Insulin is a mainstay of therapy for both type 1 and type 2 diabetes. It has been around since 1921 when Banting and Best discovered it. Over the years we have gotten away from animal sources, modified organisms to produce it in large quantities, and increased the capacity to do so … a classic scenario for lowering the price! If that’s the case, why is it still so expensive … and increasing faster in recent years than in the past? Yes, we know that making a biological agent is not cheap, and there are concerns for stability, and other factors that could be invoked to explain the price increase but if patients need it and can’t afford it, what’s the point of this sudden rise in insulin(s) cost?
Working in the diabetes world when insulin cost has increased in some cases by 200% and in others by 600% between 2002 and 2013 seems inconceivable.1 Compare this to other countries where the cost of insulin seems more reasonable with Lantus® costing approximately $6 per vial and Humulin® NPH costing $3 per vial in India.2,3 Newer insulins have been added in the past year elevating the price game as well, but it is easier to explain at least some component of higher price with more ‘benefit’… although those additional benefits seem smaller with each new product. There is a little hope with generic alternatives such as Basaglar® (insulin glargine) becoming available along with Wal-mart’s cheaper Novolin Relion® 70/30 being approximately $25 a vial compared to Novolin® 70/30 prices at other facilities costing approximately $145.4 If that wasn’t enough, add into the picture PBMs where the preferred insulins change in some cases on a yearly basis and it’s understandable as to why the use of insulins can be an even more subject for both providers and patients heaped onto the striking increases in cost!
Now let’s think about our Medicare patient. They usually have a fixed budget and those patients with diabetes are often on at least 3-4 other medications for prevention of complications, which does not even take into account other medical conditions. Just looking at a patient prescribed a long-acting insulin, rapid-acting meal time coverage, an ACE inhibitor or angiotensin-receptor blocker (ARB) for hypertension or nephropathy, and a statin for dyslipidemia, they will hit the Medicare gap in approximately July when utilizing Lantus® and Novolog® compared to not entering it when utilizing the Novolin ReliOn® products. However, what is the quality of glycemic control?
Should patients on fixed incomes and at a lower income level be subjected to different care than those without income issues? Let’s also not forget that most Medicare patients don’t qualify for patient assistance programs that could help with more expensive standard of care insulin products.
This rising cost of insulins has caught the attention of the American Diabetes Association (ADA) who published a press release in February 2016 advocating for 3 changes: 5
- Wanting to see all off-patent diabetes medications, including insulin, in the lowest cost-sharing tier on all formularies;
- Supporting the authorization of the Centers for Medicare and Medicaid Services (CMS) to negotiate prices for prescription drugs under Medicare Part D; and
- Supporting the move toward value-based benefit design from the current fee-for-service system to incentivize better outcomes, in addition to promoting adherence to recommended therapy to reduce emergency department visits and hospitalizations.
In addition, one of the leading experts in the field of diabetes, Dr. Hirsch presented a talk at the 2015 ADA national meeting discussing the issue of rising costs of insulins. He advocates a call for change and action by not only by the national organizations, lobbyists, insurance companies, hospitals, patients, and providers, but also for a need to educate students, residents and fellows in the treatment of diabetes utilizing human insulins.6
Why are insulins still so expensive in the United States? Why are the prices of insulins allowed to increase like this when for some patients it is a matter of life or death? Overall, it is appalling that insulin costs overall are rising rather than decreasing and it seems like something needs to be done. So what are we going to do about it? Any thoughts?
Hua X, Carvalho N, Tew M, Huang ES, Herman WH, Clarke P. Expenditures and prices of antihyperglycemic Medications in the United States: 2002-2013. JAMA. 2016;315:1400-1402.
Medindia Network for Health. Lantus (insulin glargine) price list. Available at: http://www.medindia.net/drug-price/insulin-glargine/lantus.htm. Accessed 7/25/16.
Medindia Network for Health. Huminsulin-N (insulin) price list. Available at: http://www.medindia.net/drug-price/insulin/huminsulin-n.htm. Accessed 7/25/16.
Novolin 70/30. Good Rx. http://www.goodrx.com/novolin-70-30. Accessed 7/25/16.
American Diabetes Association. Statement on Accessibility and Affordability of Diabetes Medications. http://www.diabetes.org/newsroom/press-releases/2016/statement-on-accessibility-and-affordability-of-diabetes-medications.html. Accessed 7/25/16.
Hirsch IB. Changing costs of insulin therapy in the U.S. Available at: http://webcasts.diabetes.org/html5Player/default.aspx?webcastXmlInfo=http://webcasts.diabetes.org/netadmin/Content/ADA2015/sync/CT-SY06/38134.xml&videoBaseUrl=https://s3.amazonaws.com/ada-stream01/ADA2015/CT-SY06/. Accessed 7/26/16.