The high cost of insulin is a major concern for people with diabetes, which has skyrocketed over the past 20 years. And while ongoing changes reduce the value — at least for some patients — new drugs add to the confusion.
The good news is that help is on the way, including new legislation that caps costs for seniors and generic insulin that could be available as soon as next year.
bad news? It takes real work to sort out the complexity of costs and get the best deal on these life-saving drugs.
“Sometimes it feels like untangling the biggest ball of thread ever,” said Stephanie Field, director of pharmacy business services at Corwell Health.
That’s why Corewell now has a Medication Care Coordination team helping patients solve the insurance riddles, doing their best to simplify coverage for complex drug treatments.
“We make sure that this is the most cost-effective approach for the patient and that they are getting the right medication that is covered by their insurance,” she said.
Sometimes, this is not possible.
“In those cases, we help with drug assistance, which could be a co-pay card or a grant. There are opportunities for us to help get coverage,” she said.
Some drug companies offer relief.
And companies like GoodRx are also helping patients find ways to save money on coupons and drug discounts.
Field says Corwell Health works with patients to help them find out as much as possible before they are shocked by the sticker shock on the pharmacy window.
And it’s working. Field said the average time from prescription to pharmacy pick-up has gone from seven and a half days to three days.
“And we’ve seen a significant reduction in patient out-of-pocket costs,” he added.
Understanding Cost Complexity
It helps to understand how the cost of diabetes has spiraled out of control. Insulin was discovered over 100 years ago—and for the 1.9 million people with type 1 diabetes in America, it’s 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 make their own insulin, but their body can’t use it properly. They can usually manage it with lifestyle changes and oral medications. But in some cases they also need insulin injections.
more than 37 million Americans According to the American Diabetes Association, about 11% of people have diabetes—and it’s growing at epidemic levels.
An estimated 8 million people in the US are dependent on insulin.
As that number grows, it puts more pressure on the supply of insulin, a market controlled by the three pharmaceutical giants.
“These three manufacturers are making insulin for the whole world,” said Gregory Dines, DO, a Corwell Health Spectrum Medical Group internal medicine physician. “It takes a significant investment to build manufacturing facilities that can safely make a drug molecule.”
Semgly, a biosimilar form of insulin made by a fourth company, has recently entered the market. (Biosimilar drugs are defined as biological formulations that are so similar to the drugs they imitate that there is no clinical difference. Generic drugs, on the other hand, are identical to brand-name drugs.) which they copy.)
While this has improved affordability for some patients, many advocates are frustrated by the limited effect.
Field shares patients’ frustration. While the average price patients pay for their insulin within the Corwell Health System is $20.70, some patients pay as much as $165, depending on their insurance.
“It’s related,” she said.
And people with different insurance and education levels have different degrees of health care literacy.
Even for experts like him, navigating that maze is challenging.
“I’ve done it for 13 years and still struggle with my parents getting them to make the right choices,” she said.
Some patients face bills of up to $2,100 per month.
“No middle-income person can afford it,” she said. “You have to be a millionaire. At some point, you probably give up.
Sadly, many people are forced to choose unsafe options.
recently Study found that 17% of insulin users either skip doses of insulin, take less insulin than they need, or delay filling prescriptions due to financial constraints.
And rationing was even more common among black Americans, affecting 16%, compared to whites and Hispanic Americans, affecting 23%.
New drugs add to the confusion
Insulin is not the only drug for diabetes that is prohibitively expensive. Newer drugs for type 2 diabetes, such as Ozempic, Trulicity and Monjaro, are highly effective in obesity-related diabetes. But they can cost patients as much as $1,000 per month.
And the publicity about those costs, Field said, adds to the perception that all diabetes drugs are so expensive.
“The nuances get lost on a lot of people, and it becomes kind of a convoluted story,” she said.
Groundbreaking legislation recently capped the cost of insulin at $35 for Medicare, which covers US seniors.
But that life-saving measure comes at a cost. A recent study by the Congressional Budget Office shows that it also increases the cost of government and increases the cost of insurance premiums.
Taxpayers and consumers also bear those costs.
Michigan is working to reduce the cost of manufacturing insulin in the state. It is one of several states calling for an investigation into the pricing policies of Eli Lilly & Co., Sanofi and Novo Nordisk.
The same vial of insulin that costs $98 in the US is available for $12 in Canada, $8 in the UK and $7 in the US. Margin,
On average, insulin prices in the US are eight times higher than in 32 high-income countries.
For the most part, pharmaceutical companies, however, defend the pricing of their products.
“It has long been the philosophy of the pharmaceutical industry that they have a right to do so because it costs billions of dollars to make a new drug — and since many new drugs fail,” Dr. Daines said.
Managing the High Cost of Medicines
Relief is coming—at last. Eli Lilly recently slashed the price of its insulin, capping it at $35 for everyone. Civica, a non-profit organization, plans to introduce three biosimilar insulins as early as 2024.
Until then, he said the most important step is “to make sure you understand your insurance benefits.”
It is important to know which drugs are covered and which are not and how to get the lowest possible co-pay.
And it stresses checking in with your insurer annually because plans change often.
Unfortunately, he said, many people may be underpaying and not know it. And while plans are required to inform patients about the changes, “often, the letter came three months early, and the effect isn’t apparent until it’s time to pay for their medication at the pharmacy.” Is.”
It’s also important to ask your provider how a new prescription fits into coverage.
