Nearly 40 million Americans have diabetes and of those, more than 7 million must take daily insulin to keep control of their disease. For these individuals, receiving a monthly supply of insulin is quite literally a matter of life and death.
Yet the price of insulin in this country has skyrocketed in the past decade, causing extreme financial hardship for more than 14% of those who use it, according to a new study out of Yale. The researchers attribute rising costs on pharmaceutical companies and all the businesses that deliver the drugs from these companies to the pharmacies. Each step of the supply chain collect profits along the way, leading to higher costs for the patient.
While Medicare patients experienced the most hardship paying for insulin (which the study attributes to lower incomes and stricter coverage limits) the Yale researchers also found that those with private insurance and those with no insurance at all actually shelled out the most in out-of-pocket expenses.
To help combat these price increases, some states, including New York, New Mexico, Illinois and Maine, have passed laws capping insulin costs at $100 or less per 30-day supply (though some loopholes exist that can result in higher costs to the patient); in July, California’s Governor Gavin Newsom announced that his state will become the first to produce its own insulin, a move he hopes will reduce prices by as much as half or even more. On the federal level, a bill capping the cost at $35 under the Medicare drug plan has passed the House of Representatives; a similar bill was introduced in June to the Senate but its future remains uncertain.
As Americans wait for a federal resolution to this issue, here are some ways individuals with diabetes can access and pay for these life-saving prescriptions.
1. Buy generic.
Some manufacturers offer a generic version of their brand-name insulin at a significantly discounted price. For example, Eli Lilly and Company (Lilly) makes Lispro, the generic version of their rapid-acting insulin Humalog. Novo Nordisk offers Insulin Aspart, a generic version of their Novolog, and Insulin Aspart Mix, the generic version of Novolog Mix. People prescribed the brand name version can get the pharmacy to fill the generic version instead without the need of a new prescription. You can also ask your health care professional for samples of vials or pens.
2. If eligible, join a Medicare plan.
For those 65 years of age and older, Medicare will cover many costs related to diabetes as long as they're medically necessary and you have a prescription. Medicare Part B primarily covers screenings, doctor exams, glucose monitors and diabetic shoes; Medicare Part D covers insulin and diabetes medications; and Medicare Advantage, also called Medicare Part C, combines the coverage you’d get in Part B with the prescription coverage in Part D.
Starting in 2023, all Medicare participants with prescription coverage will have their insulin copay capped at $35 per month, as part of the federal Inflation Reduction Act, which was passed in August 2022.
To ensure you’re getting the best coverage in 2022, a person with diabetes should pair a Medicare Advantage plan with the Part D Senior Savings Model, also called the Insulin Savings Program, which provides 30 days of insulin for $35 or less. (Medicare Advantage plans are sold by private insurance companies; make sure to tell your broker you want the plan that includes prescription benefits and insulin savings when selecting your coverage. Here’s helpful advice on how to apply for Medicare.)
While anyone can participate in the Insulin Savings Program, those who meet the financial requirements can get even cheaper copayments for insulin through the Medicare Extra Help program, which helps people with limited income and resources pay for Medicare prescription drug program costs, like premiums, deductibles and coinsurance. Keep in mind that beginning in 2023, all plans will have a $35 maximum copay for a 30-day supply of insulin, per federal regulation.
3. Use a pharmaceutical company’s copay savings card.
Major insulin manufacturers like Eli Lilly, Novo Nordisk, Sanofi and Xeris Pharmaceuticals, Inc. offer copay cards for patients with and without private insurance coverage. (Except for rare exceptions, you can’t use these cards if you’re on Medicare or Medicaid.) These coupons can reduce out-of-pocket costs to as little as $10 or even $0 a month.
4. Check out patient assistance programs from nonprofits and/or pharmaceutical companies.
There are a number of patient assistance programs (PAPs) available to help with the costs of insulin, either run by nonprofit organizations or through the pharmaceutical companies themselves. Each program has its own eligibility requirements, so read the fine print carefully. The nonprofit JDRF, which serves the Type 1 diabetes community, offers a comprehensive list of nonprofit and manufacturer PAPs here.