Hyma Gogineni, Pharm. D, MSc, BCACP, TTS
We all have patients in our clinics deciding to choose between buying a prescription vs paying for other supplies, posing them at a higher risk for serious health consequences. Patients who use insulin, the quantity will be increased over time as well as the prescription costs putting these patients at increased medication expenditure. The average price of insulin has been tripled between 2002 ($231.48) and 2013 ($736.09) and the total cost of insulin was significantly higher than the other antihyperglycemic medications.1
Recently American Diabetes Association released a white paper, Insulin Access and Affordability Working Group: Conclusions and Recommendations derived from the product of meetings with representatives from major stakeholders.2 The authors concluded that insulin supply chain is a complex system and lacking transparency and making it difficult to understand the dollars flow and intermediary profits even after extensive research and stakeholder discussions.2 The average Wholesale Acquisition Cost (WAC) and National Average Drug Acquisition Cost (NADAC) for insulin increased by 15% to17% per year from2012 to 2016, as with the increased insulin prices, consumers out of pocket costs increased simultaneously.2 The current pricing and rebate system encourages high list prices, due to this list prices of insulin has been tripled between 2002 and 2013 (Fig 1).3
Fig 1 – Report of changes in list and net prices for Lantus.3
Regardless of the negotiated net prices by the PBMs, the cost of the insulin is greatly influenced by the list price causing high out-of-pocket costs for people with diabetes who are uninsured, or who have high deductibles or who are in the Medicare Part D donut hole.4-6 Many of us face this challenge in practice that patients with high co-pays or deductibles are less adherent to recommended dosing which can adversely impact their health. There was a shift in the prescribing patters of insulin favoring newer and more expensive insulin analogs over inexpensive human insulins which is also adding additional dollars to both healthcare system and to patients, the cost of the human insulins range from $25 to $100 per vial compared to $174 to $300 per vial for human insulin analogs.7-9 The authors stressed the importance of healthcare providers especially pharmacists role in educating patients about advantages, disadvantages, and financial implications of insulin preparations and its impact.2
As pharmacist it is essential for us to discuss with all diabetic patients about the cost of the insulin products, co-pays, availability of alternative insulin products and diabetic supplies and make them understand the true cost(s) of these products that they are receiving on a monthly/quarterly basis. This will not only change their perspectives and perhaps may enhance adherence.
Here are some of the available programs that can be an added value for both insured and uninsured patients…..
- Partnership for prescription assistance – helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free. https://www.pparx.org/
- Rxassist – offers a comprehensive database of patient assistant programs for both healthcare providers and patients. http://www.rxassist.org/
- NeedyMeds – is a nonprofit organization dedicated to helping people with financial assistance for their medication treatments. https://www.needymeds.org/
- Rx Hope – is prescription assistance organization that help people get their medicines at little or no cost. https://www.rxhope.com/
- BenefitsCheckup – is a prescription assistance program run by the National Council on Aging (NCOA). This program helps people over age of 55. https://www.benefitscheckup.org/
- CR3Diabetes – providing equipment and encouragement for people living with diabetes all over the world. https://www.cr3diabetes.org/
- Insulin Pumpers Foundation – assist patients who do not have financial resources to purchase an insulin pump on their own. http://foundation.insulin-pumpers.org/
- Insulin for Life USA – rescues unused diabetes supplies here in the United States and deliver them across the world who have no access to these supplies. http://ifl-usa.org/
- Affordable Insulin Project – offers tools, resources and data can be used by a patient, caregiver, employer or healthcare professional. This site is also useful for patients with no insurance or high deductibles. http://affordableinsulinproject.org/
- GoodRx – is a source for the lowest local price for all insulins and antidiabetic agents. https://www.goodrx.com/
- Blinkhealth – for those who do not have prescription insurance, high copays, or high-deductible with insurance plans. Blink Health offers 40% discounted price and patient has to pay online and pickup insulin in any pharmacy. https://www.blinkhealth.com/
- ReducedRxTM – for those with prescription coverage https://www.reducedrx.com/
Pharmaceutical programs and copay cards available for patients – please refer to the website for specific instructions
- Note: Not all assistance programs are available to Medicare patients, be sure to check patient’s eligibility
|Lilly Cares Program – for patients with no prescription coverage, not enrolled in Medicaid or VA benefits and must meet the household guidelines. http://www.lillycares.com/||1. Humalog U-200 Kwikpen Prescription Co-Pay card
2. Basaglar Prescription Co-pay Card
3. Trulicity Savings Card
|NovoNordisk Patient Assistance Program (PAP) –no prescription coverage
Must be US citizen, household income <300% of federal poverty level, not enrolled in Medicare or Medicaid etc. https://www.novocare.com/hcp/more-resources/PAP.html
|1. Levmir Instant Savings Card
2. Novo Nordisk prescription savings card
3. Victoza Instant Savings Card
|Sanofi Patient Connection Program – No insurance
Must be US citizen, household income ≤ 250% of federal poverty level, not enrolled in Medicare or Medicaid etc.
|1. Apidra No Co-Pay Savings program
2. Lantus co-pay card
3. Soliqua 100/33 co-pay card
4. Toujeo co-pay card
Patients with diabetes should not be deciding between purchasing an insulin vial vs. school supplies for kids, as a healthcare partner we have to make every effort to reduce the economic burden for our patients and optimal outcomes.
- 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.
- Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, NuysKV et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care 2018 Jun;41(6):1299-1311.
- Roland D, Loftus P. Insulin prices soar while drugmakers’ share stays flat [article online]. Wall Street Journal, 7 October 2016.
- Karter AJ, Parker MM, Solomon MD, et al. Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE). Health Serv Res 2017;53:1227–1247.
- Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: associations with medication and medical utilization and spending and health. JAMA 2007;298:61–69.
- Kesselheim AS, Huybrechts KF, Choudhry NK, et al. Prescription drug insurance coverage and patient health outcomes: a systematic review. Am J Public Health 2015;105:e17–e30.
- Johnson CY. Why treating diabetes keeps getting more expensive [article online]. Washington Post, 31 October 2016. Available from https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-insulin-prices-have-kept-rising-for-95-years/?utm_term=.9c77afd62bb0. Accessed August 4, 2018.
- Luo J, Avorn J, Kesselheim AS. Trends in Medicaid reimbursements for insulin from 1991 through 2014. JAMA Intern Med 2015;175: 1681–1686 19.
- Lipska KJ, Hirsch IB, Riddle MC. Human insulin for type 2 diabetes: an effective, less-expensive option. JAMA 2017;318:23–24.