On Insulin Pricing

Nov, 2017

When President George W. Bush moved to include drug coverage benefits for Medicare patients he had to secure the support of Big Pharma. The drug companies demanded and obtained two important concessions: (1) Americans may not purchase their medications from foreign pharmacies, and (2) Medicare may not negotiate the price of medications. The drug companies do negotiate on price with the Veteran’s Administration and with foreign governments, and this competitive process helps keep costs down for patients. So Big Pharma was adamant that this power be denied to Americans on Medicare, otherwise their lobby would torpedo the legislation.

The result has been outrageous price increases on certain critical drugs including long-acting (24 hour) insulin and rapid-acting (15 minute) insulin, which together are the mainstay of current therapy for insulin-dependent diabetes. Examples of the former include Lantus, Levemir, and Basaglar, and examples of the latter include Humalog, Novolog, and Apidra. Over the last ten years the cost of these insulins has seen a more than 250% increase according to the magazine Medical Economics, These cost increases have been an enormous burden for many patients forcing some into the “doughnut-hole” and others to become non-compliant with their prescribed medication regimen in order to save money.

Fortunately there is a solution. Doctors must step back in time and return to prescribing intermediate-acting insulin (12 hour) and short-acting insulin (4 hour); the former is known as NPH insulin and the latter is called Regular insulin. Examples of NPH are Novolin N and Humulin N, and examples of Regular insulin are Novolin R and Humulin R. Walmart also has their own name brands for these insulins which are called Relion N and Relion R. The Relion bottles are currently only $26.00 for 1000 units of insulin, and a patient may purchase 2 bottles without a prescription.

The conversion to NMI means that the patient will have to inject insulin twice a day rather than once a day. Moreover, the conversion is not exactly one-to-one. For example, let us say that you are on 30 units of Lantus once daily; you would convert to NPH insulin at 20 units in the am and 10 units in the pm; that is two-thirds of the dose should be given in the morning and only one-third at night to avoid hypoglycemia. Rapid-acting insulin can convert to Regular insulin on a one-to-one basis, but with the awareness that Regular lasts much longer and so there is more of a risk for hypoglycemia; this requiries regular and more frequent meals or snacks. Rapid-acting and short-acting insulins are only necessary in fragile diabetics with labile sugars and most diabetics do fine without them. A patient with labile sugars must work closely with the doctor or diabetic educator in adjusting insulin dosages.

– Gary Gallo, MD