Contributor: Zachary Powell, PharmD Candidate Class of 2023, PCOM Georgia School of Pharmacy
Sticker shock! LW was slammed when he went to pick up his insulin prescription. What?? More than $200 for a pack of insulin pens. How is this possible? He thought, “I will need to take out a loan to afford this medication.” LW had just been discharged from the hospital after an emergency high blood sugar level occurrence and learned that he has diabetes. He was told “…you are fortunate you will only need one insulin injection per day…” Really?? He was scared to stick himself and horrified at the cost of this medicine.
Insulin affordability is at the forefront of persons with diabetes, their loved ones, and their healthcare professionals. Interestingly, Walmart recently announced a partnership with Novo Nordisk to begin selling the rapid-acting insulin analog, Novolog (insulin aspart), under the Walmart branding ReliOn. For several years, the partnership between Walmart and Novo Nordisk has included affordable, over-the-counter (OTC) human insulins including regular insulin (short-acting), NPH (intermediate-acting), and 70/30 combination, starting at $25 per vial. The ReliOn human insulin provided another option for persons with diabetes struggling to afford the insulin price hikes within the last two decades leaving many people to ration their insulin and, in some instances, die. Simply that. Using human insulin, however, raises its own safety and efficacy concerns in managing glycemic variability for persons on insulin therapy.
“But the word ‘human’ in this insulin means it’s natural and safer, right?” Not quite. Diabetes is a complex disease which may impact one individual much differently than another. According to the CDC, as of June 2020 more than 34 million people in the US have diabetes, each requiring an individualized plan; not only focused on their medication therapy but also an individualized diet and exercise plan. Human insulins, though potentially helpful in a pinch, aren’t as versatile for managing diabetes when compared to insulin analogs.. There are three important characteristics to keep in mind when discussing the different types of insulins: onset of action – how quickly the insulin works; peak – how long it takes for the insulin to reach the maximum therapeutic benefit; and duration – how long the action of the insulin lasts. Newer, more expensive insulin analogs differ in their molecular structure when compared to human insulin and allows healthcare providers to fine tune insulin requirements for each individual because these molecular modifications change our 3 important characteristics: onset of action, peak, and duration. On the other hand, human insulin is cheaper but puts the person with diabetes at risk of experiencing wide fluctuations in their blood glucose and could ultimately be life-threatening without proper supervision from a healthcare provider.
With the announcement of Walmart’s new insulin analog, it may begin a much needed trend towards affordable insulin for diabetics. The insulin analog, ReliOn Novolog, is now available with a prescription as 10 mL vials priced at $72.88 as well as 3 mL single-patient pens and 3 mL single-patient PenFill cartridges starting at $85.88. Though the prices are still substantial, especially for individuals who require multiple vials and pens each month, the $73 vial and $86 pens provide individuals with a 58% and 75% discount off branded insulin analogs, respectively. This correlates to a savings of $100 per vial and $250 per package of pens.
Available reduced cost insulin at Walmart
- Insulin aspart (100 units/mL; U-100) — analog
- 10 mL multiple-dose vial
- 3 mL single-pt use PenFill cartridges for the 3 mL PenFill cartridge device
- 3 mL single-pt use NOVOLOG FlexPen
- 3 mL single-pt use NOVOLOG FlexTouch
- $86/box (5 pens/box)
- 10 mL multiple-dose vial
- Human insulin 10 mL vials
- ReliOn Novolin R U-100 (short acting)
- ReliOn Novolin N (intermediate acting)
- ReliOn Novolin 70/30 (combination of intermediate-acting and short-acting)
There is still work to be done to make insulin more affordable for diabetic patients but Walmart is fulfilling their slogan “Save money. Live better.” Another area to improve would be the reduction in cost of long-acting (basal) insulin analogs. The longer acting insulins are the go-to for healthcare providers as they allow for better control of glucose levels but also carry a larger cost to patients.
Back to LW, he shared with the pharmacist that he had not seen a primary care provider in years since he went a few years without health insurance and recently began a new job and health insurance. The pharmacist provided guidance for LW in finding a primary care provider for ongoing care for his diabetes and walked LW through the website, getinsulin.org, to explore available financial resources.
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