Jan 18, 2020 – Navigating the healthcare system to manage your disease can be very tricky. The constant outrage over insulin prices in the last few years has inspired me to find ways to help patients cope with this unfortunate dilemma. First of all, the term – insulin prices – is too vague. There are over 30 brands of insulin when counting all the various preparations; some were first available in the 1980s, some came along in the 1990s, and some since then. The older the insulin, the less expensive it is. This trend has remained in spite of all the recent spikes in certain brand pricing.
The oldest currently available insulin – regular – lacks all the bells and whistles of the newer rapid-acting brands, but it stays at around $30 per vial and you can buy it without a prescription. Yep. Just walk up to the pharmacy counter and ask for regular insulin. Two brands of regular are Novolin R (Novo Nordisk) and Humulin R (Lilly). Regular insulin only lasts about 4-6 hours and is generally injected subcutaneously 30 min. before each meal. It is classified as a short acting insulin. Prefilled syringes or insulin pens will always drive up the price; use a vial and syringe if possible. There are syringe-magnifying devices to help those with vision problems like me. If you cannot hold a syringe steady to measure a dose, ask a friend or relative to prepare a few days or a week’s supply for you and keep your filled syringes in the refrigerator clearly marked and clean. Make sure your refrigerator stays around 4 degrees Celsius (2-8 degrees Celsius). Warm up the syringe in your hand for a less painful injection.
Currently available intermediate-acting insulin, NPH, has also been around since the 1980s and is priced about the same as regular insulin. It is also available without a prescription and the same companies producing regular also make NPH: Novolin N (Novo Nordisk) and Humulin N (Lilly). NPH lasts around 12 hours on average and is most often dosed once or twice per day. NPH is not as fancy as newer ultra long acting insulin but it is the least expensive basal insulin and the only one available without a prescription. The same holds true with NPH prefilled syringes or pens, they will be more expensive. Follow the fill-your-own syringe method and keep everything in the refrigerator and you will save quite a bit of money.
My advice is this: if you cannot afford the insulin your physician prescribed for you for whatever reason (high deductible, no insurance, high copay, non-formulary) you can always ask the physician to switch to the insurance-preferred brand or switch your insulins to vials of regular (Novolin R or Humulin R) and NPH (Novolin N or Humulin N). Sometimes just following your insurance formulary saves buckets of money. If you are trying to pick up a newer expensive insulin that is not covered by your insurance, make the doctor change the prescription. Look online for your insurance website to find their formulary and see what their preferred insulin brands are. The formularies change every year. Give this information to your doctor at your visit. The doctor will need to convert your dose and schedule when switching insulins as the dosing is not the same with all insulins. Every insurance plan I have ever dealt with covers the old basic insulin brands and if they don’t you can purchase them without a prescription. The pharmacist could also convert the dosing for you. Many patients can manage their diabetes with the combination of short acting and intermediate acting insulin. This regimen is better than nothing. The schedule may not be as simple as the newer insulins and may require more injections and dedication, but it is a much better alternative than going without insulin because you cannot afford it. There are free phone apps to help with medicine schedules, also you can set basic phone reminders and alarms. This advice has also helped patients who forgot to bring their insulin from home while on vacation.
Going off of insulin due to costs should be avoided whenever possible. The National Institutes of Health has a page dedicated to help patients find resources for diabetes care. The US healthcare system has always been tumultuous for me and I’ve worked in the field for over 20 years. It is sad to see so many people failed by the system, yet so many incredible cutting-edge treatments are available. Hopefully you will not be a victim of a failed system and instead find ways to make the system work for you.