If you use standard breathing medicines such as albuterol inhalers for asthma, the COVID-19 pandemic may soon make them harder to get. Hospitals and emergency rooms are using the inhalers to treat coronavirus, sharply increasing the demand.
Other medicines are also at risk, as factories around the world close and transportation routes are blocked by COVID-related shutdowns. Pharmacist Joel Albers, PhD, reports that “72% of pharmaceuticals are imported into the U.S. from many other countries, primarily India and China, but also Europe,” and these supply chains are under threat.
The good news is that insulin supplies appear stable for now. Mike Mason, president of insulin manufacturer Eli Lilly and Company, says, “Our insulin manufacturing sites in the U.S. and Europe remain operational, and Lilly does not source active pharmaceutical ingredients for any of our approved medicines from China.” Insulin maker Novo Nordisk advises on their site, “We are working with our distributors to ensure that there is enough inventory to fill prescriptions quickly. We encourage patients to plan ahead and know that it may take some extra time to get a prescription filled.”
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No other diabetes medications have been reported running low. But blood pressure drugs such as valsartan and pindolol, generic antibiotics and some over-the-counter medicines like acetaminophen are at risk because of shutdowns in India and elsewhere. According to a recent report from the U.S. Department of Defense, such basic drugs as penicillin, ibuprofen and aspirin largely come from China.
American drug supplies have become less reliable as manufacturers moved factories to countries with lower-cost labor, creating long supply chains. Albers explains, “By exporting its once-extensive U.S. manufacturing base (along with tens of thousands of jobs), the U.S. pharmaceutical industry has left our country extremely vulnerable to shortages, especially during the current coronavirus pandemic. Often the active ingredient, the bulk powder, is made in one country; the tablet then formulated in another, then shipped to centers in New Jersey, then to one of the big three wholesalers, then to a pharmacy.” Now those supply chains are being disrupted by COVID-19.
As the supply of medicine becomes endangered, demand is increasing, causing prices to rise for some drugs. As a result, according to Reach MD, counterfeit drugs have begun flooding into countries where demand exceeds supply. These fake drugs have not generally found their way to the U.S. yet.
Meanwhile, according to the business publication Kiplinger, up to 35 million people could lose their medical insurance along with their jobs due to the economic fallout of the pandemic. About half of Americans receive their health insurance through their employers. How can newly-unemployed patients buy increasingly expensive medicines?
Kiplinger suggests four possibilities for remaining insured. Some workers might find coverage through their spouse’s employer-based insurance. Some might be able to continue their own insurance through COBRA, a law allowing laid-off workers to keep their old health coverage at their own expense.
If COBRA is not possible for you, check out the Health Insurance Marketplaces set up by the Affordable Care Act (Obamacare). Even though we are not now in the usual time window for enrollment, most states allow people to enroll at other times if a job loss occurs. Some plans in the Marketplace are heavily subsidized, depending on income. Visit HealthCare.gov or your state’s health insurance marketplace to find out if this is a match for you.
Kiplinger also advises newly unemployed workers to apply for Medicaid (government insurance for low-income people). Under the Affordable Care Act, 37 states and the District of Columbia expanded their Medicaid programs to expand coverage to more residents. The income limits are low, but if you have lost your job, your income going forward might qualify you. Visit Medicaid.gov or HealthCare.gov to find out more. Be patient — Medicaid phone lines are pretty swamped right now. Fortunately, the Federal government has recently increased contributions to Medicaid during the COVID-19 crisis.
Working your way through these options might be challenging and stressful. Kiplinger suggests getting an adviser, preferably one who is not trying to sell you something. Your hospital or medical center should have a social service department who can help find out about insurance. Companies such as HealthPlans.com can find you affordable coverage, but the co-pays and deductibles for drugs might make cheap plans unaffordable for a person on expensive diabetes medicines.
Most manufacturers of brand name drugs have patient assistance programs. Lilly’s Mike Mason, for one, says “Our solution center can provide real insulin affordability assistance for people during this difficult time, including people whose jobs have gone away.” Other companies have similar programs. The site RxAssist has a complete directory of these programs, including applications to download or submit online. Some nonprofit agencies also have programs to help people buy medicines. These include the Partnership for Prescription Assistance, NeedyMeds, and the National Council on Aging’s Center for Benefits.
Most drug assistance programs are experiencing high call volumes right now, so give yourself time to connect with them. If they can’t help, your doctor or pharmacist may suggest a lower-cost alternative medication. Also allow extra time for prescriptions, including insulin, to be filled. EndocrineWeb recommends keeping a two-month supply of insulin on hand in case of shortage.
At the moment, supply chain shutdowns may slow the supply of diabetes medications, but not stop them. Insulin and other drugs are available, but other drugs, especially antibiotics, breathing medicines and some over-the-counter meds may not be. To make drug supplies more reliable in the future, according to Albers, legislation is being introduced in Congress to bring drug manufacturing back to the United States. We might want to support that bill.
Want to learn more about coronavirus and diabetes? Read “Coronavirus and Diabetes: What You Need to Know,” “Healthy Eating During Hard Times” and “Avoiding Coronavirus With Diabetes: Stock Up and Stay Home, CDC Says.”
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