Educate Patients About Affordable, Accessible Insulin Options

Over the last 20 years, the price of insulin has dramatically increased, which has led to many individuals rationing this lifesaving drug.¹ Unfortunately, there have been deaths reported in patients with diabetes due to insulin’s lack of affordability. Since about 90% of insulin sold in the United States is manufactured by 3 companies, there is limited direct competition.¹

Pharmacists can play an integral role in helping patients access and afford insulin, especially during the coronavirus disease 2019 (COVID-19) pandemic.

Eli Lilly and Company has introduced the Lilly Insulin Value Program $35 copay card (monthly) for those with and without insurance, and the manufacturer has developed additional patient assistance programs (PAPs) as well.² Humalog U-100, Humalog Mix75/25, and Humalog Junior KwikPen are available as lower-priced versions at a 50% discount and can be ordered through pharmacies.³

Novo Nordisk is offering a free 90-day supply of insulin through their PAP to patients who have lost health insurance coverage because of a change in job status due to the coronavirus disease 2019.⁴ The My$99Insulin program provides individuals with up to 3 vials or 2 packs of FlexPen/FlexTouch/PenFill pens of any combination of Novo Nordisk insulins with a prescription for $99.^3,4 Authorized generics of NovoLog and NovoLog Mix are available at 50% off the list price of brand products.³

Sanofi offers copay assistance programs and an Insulins Valyou Savings Program for patients without insurance that is $99 per month for 1 or multiple insulins (up to 10 packs of pens and/or 10 mL vials per month).⁴

MannKind Corporation has a savings card ($15 per prescription fill) for insulin human (Afrezza) inhalation powder for patients with insurance.⁶

Insulin Prices and Counseling Pearls

In an interview with Drug Topics®, Sandra Leal, PharmD, MPH, FAPhA, CDCES, executive vice president of Tabula Rasa HealthCare and president-elect of the American Pharmacists Association (APhA), said that APhA is examining why drug prices in general are increasing, and the organization is helping patients navigate this complex system. Even though insulin manufacturers are not experiencing drug shortages, mail order delays have slowed the delivery of medications, which could affect adherence.² The American Diabetes Association (ADA) recommends that health care providers “prescribe the lowest-priced insulin required to effectively and safely achieve treatment goals.”³ The ADA maintains a comprehensive list of resources to help patients afford insulin products and medical devices.³

“Pharmacists should always be good advocates and put the patient first,” Leal said. Amid the pandemic, Leal discussed the importance of educating patients transitioning to different insurance plans and assisting individuals who are uninsured about the best and most affordable insulin options. Individuals also should be educated about patient assistance programs (PAPs) and discount cards for insulin savings.

Insulin is now regulated as a biological product after recent regulatory changes to facilitate the approval of biosimilars.⁷ The biologic product insulin glargine injection (Semglee) vial and pen are FDA approved and recently launched in the US at a 65% discounted list price, and Mylan is seeking biosimilar status for Lantus with the FDA.^8,9

Some states have approved insulin copay cap legislation, and the ADA has urged governors to implement zero-dollar copayments for insulin during COVID-19.¹⁰ The Trump administration signed executive orders that include lowering insulin drug costs.¹¹ Additionally, Medicare Part D prescription drug plans will provide insulin at a maximum $35 copay per month.¹² The savings programs and recent state and federal laws are an important step in the right direction, but there is still more work to be done for expanded access to affordable insulin.

References

1. Fralick M, Kesselheim AS. The U.S. insulin crisis—rationing a lifesaving medication discovered in the 1920s. N Engl J Med. 2019; 381(19):1793-1795. doi:10.1056/NEJMp1909402

2. Lilly commits Insulin Value Program, featuring $35 copay card, to suite of affordability solutions for people with diabetes. News release. Eli Lilly & Company; September 10, 2020. Accessed September 19, 2020. https://investor.lilly.com/news-releases/news-release-details/lilly-commits-insulin-value-program-featuring-35-copay-card​

3. American Diabetes Association. Help with insulin is a phone call away. Accessed September 19, 2020. https://www.insulinhelp.org/​

4. Novo Nordisk offers free 90-day insulin supply to people experiencing financial hardship due to COVID-19. News release. Novo Nordisk; April 14, 2020. Accessed September 19, 2020. https://www.novonordisk-us.com/media/news-releases.html?122988​

5. Sanofi set a new standard with one set price for cash-paying patients. Admelog. Accessed September 19, 2020. https://www.admelog.com/insulins-valyou-savings-program​

6. Afrezza quick reference guide pharmacy instructions. MannKind Corporation. Accessed September 20, 2020. https://www.afrezza.com/pdf/Pharmacy-Instructions.pdf​

7. Information for patients about regulatory changes for certain biological product medications. FDA. Accessed September 20, 2020. https://www.fda.gov/media/135341/download​

8. Mylan and Biocon Biologics announce launch of Semglee (insulin glargine injection) in the U.S. to expand access for patients living with diabetes. News release. Mylan; August 31, 2020. Accessed September 20, 2020. http://newsroom.mylan.com/2020-08-31-Mylan-and-Biocon-Biologics-Announce-Launch-of-Semglee-TM-insulin-glargine-injection-in-the-U-S-to-Expand-Access-for-Patients-Living-with-Diabetes​

9. Hagen T. Biocon, Mylan launch Semglee and seek biosimilar, interchangeable status. AJMC The Center for Biosimilars. August 31, 2020. Accessed September 20, 2020. https://www.centerforbiosimilars.com/view/biocon-launches-semglee-and-seeks-biosimilar-interchangeable-status​

10. Insulin copay caps approved in five more states. American Diabetes Association. April 7, 2020. Accessed September 20, 2020. https://www.diabetes.org/blog/insulin-copay-caps-approved-five-more-states​

11. Trump administration announces historic action to lower drug prices for Americans. News release. HHS; July 24, 2020. Accessed September 20, 2020. https://www.hhs.gov/about/news/2020/07/24/trump-administration-announces-historic-action-lower-drug-prices-americans.html​

12. President Trump announces lower out of pocket insulin costs for Medicare’s seniors. News release. Centers for Medicare & Medicaid Services; May 26, 2020. Accessed September 20, 2020. https://www.cms.gov/newsroom/press-releases/president-trump-announces-lower-out-pocket-insulin-costs-medicares-seniors​

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