the coverage rules reflect the different clinical needs being treated?

Are medications, monitoring, and member support working together?

Where are approvals, handoffs, or benefit rules making care harder to navigate?

The answer may be different for diabetes, cardiovascular disease, and weight management. A benefit strategy should be precise enough to recognize those differences.

Separate benefits can create one difficult experience

The stressful moment for a member is not always a major clinical event.

It may be an unexpected charge at the pharmacy. A refill that cannot be completed. A glucose monitor covered under a different benefit. An authorization that expires before the next appointment. Or one more call to determine which organization can answer a question.

Each issue may look small when viewed separately.

Together, they can make it harder for someone to manage a complex condition.

This is where clinical support and benefit design need to connect.

A pharmacist, nurse, or certified pharmacy technician may help a member understand coverage, coordinate with a prescriber, identify an affordability option, or resolve a delay. A nurse adds a whole-person view by asking how the regimen is working in daily life. Does the member understand the plan? Can they afford and access the right therapies? Do they feel confident using monitoring tools and know when to contact the care team? The plan also needs data that can identify where those problems occur across the covered population.

Neither capability is enough by itself.

Support without useful information can remain reactive. Data without a practical way to help members can leave the underlying problem unresolved.

Employers need a regimen-level view

The goal is not simply to spend less on diabetes care.

It is to understand where the investment is going, what members are paying, and whether the different parts of care are working together.

That requires employers to look beyond individual drug costs and ask:

Which combinations of therapies are members using?
Where is out-of-pocket exposure concentrated?
Are coverage rules creating avoidable friction?
Are members able to begin and continue clinically appropriate treatment?
How do pharmacy, device, and medical costs interact?
Which interventions improve the financial and care experience?
How will the plan measure whether a change worked?

Not every employer can answer all of these questions today.

But a plan cannot manage what it only sees in fragments.

A clearer starting point

Better prescription care begins by seeing diabetes the way the member experiences it, not as separate insulin, GLP-1, and glucose-monitor claims.

It is one regimen made up of medications, monitoring, coverage decisions, costs, and day-to-day support, all organized around goals that matter to the member.

When employers can see that fuller picture, they can make more informed choices about benefit design, affordability, and member support.

Diabetes care will continue to evolve.

Employers need enough information to understand the whole regimen and adjust the benefit as care changes.

Sources

1. Zhu J, Sell Reagan C, Midlam C, Levin-Scherz J. “Out-of-Pocket Costs for Diabetes Medications in Employer-Sponsored Health Plans.” The American Journal of Managed Care. Published May 5, 2026. The analysis used 2023 pharmacy claims from more than 400 employer-sponsored plans covering 5.3 million members.

2. Dexcom. “Dexcom CONNECT Study: The Most Significant Clinical Study Demonstrating CGM Benefits for People with Type 2 Diabetes Not Using Insulin.” Published June 6, 2026. CONNECT was a Dexcom-sponsored randomized controlled trial presented at the 2026 Scientific Sessions of the American Diabetes Association.

3. Business Group on Health. “GLP-1 Costs Loom Large for Employers, Forcing Challenging Coverage Decisions.” Published May 5, 2026. The survey included 105 Business Group on Health employer members and focused specifically on GLP-1 coverage for weight management.

4. American Diabetes Association Professional Practice Committee for Diabetes. “Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S61–S88.

Diabetes Affordability Is About More Than One Prescription

5 Min read

Julia Murray, MSN, RN

The cost burden extends beyond insulin

Diabetes care is also becoming more complex

GLP-1s make indication and context essential

Separate benefits can create one difficult experience

Employers need a regimen-level view

A clearer starting point

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