In the last few months, there’s been an increase in media coverage of the rising price of insulin in the United States in recent years. Sometimes, those stories focus not just on the ongoing crisis, but on proposed policy solutions to help resolve it — such as requiring greater pricing transparency or introducing more competition among insulin manufacturers by streamlining the regulatory approval process for biosimilars (the equivalent of “generic” biologic drugs like insulin).
But aside from attention-grabbing moves like caravanning to Canada for cheaper insulin, there hasn’t been much media coverage of ways to get cheaper insulin right now — something that’s a top priority for millions of Americans with both type 1 and type 2 diabetes. One professor decided to give this topic the attention it deserves at the Cardiometabolic Health Conference 2019, held October 10–13 in Chicago.
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As described in a Healio article, Irl B. Hirsch, MD, a professor of medicine at the University of Washington School of Medicine in Seattle, noted in his presentation that the current insulin supply chain is so complex that any immediate changes aren’t likely to give patients much price relief. Because of this reality, says Hirsch, it’s important for doctors to work within the current system to reduce costs for their patients.
Hirsch points to four different ways that doctors can help people with diabetes get cheaper insulin. One is to explore switching to NPH or regular insulin, both of which are widely available at low cost and even without a prescription in many states. There are risks to using these older forms of insulin, he notes — including a higher chance of nighttime hypoglycemia (low blood glucose) — but they can be managed if doctors are willing to learn about them.
Another option is to refer people to patient assistance programs from insulin manufacturers, which are more accessible now than they were even a handful of years ago, largely due to public pressure. But if doctors are willing to do some work within their own employer’s bureaucracy, a better option in many cases may be a 340B pricing plan, a federal program in which certain healthcare organizations can directly obtain heavily discounted drugs from manufacturers — in this case, insulin for as little as $10 or $20 per vial. This program accounts for 5% of all drugs purchased in the United States, according to Hirsch.
Finally, if you live near Canada, crossing the border to buy insulin is a good option for many people — and it’s legal and common for Canadian pharmacies to ship insulin to the United States, although this remains illegal under U.S. law. If you show up in person, insulin costs about $30 per vial or $50 per box of insulin pens at most Canadian pharmacies, and no prescription is required. Hirsch estimates that about 20% of his patients cross the border to buy their insulin.
If you’re struggling to afford your insulin, talk to your doctor about whether any one of these options might be available and right for you.
Want to learn more about saving money on insulin? Read “Insulin Prices: Four Ways to Pay Less” and “Cheaper Insulin: Older Insulins May Be Answers to High Prices.”
A freelance health writer and editor based in Wisconsin, Phillips has a degree in government from Harvard University. He writes on a variety of topics, but is especially interested in the intersection of health and public policy.