The high cost of insulin is a major concern for people with diabetes, skyrocketing over the past 20 years. And while ongoing changes are reducing the price, at least for some patients, new drugs are adding to the confusion.
The good news is that help is on the way, including new laws that cap costs for seniors and generic insulin that could be available as early as next year.
The bad news? It takes real work to unravel the complexity of the costs and get the best possible deal on these life-saving drugs.
“Sometimes it feels like you’re untangling the biggest ball of yarn ever,” said Stephanie Field, director of pharmacy business services at Corewell Health.
That’s why Corewell now has a Medication Care Coordination team to help patients solve insurance conundrums, doing their best to simplify coverage for complicated drug plans.
“We make sure this is the most cost-effective approach for the patient and that they get the right drug covered by their insurance,” she said.
Sometimes that’s not possible.
“In those cases, we help with medication assistance, which can be a co-pay card or a subsidy. There are opportunities for us to help get coverage,” she said.
Some pharmaceutical companies offer relief.
And companies like GoodRx also help patients find their way to coupons and drug discounts.
Field says Corewell Health is working with patients to help them learn as much as possible before they’re dazed by the shock of the stickers in the pharmacy window.
And it works. Field said the average time from prescription to pharmacy pick-up went from seven and a half days to three days.
“And we saw a significant reduction in out-of-pocket expenses for patients,” she said.
Understanding Cost Complexity
It helps to understand how the costs of diabetes have gotten so out of control. Insulin was discovered over 100 years ago and for the 1.9 million people with type 1 diabetes in the United States, it is essential.
Insulin is a hormone that occurs naturally in the body, secreted by the pancreas. People with type 1 diabetes do not produce it at all.
People with type 2 diabetes create their own insulin, but their body doesn’t use it properly. They can usually manage this with lifestyle changes and oral medications. But in some cases, they also need insulin injections.
More … than 37 million Americans have diabetes, according to the American Diabetes Association, about 11% of the population – and it is growing at epidemic levels.
It is estimated that 8 million people in the United States are dependent on insulin.
As this number grows, it puts increased pressure on the supply of insulin, a market controlled by three pharmaceutical giants.
“These three manufacturers make insulin for the whole world,” said Gregory Deines, DO, an internal medicine physician with Corewell Health Spectrum Medical Group. “It takes a significant investment to build manufacturing facilities that can safely manufacture the drug molecule.”
Semglee, a biosimilar form of insulin made by a fourth company, recently hit the market. (Biosimilar drugs are defined as biological formulations that are so similar to the drugs they imitate that there is no clinical difference. On the other hand, generic drugs are identical to the brand name drugs they copy. )
While this has improved affordability for some patients, many advocates are disappointed with the limited impact.
Field shares the patients’ frustration. While the median price Corewell Health System patients pay for their insulin is $20.70, some patients pay $165, according to their insurance.
“It’s concerning,” she said.
And people with different levels of insurance and education have varying degrees of health care literacy.
Even for experts like her, navigating this maze is a challenge.
“I did this for 13 years and I still struggle with my parents to get them to make the right choices,” she said.
Some patients face bills of up to $2,100 per month.
“No middle-income person could afford it,” she said. “You should be a millionaire. At some point, you would probably give up.
Unfortunately, many people are forced to make dangerous choices.
A recent study found that 17% of insulin users skipped insulin doses, took less insulin than needed, or delayed filling prescriptions due to financial constraints.
And among black Americans, rationing was even more common, affecting 23%, compared to 16% of white and Hispanic Americans.
New drugs add to the confusion
Insulin is not the only diabetes drug that is prohibitively expensive. Newer drugs for type 2 diabetes, such as Ozempic, Trulicity and Mounjaro, are very effective in obesity-related diabetes. But they can cost patients up to $1,000 a month.
And publicity about those costs, Field said, adds to the perception that all diabetes drugs are so expensive.
“The nuances are lost for a lot of people, and it becomes kind of a muddled story,” she said.
Groundbreaking legislation recently capped the cost of insulin at $35 for Medicare, which covers American seniors.
But this vital measure comes at a price. A recent study by the Congressional Budget Office shows that it also increases the cost to the government and drives up the cost of insurance premiums.
Taxpayers and consumers also bear these costs.
Michigan is working to cut costs by manufacturing insulin in the state. It’s one of many states calling for investigations into Eli Lilly & Co., Sanofi and Novo Nordisk for their pricing policies.
According to an analysis of Rand.
On average, insulin prices in the United States are eight times higher than in 32 high-income countries.
For the most part, however, pharmaceutical companies defend the price of their products.
“It has long been the philosophy of the pharmaceutical industry that they have the right to do this since it costs billions of dollars to create a new drug and since so many new drugs fail,” said Dr Deines. .
Managing high drug costs
Relief comes – eventually. Eli Lilly recently reduced the price of its insulin, capping it at $35 for everyone. Civica, a non-profit organization, plans to introduce three biosimilar insulins starting in early 2024.
Until then, he said the most important step “is to make sure you understand your insurance benefits”.
Knowing which drugs are covered and which are not and how to get the lowest possible co-payment is essential.
And that means checking with your insurer every year, as plans change often.
Unfortunately, he said, many people might be paying less and don’t know it. And while plans are required to notify patients of the changes, “often the letter has arrived three months ago, and the impact is unclear until it’s time to pay for their medications. to the drugstore”.
It’s also important to ask your provider how a new prescription fits into coverage.
