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While wholesale costs for glucagon skyrocketed over the past decade, out-of-pocket costs haven't increased by much, researchers reported.

The cost of unmixed glucagon increased 192% from 2010 to 2020 based on wholesale acquisition costs, which represent an estimate of the manufacturer's list price, according to Margaret Zupa, MD, of the University of Pittsburgh School of Medicine, and colleagues.

In 2010, the wholesale acquisition cost of glucagon hovered around $100 per kit and later rose to just under $300 per kit by 2020, they wrote in .

When novel formulations of glucagon emerged onto the market by 2019, including intranasal and premixed liquids, their wholesale acquisition costs per kit started just below the cost of unmixed formulas, at $280.80 in 2020.

However, throughout this decade, the median out-of-pocket costs for unmixed glucagon stayed at $0 for Medicare Advantage (MA) beneficiaries. But those in the top 75th percentile for out-of-pocket costs saw a price-tag of $25 in 2010, which later rose to $40 by 2020.

As for commercially insured patients, the median out-of-pocket costs mildly fluctuated throughout this 10-year period. The lowest cost was $27.04 in 2010, peaking at $36.43 in 2018, then slowly dropped back down to $30 in 2020.

As for , which was first FDA approved in July 2019, out-of-pocket costs were lower than unmixed glucagon for commercially insured patients. Median costs were $10.89 in 2019 and $15 in 2020. For MA beneficiaries, costs were $7.71 in 2019 and $10 in 2020.

Out-of-pocket costs were scaled per single-use kit and defined as the sum of copays and deductibles, while also being adjusted for inflation.

"Cost-sharing should not serve as a major barrier to accessing glucagon for MA and commercially insured patients," Zupa's group pointed out.

Currently, the advises that any patients with diabetes who are at risk for moderate to severe hypoglycemia should have access to glucagon. The researchers noted that this is especially valuable for young children who may not be able to effectively communicate symptoms of hypoglycemia.

That being said, Zupa's group referenced a of nationally representative claims data indicating only 3.5% of adults with type 1 diabetes and 8% of those with type 2 diabetes with a prior history of severe hypoglycemia filled a prescription for glucagon that year.

Zupa's group suggested future studies zero in on some of the barriers to glucagon access among patients with diabetes. "Such barriers may include awareness among patients and primary care, emergency, and diabetes clinicians of the availability of this potentially life-saving treatment," they said.

For the analysis, the researchers pulled claims data from the Optum deidentified Clinformatics Data Mart, which included individuals with large commercial and MA health plans.

In 2010, there were 15,691 prescription fills for unmixed glucagon, which peaked in 2018 with 25,479 fills, dropping back down to 14,748 by 2020. Only 449 intranasal glucagon prescriptions were filled in 2019 when it hit the market, when this number jumped up to 6,061 the following year. The researchers excluded , approved in September 2019, because they only accounted for 24 fills.

Study limitations included the fact that the findings may not generalize to patients with insurance traditional to Medicare or Medicaid, or those without any insurance. Also, the authors could not access patients who did not fill a prescription because of high out-of-pocket costs, or whether manufacturer patient-assistance programs and coupons made a difference.

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