Insulin And Drug Affordability
The cost of managing diabetes can be unsustainable. People with diabetes should not have to choose between their medications or other life essentials including housing, utilities, food, or other health care.
The price of insulin and other life-saving medications contributes immensely to the cost of care for the diabetes community. The average cost of insulin nearly tripled between 2002 and 2013, and the price of the four most popular types of insulin has tripled over the past decade.
People with diabetes account for $1 of every $4 spent on health care in the U.S.
Estimates of excess costs associated with medications include approximately $15 billion for insulin, $15.9 billion for other anti-diabetes agents, and $71.2 billion in excess use of other prescription medications attributed to diabetes many comorbidities.
ADA surveys have found that people with diabetes who depend on insulin cut back or skip doses putting their lives at risk1 in 4 insulin users have said cost has impacted their insulin use.
Robin Feldman Professor Of Law Uc Hastings College Of Law San Francisco
One would have to see how these orders were implemented to know how powerful and effective they will be.
We are still seeing many struggle in clinical practice with affordability, says Redmond. So it is unclear to most healthcare providers who gets these insulin cap benefits. Even myself as an expert would really love any more guidance on this. There are eligibility requirements that many patients still dont meet.
As with any legal order, the devil’s in the detail, Robin Feldman, Arthur J. Goldberg Distinguished Professor of Law at UC Hastings College of Law San Francisco, tells Verywell. One would have to see how these orders were implemented to know how powerful and effective they will be. We are, however, going to need some systemic changes to try to address the problems that are driving drug prices higher in general, and insulin prices higher specifically.
New Product Features Can Come With A High Price Tag
Xultophy and Soliqua both contain a long-acting insulin and another non-insulin diabetes medication. Xultophy is a combination 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 insulin ingredient.
Approved in June 2020, Lyumjev contains insulin lispro, the same insulin in Humalog, and some additional ingredients. In studies, Lyumjev was found to start lowering blood glucose sooner than Humalog, though this doesnt necessarily make Lyumjev more effective than Humalog or generic insulin lispro at lowering blood sugar. At present, per insulin unit prices for Lyumjev are about double that of generic insulin lispro.
Fiasp contains insulin aspart, the same insulin in Novolog, but it also has vitamin B3. Like Lyumjev, Fiasps added ingredient may speed up insulin absorption. Interestingly, the retail prices for Fiasp and Novolog are about the same on a per insulin unit basis.
Then theres Tresiba, an ultra-long-acting insulin that stays active for up to 42 hours. For this unique property, its average retail price is about $630 for a carton of 5 KwikPens .
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Is It Legal To Order Insulin From Canada
According to the legislation of the USA, individuals cannot order insulin from abroad, including Canada, for their diabetes management. Nevertheless, thousands of Americans day by day do multiple orders and receive insulin shipped from Canada.
At the present moment, the US customs close their eyes at the parcels with insulin for individuals, perhaps, understanding the life-saving prices for Canadian insulin compared to American. So, right now, if you buy Canadian insulin, you will receive it without any problem. How long will it last? No one can give a precise answer. But thousands of Americans dependent on insulin from Canada hope they can reduce their insulin spending by ordering it from Canada.
How Insulin Pricing Works In The Us
Editors Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, .
How did insulin become so expensive in the United States? The American healthcare system is made up of a complex web of players who exchange money for pharmaceutical products in ways that are not entirely clear to consumers. This makes it difficult to know who to blame. Indeed, they often blame each other for the high cost of insulin. When everyone is confused and pointing fingers, nobody knows how to fix the problem, and the status quo reigns. So lets dive into the issue of insulin pricing and figure out who these players are, how the money flows, and what this means for patients.
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How Much Is Insulin In America For Uninsured Patients
The cost of insulin can be devastating for an uninsured person who requires it to manage their diabetes. With the average price ranging from $175 to $300 per vial of insulin, it can become impossible to afford the medications you need. There are programs to help underinsured or uninsured patients afford their diabetic medications and supplies. Ask your doctor for references to national and local programs that can help lower your medication costs. Uninsured Americans with diabetes are more likely to be using older, less effective insulin formulations than those with private insurance or Medicaid. Although these older forms of insulin are more cost-effective, 68% of uninsured patients pay full insulin costs.
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 provider about affordable options. Here are more ways you can save:
1) 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.
2) 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.
3) 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.
Co-contributors:Diane Li, Hannah McQueen, Swetha Pola
Methodology
A note about insulin use
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Abhorrent Wrong And Won’t Help Patients
The trade group Pharmaceutical Research and Manufacturers of America, or PhRMA, said that it objected to the report’s characterization.
“We agree the status quo isn’t working and needs to change, but to suggest those who develop life-saving medicines are complicit in human rights violations is abhorrent, wrong and won’t help patients,” said Debra DeShong, head of public affairs for PhRMA, in a statement to CBS MoneyWatch.
DeShong noted that pharmaceutical companies “provide patient assistance to help those who can’t afford their medicines, including to those who rely on insulin, and it’s why we’re urging lawmakers to reform an insurance system that too often forces sick patients to subsidize the insurance costs of healthy individuals.”
In a statement, Eli Lilly said that the “average monthly out-of-pocket cost for Lilly insulin has decreased 44%, to $21.80, over the past five years.” It added that it also provides programs for people facing higher out-of-pocket costs.
“We welcome new public policies, such as co-pay caps on insulins, which could bring much-needed relief to people who face higher out-of-pocket costs for their medications,” Eli Lilly said in the statement. “Until actual reforms fill gaps, Lilly remains firmly committed to providing affordability solutions to people who need them.”
The Astronomical Price Of Insulin Hurts American Families
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A woman from Minnesota holds up her U.S. bottle of NovoLog insulin and a Canadian box of NovoRapid, which she bought at a pharmacy in Ontario, Canada, June 29, 2019
Drug companies charge more for insulin in the United States than in nearly three dozen other countries RAND researchers examinedand it’s not even close. The average list price for a unit of insulin in Canada was $12. Step across the border into America, and it’s $98.70.
Those differences help explain why insulin has become a symbol of the high cost of American health care. Its prices have shot up in recent years, for reasons that are opaque at best, with those who can least afford it often paying the most. Reining in those prices has become the rare political cause embraced by Democrats and Republicans alike.
This isn’t just some academic question: ‘How do our prices compare with those in other countries?’ said Andrew Mulcahy, a senior policy researcher at RAND who specializes in health care economics and led the study. It’s becoming a very practical question, because there are ideas out there to do something about it, and they can benefit from this kind of analysis.
The U.S. Department of Health and Human Services asked RAND to investigate how American insulin prices compare with those in other parts of the world. Researchers obtained list prices for all types of insulin from 33 countries in Europe, Asia, Australia, and the Americas. Plotted on a graph, the U.S. prices stand alone.
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Factors That Influence The Cost Of Insulin
Between 2001 and 2018, the average list price of insulin increased 11% annually. This equates to average annual per capita insulin costs nearing $6000. Since a patient’s out-of-pocket costs are based on the list price, consumers have undoubtedly felt the burden of these price increases.
Diabetes patients’ need for insulin to survive is indisputably one of the largest determinants of insulin cost. Insulin and insulin analogs are the only drugs able to save the lives of diabetes patients therefore, consumers’ need for these drugs to stay alive gives way to high pricing for profits. In other words, since diabetic patients have no other options, they have no other choice but to pay the price that the stakeholders set.
The three primary factors in the pricing of insulin vials are as follows:
Not So Sweet: Insulin Affordability Over Time
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With costs rising rapidly, insulin is becoming more difficult to afford for many Americans, especially those with inadequate insurance coverage.
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For adults ages 18 to 64, the most important policy factor in having affordable access to insulin is living in a state that expanded Medicaid eligibility. Medicaid protects people with diabetes from high out-of-pocket costs.
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With costs rising rapidly, insulin is becoming more difficult to afford for many Americans, especially those with inadequate insurance coverage.
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For adults ages 18 to 64, the most important policy factor in having affordable access to insulin is living in a state that expanded Medicaid eligibility. Medicaid protects people with diabetes from high out-of-pocket costs.
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There have been several initiatives carried out in the commercial sector to address insulin affordability. Last year, for example, the insurer Cigna and its pharmacy benefit management division Express Scripts announced a program designed to cap out-of-pocket costs for diabetic patients at $25 a month.
Moreover, the recent advent of biosimilar insulin products may help reduce out-of-pocket costs, as could the possibility of automatic interchangeability of biosimilar insulin and originator products.
Nevertheless, for a comprehensive approach to improving insulin affordability that reaches a larger number of diabetic patients the federal government would need to get involved, and it has to a certain extent.
Trump Administration has lowered out-of-pocket insulin costs for some
President Trump has made some dubious claims on insulin prices, including one he uttered during a September presidential debate. There, he boasted that he had helped lower the price of insulin to the point that its so cheap, its like water.
Trump also signed an executive order in July that would require federally qualified health centers to share the steep savings they receive through the 340B program with indigent patients, specifically for epinephrine and insulin products. But, this only applies to a very small portion hospitals participating in the 340B program. And, it doesnt resolve the much larger issue that the 340B program discounts arent generally winding up where theyre supposed to.
Hanie Redmond Pharmd Cde Bc
Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
If someone has type 1 diabetes or if someone has had damage to their pancreas, these are instances where their body doesnt produce any insulin, Stephanie Redmond, PharmD, CDE, BC-ADM, founder of Diabetes Doctor, tells Verywell. Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
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Generics And Biosimilar Forms Of Insulin
Generic and biosimilar forms of insulin have helped lower the price overall. Generic forms of medications contain the same active ingredients and effectiveness. Insulin is a Biologic drug. A Biologic drug or biopharmaceutical is any pharmaceutical drug product manufactured in or extracted from a biological source. These types of drugs are often extremely difficult to recreate, and in turn, Biosimilars are created. Biosimilars are developed by a pharmaceutical manufacturer creating a close copy of the drug instead of a replica. The generic form of insulin is still commonly the most cost-effective way to purchase insulin. Biosimilars are still a cheaper form of a brand-name drug.
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“A lot of time we get caught up in some of the hype,” Riggs says. “When a new medicine comes out and it has theoretical advantages, we buy into that and think newer is better.”
The company that made the new form of insulin, called Humulin, launched a large marketing effort aimed at doctors and patients shortly after its release.
But newer drugs aren’talways better, says Dr. Adriane Fugh-Berman, a professor of medicine and pharmacology at Georgetown University. That’s partly because drug companies don’t have to prove that a new drug is better than what is already on the market they just have to prove that it’s not worse.
Insulin made via recombinant DNA technology in 2009.
“In government-funded studies that have compared older drugs to newer drugs, often older drugs come out looking better or equal to newer drugs,” Fugh-Berman says.
For example, some patients have found that animal-derived forms of insulin work better for them, she says. They cause less variability in blood sugar, and fewer episodes of hypoglycemia.
And while those older kinds of insulin are not available in the U.S., they are available elsewhere.
“In Canada, there actually is still an animal-derived insulin on the market, and that was really due to the efforts of consumer advocates,” Fugh-Berman says.
“But there’s concern that the cost savings will be nowhere near as robust as they have been with generic drugs,” Greene says.
Correction March 19, 2015
Clarification
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Study: Insulin Prices Up To 8 Times Higher In Us Than Other Countries
Oct. 6 — The price of the diabetes drug insulin is more than eight times higher in the United States than in 32 other high-income nations combined, according to a RAND Corp. analysis released Tuesday.
The average price per unit across all types of insulin in the United States is $98.70, which is just over six times the drug’s average price in Canada — about $15.70 — and just under six times the average price in Britain and Japan — about $16.70 — the researchers said.
And the average U.S. price is nearly 28 times as high as that of Turkey, which is about $3.60, they said.
“This analysis provides the best available evidence about how much more expensive insulin is in the U.S. than in other nations around the world,” RAND senior policy researcher Andrew Mulcahy said in a statement.
“Prices in the U.S. are always much higher than other nations, even if you assume steep discounts to manufacturer prices in the United States,” he said.
Insulin is used to control blood sugar levels in people with insulin-dependent diabetes. The drug is sold in many different forms, with different chemical properties and different duration of effects.
List prices in the United States have increased dramatically over the past decade, according to Mulcahy and his colleagues.
Where Does That Leave Us
Insulin pricing in the United States is unfortunately only one example of the complexity of a for-profit healthcare system. There is no doubt that people with any kind of diabetes who need insulin to live face difficult choices when navigating this system, and it is unjust that an ability to pay for a drug is often the determining factor for their quality of care. If reading this made your head spin and youre looking for ways to make a difference, find out more about how you can get involved with access advocacy in the USA.
If you or someone you know needs help getting insulin, . For a more in-depth look at insulin-pricing, read The Insulin-Pricing Machine.
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