What Can We Do
Greene writes that one of the things people can do to help the situation is to take care of themselves. A healthy diet, regular exercise, and keeping a healthy weight can help most people avoid a diabetes diagnosis. He mentions that Some researchers even believe that changes in diet and lifestyle can reverse Type 2 diabetes to the point where an insulin prescription is no longer needed.
Insulin becoming more in demand doesnt just mean that people on insulin pay more for it. It also means that the price of other drugs rises, too.
The general idea out there right now is that the problem lies in the greed of the insulin makers. However, if the companies that make our insulin are somehow required by the government to lower the prices, we may say goodbye to any further insulin improvements since the process is so costly.
Gary Scheiner, a Certified Diabetes Educator and clinical director of Integrated Diabetes Services who lives with type 1 diabetes told Insulin Nation that the FDA regulations slow down the process of getting new insulin therapies to consumers and this causes price increases, too. He said, It sometimes costs hundreds of millions or even billions to bring a drug to market. This is hurting our economy in so many ways, and that The FDA needs to do a much better job of streamlining the process.
Monthly Insulin Price As High As A Playstation 5
Catie Santos, a 28-year-old from New Orleans, grew up knowing about Type 1 diabetes because her brother was diagnosed with the disease at age 10. On her 23rd birthday, she was horrified to learn she had the same disease.
Since then, she has met people who were diagnosed in their 50s with the disease once known as juvenile diabetes.
The monthly price of her insulin, she said, ran as much as the new Sony PlayStation 5, which can carry a price tag of more than $1,000.
Santos went on her parents insurance, but that assistance ended when she turned 26. You really have to figure out this insurance thing quickly, she said. Ive known diabetics who had to take corporate jobs just to stay alive.
Some have to move back home with their parents to make it financially, she said. She is one of them.
Her most recent scare took place in the wake of Hurricane Ida, which left her family without power for three weeks. She had to cram a months worth of her insulin into the refrigerator of her aunt, who happened to have a generator.
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The high cost of insulin has prompted some Americans to head for Canada or Mexico and still others manage to get the medicine or diabetic supplies through an underground network.
Through social media, she connects people, she said. If I hear people are in need, Ill start a Twitter thread. Were not trying to profit off of people were trying to work the system that profits off of people.
How Much Does A Bottle Of Insulin Cost With Insurance
It is difficult to say how much a vial of insulin costs when paying through your health plan. Each insurance plan covers insulin products differently.
It is when you actually have health insurance coverage that getting the insulin for a decent price becomes a problem, says Dr. Carnathan. In those cases, the patients are sometimes forced to switch to a different and cheaper type of insulin called NPH or 70/30 among a few others. These insulins have been around for a long time and are affordable. The patient needs a primary care doctor or endocrinologist who is comfortable using these older insulins and adjusting them safely.
Each health plan has varying copays and deductibles, too. For example, for people with a high-deductible plan, the cash price for insulin is paid until you meet the deductible. Some copays can be as high as 50% of the cost of the medication.
It can also sometimes be difficult for people on Medicare to afford insulin. Many patients who are faced with the high cost of insulin find themselves caught in the Medicare donut hole, says Gail Trauco, RN, the principal CEO of The PharmaKon LLC.
Like uninsured customers, patient assistance programs might be of help to Medicare customers. However, these programs require an application, which can take 30 to 60 days for review and approval, and documentation with receipts to confirm your monthly cost-of-living expenses.
Historic Claims Of Insulin Price
Flash forward a couple of decades to 1941, when Eli Lilly and two other insulin companies were accused of illegal anti-trust violations in overcharging for insulin to rake in profits
This Chicago Daily Tribune story from April 1, 1941, reports that a federal grand jury indicted a corporate trio insulin manufacturer Eli Lilly in Indianapolis, distributor Sharp & Dohme in Philadelphia, and drug maker and distributor E.R. Squibb & Sons in New York for conspiring to unlawfully bring about arbitrary, uniform, and non-competitive prices for insulin and to prevent normal competition in the sale of the drug. That was a federal charge of violating the Sherman Antitrust Act, the landmark legislation preventing anti-competitive business practices.
In my sleuthing I also found an Indianapolis Star story from that same day with more detail, including a statement from Mr. Eli Lilly himself, pointing to how proud he was of the companys insulin history and how 13 price decreases had supposedly been made between 1923-41.
Hes quoted as saying: Our price is now 3.5% of what it was when it was first sold in 1923, and today it costs the average diabetic just 7.5 cents per day.
All three companies eventually pleaded no contest, but never admitted any wrongdoing. In July 1941, newspapers reported that the accused companies were fined $5,000 each and their corporate officers each faced $1,500 in individual fines for the price-fixing charges.
Are Insulin Vials Cheaper Than Pens
There is a significant difference in insulin prices between insulin vials and insulin pens. Using vials is less expensive than pens. However, some people feel that using pens as a delivery system provides a higher quality of life. The pens come prefilled, and when using the analog medications, the number of doses could be lower. The pens make it easier to take insulin with you, providing more freedom.
Using pens is safer, more convenient, and offers better glycemic control, according to a study published in 2018. However, this study also noted that people who use pens were spending significantly more each month for diabetes control. In some cases, it was three times more expensive to use pens.
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Why Does Insulin Cost So Much
According to one recent study, the cost of insulin tripled in the US between 2002 and 2013. Unfortunately, that kind of inflation isnt unusual for specialty drugs these days. But whats causing insulin prices to keep climbing?
Insulin, a protein that lowers blood sugar, is used to treat diabetes, a group of diseases that causes higher-than-normal blood sugar levels. Until about 30 years ago, insulin was made from pigs and cows.
The era of the biologic genetically engineered proteins that come from human genes brought a more sustainable production process. Today, most insulin is made from the E. coli bacteria. These medicines are much closer to the version produced in the human body, which can mean fewer complications for patients.
The Role Of Insurance
The ADAs Insulin Access and Affordability Working Group report found that nearly half of Americans have employer-sponsored health insurance. About 20% are insured through Medicaid, and 14% are insured through Medicare. Approximately 7% of Americans purchase health insurance on their owneither directly from an insurer or through a health insurance exchange. About 9% of Americans remain uninsured.
Diabetes is considered a pre-existing condition. According to research published in Diabetes Care, an estimated 1.9 million uninsured people with diabetes gained insurance coverage after the Affordable Care Act went into effect. More than half of those who gained insurance were low-income.
Still, having insurance doesn’t mean insulin is affordable. Insured patients will often pay a copay or a percentage, rather than the list price, for their insulin. Redmond says that cost could range from $30 to $50.
In cases of high-deductible health plans, patients have to pay the list price for their insulin until their deductible is met, which often translates to thousands of dollars out of pocket. Many patients just have a problem paying that much, says Redmond.
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How Much Does A Month Of Insulin Cost
Everyone has different insulin needs. There isnt a one size fits all approach to determining how much insulin you need. Those taking analog insulin take a background or basal dose once or twice a day. In contrast, those taking regular human insulin take it three to four times a day.
This cadence is the only insulin some people with type 2 diabetes need. But for type 1 diabetes, and some with type 2, additional insulin is needed at mealtime. Depending on which insulin you are using, it should be taken 10 to 30 minutes before your meal. The amount of insulin depends on what you plan to eat. For example, you might need 1-3 units per carbohydrate portion .
People with type 1 diabetes generally use two different types of insulin per day. They start with two injections per day and progress to three to four doses per day, according to the American Diabetes Association . People with type 2 diabetes might start with 0.5-0.8 units per kilogram of body weight per day and eventually take 1-2 units per kilogram of weight. For a person weighing 150 pounds, this would be 68 to 136 units per day. For a person weighing 175 pounds, this would be 80-160 units per day.
One vial of insulin contains 1000 units, and pens contain 300 units.
* Based on three vials or 10 pens
In addition to the above costs, you might also require additional supplies, such as:
Ways To Save On Insulin
Its difficult to predict where drug prices will be in the future, but if you take insulin, we hope our analysis gives you some ideas for how to talk to your doctor about affordable options. Here are more ways you can save:
Use a manufacturer savings card or patient assistance program. Major insulin manufacturers Eli Lilly, Novo Nordisk, Sanofi-Aventis, and MannKind offer copay cards and patient assistance programs for patients with and without insurance coverage. In many cases, these programs can reduce out-of-pocket costs to as little as $0 per month. For more information, just search for your drug on goodrx.com, and click on Savings Tips for details.
Shop around. GoodRx offers discounts on insulin drugs, which can save you as much as 50% off the full retail price. At goodrx.com, you can also compare insulin prices at different pharmacies in your area and find information about discount programs at specific pharmacies.
Appeal your coverage. If you have insurance and your plan doesnt cover the insulin you need, ask your doctor about submitting an appeal. Your insurance company may require a prior authorization or step therapy before you can fill your prescription, but its worth trying if you want to get your insulin covered.
A note about insulin use
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Overall Costs Associated With Diabetes
For Canadians without private insurance, diabetes costs can account for up to 27% of their annual income .
People with Type 2 diabetes who have some coverage report annual spends between $2,529-$2,868. For people with Type 1 diabetes, these costs can range between $531-$5,264.
Canadians without any coverage report spending up to $15,000 annually in out-of-pocket costs. The Canadian Diabetes Association found that 57% of Canadians are not fully complying with their treatment plan because of high costs. Canadians with diabetes have reported that they estimate their glucose levels, take less insulin than required, and take oral medications fewer times daily or in lower doses to reduce costs. Rationing insulin has been linked to diabetic emergencies, and death.
Diabetes costs related GoFundMe pages, while more common in the United States, are showing up among Canadians as well.
The above costs do not include medical visits and transportation, diagnostic tests, specialized home care visits, rehabilitation, or permanent residential care.
How Much Does It Cost To Produce Insulin
A 2018 study estimated that one vial of human insulin costs $2.28-$3.42 to produce, and one vial of analog insulin costs $3.69-$6.16 to produce. The study revealed that a years supply of human insulin could cost $48-$71 per patient, and analog insulin could cost $78-$133 per patient per year.
The study measured the manufacturing cost only. It did not include administrative fees, sales, and research and development for improving medications. However, insulin manufacturers have not provided an adequate explanation for this large discrepancy between production costs and retail costs.
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Switching To Newer Insulin For Type 2 Diabetes Comes At A Cost
Greene wondered why that was the case. Why was a medicine more than 90 years old so expensive? He started looking into the history of insulin, and has about his findings in this week’s issue of the New England Journal of Medicine.
The story of insulin, it turns out, starts back in the late 1800s. That’s when scientists discovered a link between diabetes and damaged cells in the pancreas cells that produce insulin.
In the early 1920s, researchers in Toronto extracted insulin from cattle pancreases and gave it to people who had diabetes, as part of a clinical trial. The first patient was a 14-year-old boy, who made a dramatic recovery. Most others recovered as well. Soon, insulin from pigs and cattle was being produced and sold on a massive scale around the world.
Acids, alcohol and pancreatic tissue were separated, bathed and mixed in this laboratory of a 1946 insulin factory in Bielefeld, Germany.hide caption
Acids, alcohol and pancreatic tissue were separated, bathed and mixed in this laboratory of a 1946 insulin factory in Bielefeld, Germany.
But for some, the early forms of the medicine weren’t ideal. Many people required multiple injections every day, and some developed minor allergic reactions.
“All of these innovations helped to make insulin a little bit safer, a little bit more effective,” Greene says.
Greene says there’s no one reason that companies stopped producing the older animal versions, but they clearly felt it would not be profitable.
Why Has Insulin Become So Expensive
Insulin is expensive because three companies carry 96% of the insulin market. Three is not enough companies to drive price competition, especially when your product is a matter of life and death. To boot, the U.S. government found that the three companies that carry the market share have illegally boosted drug prices alongside pharmacy benefit managers to drive profit.
For the moment, we are stuck with the Big Three: Novo Nordisk, Eli Lilly, and Sanofi.
In 2019, Senator Chuck Grassley , launched an investigation into the big three companies as well as the countrys most powerful pharmacy benefit managers , CVS Caremark, Express Scripts, and OptumRx. In January 2021, the U.S. Senate Committee on Finance released the findings of the investigation, unveiling undeniable evidence that Sanofi, Lilly, and Novo Nordisk actively ignored the needs of consumers by raising insulin prices without regard to the drugs efficacy. Most importantly, the investigation also found that insulin spending was a fraction of manufacturers revenue and sales and marketing expenses. Indeed, most pharmaceutical companies do spend more on marketing than they do on research and development.
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New Product Features Can Come With A High Price Tag
and both contain a long-acting insulin and another non-insulin diabetes medication. Xultophy is a mix of insulin degludec plus liraglutide , and Soliqua is a mix of insulin glargine plus lixisenatide . Average retail prices for Soliqua and Xultophy are more than double the price of cheaper alternatives like Basaglar and Tresiba, which have the same exact kind of insulins.
Fiasp contains insulin aspart, the same insulin in Novolog, but it also has vitamin B3. This added ingredient may speed up insulin absorption, but it doesnt necessarily make Fiasp more effective than Novolog at lowering blood sugar. Interestingly, the retail prices for Fiasp and Novolog are about the same on a per insulin unit basis.
Then theres , an ultra-long-acting insulin that stays active for up to 42 hours. For this unique property, its average retail price is about $624.76 for a carton of 5 KwikPens .
Along with these new formulations, insulin manufacturers have also started offering their insulins at higher concentrations to make them more convenient for people who need more insulin than average. Humulin R, Humalog, and Tresiba all come in higher-concentration versions, and is a higher-concentration version of Lantus. At first glance, their prices may seem high, but they actually go for the same per unit retail price as their lower-concentration counterparts.
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“This industry is anything but a free market when PBMs spur drug makers to hike list prices in order to secure prime formulary placement and greater rebates and fees,” Grassley said in a statement.
“Our investigation worked to get to the bottom of this. We found that the business practices of and the competitive relationships between manufacturers and middlemen have created a vicious cycle of price increases that have sent costs for patients and taxpayers through the roof.”
Wyden said, “Insulin manufacturers lit the fuse on skyrocketing prices by matching each other’s price increases step for step rather than competing to lower them, while PBMs, acting as middlemen for insurers, fanned the flames to take a bigger cut of the secret rebates and hidden fees they negotiate.”
The American Diabetes Association notes that determining actual costs to consumers is difficult: “out-of-pocket costs vary depending upon the type of health insurance each individual has and the type of insulin prescribed.”
A study by Ohio-based 3 Axis Advisors of 41,000 prescriptions from more than 1,500 independent pharmacies for a three-pack of Lantus Solostar insulin pens shows an average co-pay of about $34, and a median of about $9, for January through October 2020. About 1 in 12 co-pays topped $110.
J.C. Scott, president and CEO of the Pharmaceutical Care Management Association, the trade group representing pharmacy benefit managers, said in a statement:
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