Insulin Sticker Shock? Here's Why

If you're on insulin, it's not news to you that the prices have gone through the roof. In fact, costs have risen a whopping 700% in the past 20 years. These higher insulin costs have priced some people out, forcing some to the dangerous decision of having do with less insulin.1a

insulin prices skyrocket

This issue is on the minds of physicians, as well. At a recent 2017 annual meeting of the American Diabetes Association in San Diego, CA, speakers focused on why the prices have spiraled and what doctors and patients can do to make insulin more affordable.1

Here, what you need to know about what's behind the price increases and how you may be able to pay less.

In the Beginning

Back in 1921, the scientists who discovered insulin wanted to share the method of preparation with anyone who could use it.  While the discovery was a milestone, and the first insulin was cheap, the product wasn't perfect. So, others began to improve on it.

With the improvements came multiple new insulins, and many new patents—and patents generally last 20 years. On some of the new insulins, ''patents now extend well into the 21st century," says Kasia Lipska, MD, assistant professor of medicine, Yale University School of Medicine, who spoke at the meeting.

Once a drug is off patent, other drug makers can begin making cheaper, generic versions of it.

Prices Spiral—and Range Greatly

The range of prices for insulin is wide. For instance, a vial of Humalog, in 2016, sold for about $255. Compared to its $21 price tag in 1996, that's 700% higher when inflation is factored in, Dr. Lipska says.

Yet, Novolin N at Walmart, a human recombinant insulin, is about $25. That's credited to their ability to buy large quantities and get discounts.

Why Does Some Insulin Cost So Much?

You may interact only with your doctor and your pharmacist when filling an insulin prescription. But there are many more players, and they all affect costs, says Alan Carter, PharmD, the principal investigator at MRI Global, a not-for-profit research organization, and adjunct professor of pharmacy at the University of Missouri—Kansas City School of Pharmacy.

Among them, besides you and your doctor, are the suppliers of the raw material, the drug maker, the pharmaceutical wholesaler and the pharmacy and pharmacist.

There are other players, behind the scenes, Dr. Carter says, including the pharmacy benefit manager, and, for some, the Affordable Care Act and Medicare Part D.

Pharmacy benefit managers or PBMs are third party administrators of prescription drug prices for commercial health plans, employer self-insured plans, Medicare and government plans. They work as intermediaries between the plan, such as the insurance company, and the pharmacies. They decide which pharmacies are in the plan, which drugs are on the approved list (the formulary) and negotiate prices and rebates from the drug companies.1

Some critics say that rebates that these managers get from drug companies are one trigger driving up drug prices—and that there needs to be more ''transparency'' about who benefits from the savings from the rebates—the PBMs or patients?

How To Save

In efforts to keep costs down, physicians are discussing a variety of approaches.

It's time for physicians to think about alternatives, says David Robbins, MD, professor of medicine and director of the KU Diabetes Institute at the University of Kansas. Among his suggestions:1

Different insulins—One way to cut costs, he says, is to prescribe three times a day intermediate acting insulin instead of longer acting, in some patients. In one study, researchers found little difference in the frequency of low blood sugar in those with type 1 diabetes taking long-acting versus intermediate-acting insulin.3

Urine testing instead of blood—For those with type 2 diabetes on less intense insulin therapy, testing blood sugar more frequently can produce a better A1C result, Dr. Robbins says, and urine testing (generally cheaper) may produce the same control, he says. Researchers looked at the results of eight studies comparing blood testing with urine testing and the result on A1C. Only one found a better result overall with using blood testing over urine.4

"It's not the technique of monitoring, it's the education and motivation given to patients," Dr. Robbins says.

Bariatric surgery, sooner? Since bariatric surgery has the potential to reverse or improve diabetes, Dr. Robbins asks: "Are we doing that enough?"

Expert Perspective

''The major cause for the rise in insulin prices are the pharmacy benefit managers," says Scott Isaacs, MD, FACE, FACP, an Atlanta endocrinologist and a member of the editorial board for Endocrine Web. He reviewed the symposium information and offered his viewpoint.

"The solutions is for patients, health care providers and the general public to raise awareness of the issue to 'shame' the PBMs and pharmaceutical companies to lower prices. Prices have gone up much faster than inflation."

He suggests contacting your congress representative or senator and log your concern.

Dr. Liska reports no relevant disclosures. Dr. Carter is a scientific advisory board member for Epinex Diagnostics. Dr. Isaacs is a consultant for Novo Nordisk and is on the speakers' bureau for Novo, Takeda Pharmaceutical Company and Orexigen Therapeutics Inc. Dr. Robbins reports owning 10 shares of Eli Lilly stock.





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