Tuesday’s Daily Piece: Resources for Insulin Patient Assistance

Persons with diabetes struggling to afford their insulin has been heavy on my heart recently. I have the privilege to work with many older adults with diabetes on insulin therapy which has created a passion for connecting these adults with resources to assist with affording insulin. I see time and time again older adults with Medicare Part D or Advantage Plan who simply can not afford their insulin. I also work with persons with diabetes who have lost their jobs and insurance coverage due to COVID so I also assist in connecting them with resources for the access to insulin.

What do I mean when I use the term, patient assistance, as relates to insulin? Receiving the medication from the pharmaceutical company at no cost to the patient. Typically, the medication is mailed to the provider’s office or person with diabetes’ home. I have found NovoCare (NovoNordisk – i.e. Novolog, Levemir, Tresiba, Fiasp), Lilly Cares (Lilly- i.e. Basaglar, Humalog) and Sanofi Patient Connection (Sanofi – i.e. Toujeo, Apidra) to provide excellent support for persons with diabetes who qualify (income requirements for persons covered through Medicare Part D or Medicare Advantage). Typically, persons who have lost their job and health insurance are able to get patient assistance through these programs. Also, each program varies in whether they require proof of income documentation to be submitted.

Below is the link to the website for NovoCare, Lilly Cares and Sanofi Patient Connection. If you are unsure of whether you qualify, please click on link below, and call phone to learn whether you qualify.

https://www.novocare.com/

https://www.lillycares.com/

http://www.sanofipatientconnection.com/

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#diabetes #insulin #affordability #resources

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July Blog: U-500 Insulin: What Makes It Unique?

Contributors: Ashley Butts and Saywon Flah, PharmD students at Philadelphia College of Osteopathic Medicine Georgia School of Pharmacy

CR, a 62-year-old male with a 20-year history of type 2 diabetes, is frustrated that he is taking over 200 total units of insulin daily and four injections each day.  He feels like the insulin is not being absorbed or working while enduring his frustration of feeling like a pen cushion.  His best friend, David, recently told him about a concentrated insulin, Humulin R U-500, which he started utilizing a few weeks ago. David says he injects with less frequency and less volume with each injection. CG has an upcoming appointment with his medical provider and he made a note to inquire about it.  In the meanwhile, he does a Google search to learn more about it.  

The NDEP's “4 Steps to Manage Your Diabetes For Life” brochure ...

So what is Humulin R U-500?  Humulin R U-500 is 5 times more concentrated than the standard U-100 insulin. It is often selected for persons with diabetes who are insulin-resistant and require more than 200 units daily.  It is typically injected two to three times daily 30 minutes before a meal.

U-500 Insulin Errors - Consumer Med Safety

So, does this change require the individual to recalculate insulin dose when being switched from U-100 to U-500 as the math can get tricky? Well, it all depends.  U-500 pen (officially, the Kwikpen) requires no dosage changes.  However, the vial and syringe method can be trickier as U-500 and U-100 insulin syringes are available. Use of U-100 syringes with U-500 insulin vial requires dose conversion as every unit of U-500 insulin contains 5 units of insulin so divide the U-500 dose by 5 to obtain units to draw up on U-100 syringe. Fortunately, a U-500 syringe is available from BD which simplifies things as no dose conversion is required.

FDA Approves Humulin U500 KwikPen - Bringing Convenient Pen ...

How much insulin is in U-500 pen and vial?  The pen contains 1500 units of insulin. Each click of the pen delivers 5 units of insulin, and pen can deliver 5 – 300 units with each injection.  The 20 mL vial contains 10,000 units of insulin with each line indicating 5 units and allowing for 5 – 250 units with each injection.

What is the cost? Cost varies depending on insurance coverage. A good place to start is the drug formulary (list of preferred medications by tiers; higher the tier the more $$$) as this can give a ballpark of the cost. Also, checking for copay cards and additional resources to help offset the cost of the U-500 is possible by visiting https://www.lillycares.com/

Trulicity Cost Information | With or Without Insurance | Trulicity ...

Back to CR, after researching U-500 insulin, he decides to discuss this as an alternative to his current insulin regimen with his medical provider.  He is interested in the U-500 pen as he can carry it in this pocket and only inject a couple times of day for less expensive copay each month than his current insulin copay total.

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#diabetes #U-500 #treatment #insulin

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Saturday’s Daily Piece: Novel Option for Relieving Foot Pain from Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) can cause major pain especially in feet. Several different oral medications are currently available for treatment of DPN. A new treatment option, Qutenza (capsaicin 8% patch), is now available. It is patch formulation of capsaicin that can only be administered by a healthcare professional as a single, 30 minute application on the feet using up to four patches. The single application can provide up to 3 months of pain relief.

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#diabetes #pain #treatment #patch

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Tuesday’s Daily Piece: InPen Approved for Kids and More Metformin Recalls

This week in diabetes, good news and not so good news to share. Let’s begin with the good news. InPen, a bluetooth enabled smart insulin pen has received expanded indication for kids age 7 years old and older. You may recall that InPen received FDA approved for use in adults back in 2019. It is a reusable pen that allows for tracking of insulin doses which can bring peace of mind for parents of kids with type 1 diabetes. It is available with a prescription at pharmacies. To help with cost, there is a copay card available through Companion Medical (simply click on link below).

https://www.companionmedical.com/get-inpen/

3 Reasons why you should care about InPen, the Smart Insulin Pen ...

Now, the not so good news. More metformin extended release recalls now from Lupin Pharmaceuticals and Granules Pharmaceuticals due to elevated levels of NMDA (which can increase risk of developing cancer). Please contact your pharmacy to find if out if your metformin ER has been recalled.

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/lupin-pharmaceuticals-inc-issues-voluntarily-nationwide-recall-metformin-hydrochloride-extended

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/granules-pharmaceuticals-inc-issues-voluntary-nationwide-recall-metformin-hydrochloride-extended

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#InPen #pediatrics #metformin #recall

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Tuesday’s Daily Piece: First Ready to Use (No Mixing!!!) Glucagon Autoinjector Now Available

The old school glucagon autoinjector was a challenge to use because it required mixing before use which is super stressful when one is experiencing severe hypoglycemia. Exciting news! The first ready to use (NO mixing) glucagon autoinjector, Gvoke HypoPen, is now available. No more mixing!!! To use this pen, one simply pulls off the red cap, and pushes the yellow end on the skin and holds for 5 seconds. It comes in a 2 pack box. It is indicated for persons with diabetes over 2 years of age for severe hypoglycemia. A $0 copay card is available for those with commercial insurance. Depending on your insurance, a prior authorization may be required which your medical provider will need to complete. Also the out pocket cost for the medication will vary depending on your insurance so if you are unsure of the cost contact your insurance company.

Xeris Pharmaceuticals Announces Gvoke HypoPen™ – the First ...
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#Gvoke HypoPen #ReadyToUse #Glucagon

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Tuesday’s Daily Piece: Tandem Control – IQ Expanded Approval and Lixisenatide

Technology in the form in insulin pumps, CGMs and apps have transformed the daily living with diabetes. Insulin pumps and CGMs are invaluable tools for pediatric and adult persons living with diabetes. Having options in terms of the best insulin pump and CGM for the individual living with diabetes is key. Now pediatrics specifically children 6 – 13 years old have the option of Tandem Control – IQ, hybrid closed loop system, as the FDA has expanded approval to this age group. Please click below to learn more about this exciting expanded approval of Tandem Control – IQ.

https://www.healio.com/news/endocrinology/20200618/fda-clears-interoperable-insulin-pump-for-pediatric-use?M_BT=4557970002905

https://diatribe.org/tandems-control-iq-cleared-ages-6-13-automated-insulin-delivery-children

Tandem's Control-IQ Hybrid Closed Loop Algorithm Submitted to FDA ...

Recently published data from trial with lixisenatide, short acting (daily injection) GLP-1 agonist, showed a significant delay in gastric emptying and reduction of postprandial glucose. Lixisenatide has a role in significantly reducing postprandial glucose. Please click below to learn more about the trial data.

What is Adlyxin (Lixisenatide) Used For? Side Effects and Dosage
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#FDA #Pediatrics #Tandem #ControlIQ #Lixisenatide

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Thursday’s Daily Piece: New Faster Acting Insulin Lispro and Next Generation Freestyle Libre 2

What an exciting week in the world of the diabetes with the ADA Virtual Scientific Sessions, FDA approval of a new faster acting insulin lispro and the next generation Freestyle Libre 2 continuous glucose monitoring system. Lilly has received FDA approval for their new faster acting insulin lispro (Lyumjev) available in U-100 and U-200 formulations. This new insulin will be available through Lilly Insulin Value Program ($35/month copay). More details are provided in link below.

https://www.healio.com/news/endocrinology/20200616/fda-approves-novel-fasteracting-insulin-lispro-injection?M_BT=4557970002905

FDA approves Lyumjev, Lilly's new rapid-acting insulin – PharmaLive

Secondly, the next generation of the Free Style Libre has been approved. Freestyle Libre 2 integrated continuous glucose monitoring system now has optional, real time alarms (which Freestyle Libre 14 day lacked). Similar to Freestyle Libre 14 day, this new generation integrated is placed on the upper arm for 14 days. Abbott (maker of Freestyle Libre) is still working to bring apps for Libre to U.S. Please click on link below for additional details.

https://www.healio.com/news/endocrinology/20200615/fda-clears-nextgeneration-integrated-continuous-glucose-monitor?M_BT=4557970002905

Abbott's Freestyle Libre 2 Advanced Wearable Glucometer FDA ...
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#FDA #Lyumjev #Libre2 #next generation

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Saturday’s Daily Piece: FDA Updates on Insulin Glargine and Metformin ER

FDA has approved insulin glargine (Semglee, U-100) manufactured by Mylan Pharmaceuticals this week. We now have 3 insulin glargine U-100 (Lantus, Basaglar and Semglee) formulations available. Semglee is approved for use in adults and pediatrics with type 1 diabetes and adults with type 2 diabetes.

FDA announces additional companies to being asked to voluntarily recall metformin extended release due to elevated levels of NDMA. Additional details in link below.

https://www.medpagetoday.com/endocrinology/generalendocrinology/87035?xid=nl_mpt_DHE_2020-06-13&eun=g1137305d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202020-06-13&utm_term=NL_Daily_DHE_dual-gmail-definition

Semglee® | Insulin glargine injection|HCP Website
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#FDA #Semglee #metformin #NDMA

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Tuesday’s Daily Piece: Caution When Switching from Humulin R U-500 KwikPen and Vial

Recently, I had an experience that made the hair on my head stand up. A patient was switched from Humulin R U-500 KwikPen to Humulin R U-500 vial. While on the surface, this is no big deal except that patient was given U-100 insulin syringes without any instructions on how to divide his U-500 dose by 5 when determining how many units to draw up in the U-100 syringe. Look to hear more about safe use of Humulin R U-500 in the June blog for Reece’s Pieces in a Diabetes World.

Using U-500 Insulin | Clinical Diabetes

FDA Approves First U-500 Insulin Pen Device
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#U-500 #dosing #safety

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Thursday’s Daily Piece: Out of Pocket Costs for Diabetes Beyond Insulin

For persons living with diabetes, they know first hand that diabetes is expensive. Much talk and advocacy efforts around the cost of insulin driving up the overall cost of insulin is happening. Recent research letters in JAMA Internal Medicine took a deep dive into the out of pocket costs for insulin. The findings revealed out of pocket costs are high for supplies including insulin pump supplies, glucose meters and continuous glucose monitors. We must look beyond insulin alone when considering the out of pocket costs for diabetes. For more details, please click on link below.

https://www.medscape.com/viewarticle/931631

Out-of-pocket costs | Wellmark
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#costs #supplies #diabetes

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