What Medicare Beneficiaries On Insulin Can Expect
For patients age 65 and up who rely on insulin, the Inflation Reduction Act is a “game changer,” Gabbay said.
More than 8 million people in the U.S. rely on insulin to manage their blood glucose levels, and if they stop taking the medication for a few days, they could die. “It’s deadly serious,” Gabbay said.
Yet as the year progresses, some Medicare patients tend to get nervous about a coverage gap known as a “donut hole” and may try to ration their insulin, he said.
The high costs of insulin result in 14% of patients having “catastrophic” levels of spending on the treatment, according to recent research from Yale University. For Medicare patients on insulin, catastrophic spending affects one in five patients, the research found.
Starting in 2023, the Inflation Reduction Act will cap the cost of insulin for Medicare beneficiaries at $35 per month and will include those who use insulin pumps.
Medicare beneficiaries who pay more than $35 per month after the legislation is initially enacted will be reimbursed, according to the American Diabetes Association.
For patients struggling to cover insulin, the American Diabetes Association provides resources that may help curb those costs at Insulinhelp.org.
Kildee Urges Senate To Vote On Lowering Cost Of Insulin For All Michiganders
FLINT Congressman Dan Kildee, Chief Deputy Whip of the House Democratic Caucus, today sent a letter to Senate Majority Leader Chuck Schumer, urging him to hold a vote on legislation that has already passed the U.S. House of Representatives to cap the cost of insulin at $35 per month for Americans with diabetes.
The Affordable Insulin Now Act, which Kildee introduced and passed through the House in March with support from Republicans and Democrats. Last month, as a part of the passage of the Inflation Reduction Act, Senate Republicans blocked Kildees legislation to cap insulin prices for all Americans from becoming law. While Kildee was still able to successfully cap the price of insulin at $35 for seniors on Medicare in the Inflation Reduction Act, his bill, the Affordable Insulin Now Act, would cap insulin prices for all Americans at $35 a month.
We applaud the recent passage of the Inflation Reduction Act, which lowers costs for Americans with diabetes on Medicare by capping out-of-pocket insulin costs at $35 per month and is a historic step toward making insulin affordable for everyone. It is imperative that we continue to advocate for policy that caps out-of-pocket insulin costs for Americans on private health insurance who continue to pay exorbitant amounts for life-saving insulin, the letter reads in part.
Kildee sent the below letter along with Representatives Angie Craig Lucy McBath and Raja Krishnamoorthi .
Dear Senate Majority Leader Schumer,
The High Cost Of Insulin In The United States: An Urgent Call To Action
- S. Vincent RajkumarCorrespondenceCorrespondence: Address to S. Vincent Rajkumar, MD, Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Mayo Clin Proc.Mayo Clin Proc.
N Engl J Med.
Insulin pricing in the United States is the consequence of the exact opposite of a free market: extended monopoly on a lifesaving product in which prices can be increased at will, taking advantage of regulatory and legal restrictions on market entry and importation.Lancet Diabetes Endocrinol.
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How Much Does A Month Of Insulin Cost
Everyone has different insulin needs. There isnt a one size fits all approach to determining how much insulin you need. Those taking analog insulin take a background or basal dose once or twice a day. In contrast, those taking regular human insulin take it three to four times a day.
This cadence is the only insulin some people with type 2 diabetes need. But for type 1 diabetes, and some with type 2, additional insulin is needed at mealtime. Depending on which insulin you are using, it should be taken 10 to 30 minutes before your meal. The amount of insulin depends on what you plan to eat. For example, you might need 1-3 units per carbohydrate portion .
People with type 1 diabetes generally use two different types of insulin per day. They start with two injections per day and progress to three to four doses per day, according to the American Diabetes Association . People with type 2 diabetes might start with 0.5-0.8 units per kilogram of body weight per day and eventually take 1-2 units per kilogram of weight. For a person weighing 150 pounds, this would be 68 to 136 units per day. For a person weighing 175 pounds, this would be 80-160 units per day.
One vial of insulin contains 1000 units, and pens contain 300 units.
* Based on three vials or 10 pens
In addition to the above costs, you might also require additional supplies, such as:
Average Price Per Vial Across All Types Of Insulin In 2018
- United States: $98.70
- Australia: $6.94
The average price in America, across all types of insulin, was more than ten times higher than the average for all of the other countries combined. In fact, the closest any country came to paying the $98.70 American average was the $21.48 average that Chile pays.
The differences were especially stark when the researchers looked at rapid-acting insulin, which makes up about a third of the U.S. market. Its average price in other countries was just over $8. In America, it was $119.
It comes at a high cost, and not just financially, but in terms of your life, said Mila Clarke Buckley, 30, whose autoimmune diabetes is slowly shutting down her pancreas. She runs a top-rated blog for fellow diabetics, Hangry Woman, from her home in Houston. She has more than 30,000 readers.
It’s not like one day you can just stop taking insulin, she said. You really have to manage your life thinking, OK, this is my No. 1 priority, to be able to get this little pen of liquid so that I can live.
Insulin prices in the United States are higher than prices in nearly three dozen other countries RAND researchers examinedand it’s not even close.
The prices RAND used in its studythe list prices, set by drug manufacturerswere the most available for comparison across different countries. They’re a good starting point for understanding the true cost of insulin. In the cryptic world of drug-price setting, the list price is like an opening bid.
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Reasons For The High Cost Of Insulin
|Reasons for the high cost of insulin|
|Vulnerable population who is willing to pay high costs to have access to a lifesaving drug|
|Pharmacy benefit managers and other middlemen who benefit from a high list price|
|Lobbying power of insulin manufacturers|
|Possible policy level solutions|
|Value-based reimbursement and pricing, and laws and regulations governing price increases|
|Easier path for biosimilar entry, including reciprocal approval of biosimilars|
|Governmental or nongovernmental agency to oversee pricing|
|Transparency on rebates|
|Solutions that can be implemented by physicians and institutions|
|Discussion with patients about affordability|
|Awareness about sources of information on prices|
|Practice guidelines that take cost into account|
|Preference of lower-cost biosimilars in formularies|
|1921: Discovery of insulin|
|1923: First insulin patented|
|1946: Neutral protamine Hagedorn insulin|
|1950s: Lente insulin|
|1970s: Improved purified insulins|
|1984: Recombinant human insulin|
biosimilarsgenericsN Engl J Med.
How Much Is Insulin In America For Insured Patients
There are many versions of insulin out today. The newer forms include fast-acting versions of insulin, which 90% of insured patients have been prescribed. Although these forms of insulin are faster acting and more effective, they are also more costly. On average, these newer versions of insulin can retail from $175-$300 per vial. Some patients may require 2-3 vials a month. Many diabetic patients are forced to skip or go without their insulin and diabetic supplies at such high prices. Nine percent of patients who are insured or have Medicaid still pay full list price on insulin.
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Lowering The Cost Of Insulin
Gaffney said the problem is simply that the list price of insulin is too high.
We have allowed pharmaceutical companies to set the agenda, and that is coming at the cost to our patients, he said.
Eric Tichy, who tracks insulin costs as division chair of pharmacy supply solutions for the Mayo Clinic in Rochester, Minnesota, said that a handful of drugmakers Eli Lilly, Novo Nordisk and Sanofi dominate the market for insulin in the U.S. Without generic competition, he said, they are able to keep prices high.
In addition, insulin products aren’t necessarily interchangeable, Tichy said, so if a patient is taking, for example, a product from Eli Lilly, he or she may not be able to easily switch to Sanofi’s product.
As it stands, the government is limited in its abilities to rein in drug costs, experts say.
The U.S. needs additional policies that improve the affordability of insulin for those who may have inadequate insurance coverage or no coverage at all, said Juliette Cubanski, deputy director of the program on Medicare policy at KFF, formerly known as the Kaiser Family Foundation.
One approach is for states and other entities to make their own insulin, as California has announced plans to do.
Tichy is a member of the nonprofit drugmaker Civica Rx, which announced in March that it planned to make and sell generic versions of insulin to consumers at no more than $30 per vial and no more than $55 for a box of five pen cartridges.
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The backlash against Eli Lilly showcased the real-life potential of online disinformation to trigger chaos and financial loss. Reuters
WASHINGTON: A Twitter imposter cost a US pharmaceutical giant billions of dollars, but the viral prank triggered another unexpected crisis a new wave of scrutiny of the high cost of its insulin.
Authentic-looking fake accounts proliferated last week after Twitter rolled out a paid verification service, the latest in a string of chaotic developments since Elon Musks blockbuster US$44bil buyout of the influential platform.
Among the victims was drugmaker Eli Lilly, whose stock price nosedived erasing billions in market capitalisation after a parody account stamped with a verification tag purchased for US$8 tweeted that insulin was being made available for free.
The company was forced to issue an apology for the misleading message from a fake Lily account, but the disinformation stirred fresh attention to a long-festering debate about high insulin prices.
What you should *actually* apologise for is price gouging life-saving insulin, tweeted Chicago-based human rights lawyer Qasim Rashid.
People are dying because of your greed cruelty. Apologise for that.
Gaining traction alongside such comments was a cartoon meme with a half-elephant, half-human character riling up people to be more upset about the price of insulin than the price of gas.
Parody is successful when it reveals embarrassing and widely understood truth.
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Are Insulin Vials Cheaper Than Pens
There is a significant difference in insulin prices between insulin vials and insulin pens. Using vials is less expensive than pens. However, some people feel that using pens as a delivery system provides a higher quality of life. The pens come prefilled, and when using the analog medications, the number of doses could be lower. The pens make it easier to take insulin with you, providing more freedom.
Using pens is safer, more convenient, and offers better glycemic control, according to a study published in 2018. However, this study also noted that people who use pens were spending significantly more each month for diabetes control. In some cases, it was three times more expensive to use pens.
Lowering The Cost Of Insulin Could Be Deadly
If the drug becomes significantly cheaper than newer, better diabetes treatments, more people could die from the disease.
When I heard that my patient was back in the ICU, my heart sank. But I wasnt surprised. Her paycheck usually runs short at the end of the month, so her insulin does too. As she stretches her supply, her blood sugar climbs. Soon the insatiable thirst and constant urination follow. And once her keto acids build up, her stomach pains and vomiting start. She always manages to make it to the hospital before the damage reaches her brain and heart. But we both worry that someday, she wont.
The Inflation Reduction Act, passed last month, aims to help people like her by lowering the cost of insulin across America. Although efforts to expand protections to privately insured Americans were blocked in the Senate, Democrats succeeded in capping expenses for the drug among Americans on Medicare at $35 a month, offering meaningful savings for our seniors, some of whom will save hundreds of dollars a month thanks to the measure. In theory, the policy will help the estimated 25 percent of Americans on insulin who have been forced to ration the drug because of cost, and will prevent some of the 600 annual American deaths from diabetic ketoacidosis, the fate from which Im trying to save my patient.
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How Much Does It Cost To Manufacture Insulin
One vial of insulin only costs between $2 and $10 to make, depending on the type, according to Verywell Health. However, for consumers, one vial of insulin can cost between $50 and $1,000, and a pack of insulin pens can range from $45 to $600.
So, if a vial of insulin goes for $1,000 and that insulin costs just $10 to make, that’s a 100x markup for consumers. And whereas insurance reduces the price somewhat, it still leaves a dent in your out-of-pocket expenses.
Why Are Insulin Prices So High
Only three manufacturers market insulin in the United States, and no generic versions are available despite human insulin being commercially available for more than 50 years. In addition, other intermediariespharmacy benefit managers and health insurance plansnegotiate rebates, discounts, and fees, which drives up the list price. Pharmacy benefit managers negotiate with manufacturers to get insulin on a health plan’s formulary and at a low tier hence, the manufacturer benefits from increased sales volume. In turn, the manufacturer pays rebates to the pharmacy benefit manager. To compensate for the money lost by paying these rebates, the manufacturer increases the list price for the drug. The results are catastrophic for pricing: over the past few decades, 50% of the cost increase for insulin was related to the rebates paid to pharmacy benefit managers.35
As a result of these cost pressures, insurance companies have shifted the expenses to patients through higher copayments. Although the usual copayment for a vial of insulin is $10 to $50 per month, patients with high deductibles could pay out-of-pocket costs up to $240 to $300 per month for glargine insulin or $80 to $100 per month for isophane insulin .
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Hanie Redmond Pharmd Cde Bc
Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
If someone has type 1 diabetes or if someone has had damage to their pancreas, these are instances where their body doesnt produce any insulin, Stephanie Redmond, PharmD, CDE, BC-ADM, founder of Diabetes Doctor, tells Verywell. Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
How Much Does A Bottle Of Insulin Cost With Insurance
It is difficult to say how much a vial of insulin costs when paying through your health plan. Each insurance plan covers insulin products differently.
It is when you actually have health insurance coverage that getting the insulin for a decent price becomes a problem, says Dr. Carnathan. In those cases, the patients are sometimes forced to switch to a different and cheaper type of insulin called NPH or 70/30 among a few others. These insulins have been around for a long time and are affordable. The patient needs a primary care doctor or endocrinologist who is comfortable using these older insulins and adjusting them safely.
Each health plan has varying copays and deductibles, too. For example, for people with a high-deductible plan, the cash price for insulin is paid until you meet the deductible. Some copays can be as high as 50% of the cost of the medication.
It can also sometimes be difficult for people on Medicare to afford insulin. Many patients who are faced with the high cost of insulin find themselves caught in the Medicare donut hole, says Gail Trauco, RN, the principal CEO of The PharmaKon LLC.
Like uninsured customers, patient assistance programs might be of help to Medicare customers. However, these programs require an application, which can take 30 to 60 days for review and approval, and documentation with receipts to confirm your monthly cost-of-living expenses.
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