Some Forms Of Insulin Can Be Bought Without A Prescription But Dangers Exist
As anyone who needs insulin to treat diabetes can tell you, that usually means regular checkups at the doctorâs office to fine-tune the dosage, monitor blood-sugar levels and check for complications. But hereâs a little known fact: Some forms of insulin can be bought without a prescription.
Carmen Smith did that for six years when she didnât have health insurance, and didnât have a primary care doctor. She bought her insulin without a prescription at WalMart.
âItâs not like we go in our trench coat and a top hat, saying, âUh I need the insulin,’â says Smith, who lives in Cleveland. âThe clerks usually donât know itâs a big secret. Theyâll just go, âDo we sell over-the-counter insulin?’â
Once the pharmacist says yes, the clerk just goes to get it, Smith says. âAnd you purchase it and go about your business.â
But itâs still a pretty uncommon purchase.
Smith didnât learn from a doctor that she could buy insulin that way. In fact, many doctors donât know itâs possible. When she no longer had insurance to help pay for doctorsâ appointments or medicine, Smith happened to ask at WalMart if she could get vials of the medicine without a prescription. To figure out the dose, she just used the same amount a doctor had given her years before.
It was a way to survive, she says, but no way to live. It was horrible when she didnât get the size of the dose or the timing quite right.
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Drug Forms And Administration
Humulin R comes as a liquid solution. Its available in two strengths:
- Humulin R U-100. This strength contains 100 units of insulin per 1 mL of solution. It comes in 3-mL and 10-mL vials. In the 3-mL vial, youll have a total of 300 units of insulin human. And in the 10-mL vial, youll have a total of 1,000 units of insulin human.
- Humulin R U-500. This strength contains 500 units of insulin per 1 mL of solution. It comes in a 20-mL vial. Its also available as a 3-mL KwikPen, which is a prefilled pen thats meant to be used more than once, but only by one person. In the 20-mL vial, youll have a total of 10,000 units of insulin human. And in the 3-mL KwikPen, youll have a total of 1,500 units of insulin human.
- 10-mL vials, which each hold a total of 1,000 units of insulin human
- FlexPens, which are 3-mL prefilled pens that are meant to be used more than once, but only by one person each pen holds a total of 300 units of insulin human
Whether youre using vials of either Humulin R or Novolin R, youll need to purchase appropriate syringes and needles to administer the drug. And you should use a new needle and a new syringe for each dose.
And if youre using either the KwikPen or the FlexPen, youll need to purchase appropriate needles to use with the pen. You should use a new needle for each dose of insulin given with the pen.
In some cases, Humulin R and Novolin R are given as an intravenous infusions by healthcare providers.
Do I Need A Prescription For Insulin
If you are a diabetic you may have heard conflicting information on whether or not you require a prescription to pick up insulin from a pharmacy.
When isnt a prescription required?
In Alberta, insulin can be sold to a patient without a prescription. Insulin is in the Schedule 2 drug class. Schedule 2 medications can only be sold in a pharmacy, and they must be kept behind the pharmacy counter. In order to sell a schedule 2 medication, the pharmacist must set up a complete patient profile and ensure the medication is appropriate for the patient.
While insulin is considered schedule 2, it is in this schedule in case of emergency. This means that if you are traveling and run out of insulin, or cant get in to see your doctor, the pharmacist can maintain your current insulin therapy without sending you to a walk in clinic or emergency. The pharmacist must document the sale of the insulin on your profile, along with any information that helped the pharmacist determine the insulin was appropriate.
When is a prescription required?
The majority of the time a pharmacist will not sell insulin without a prescription. The reasons for this are as follows.
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Crossing The Line Insulin
Crossing the line separating Indiana and Illinois sometimes means dealing with different laws and customs. Readers are asked to share ideas for this weekly feature. This week: Insulin. Hoosiers with diabetes who don’t have regular access to a doctor, or prefer not to visit one, often cross into Illinois to purchase the insulin needed to manage their blood sugar levels. That’s because the Indiana General Assembly unanimously voted in 2014 to make Indiana the first state in the country where diabetics must have a prescription for all insulin purchases. The requirement was strongly supported by the Indiana State Medical Association, whose doctors told lawmakers that diabetics who try to manage their condition without proper medical advice often choose the wrong insulin or administer an improper amount. Most newer insulin formulations already are prescription-only. But older versions of the drug, which can be less efficient and effective, are available over-the-counter in Illinois. IMS Health, a national medical consulting firm, estimates that about 15 percent of U.S. insulin purchasers do so without a prescription.Continue reading > >
What Humulin R Does
The active drug in Humulin R, called insulin human, is a copy of the insulin thats naturally made by your pancreas. This drug is made using recombinant DNA technology. Because Humulin R is a copy of natural insulin, your body uses the drug the exact same way it uses natural insulin.
Insulin human works by moving glucose out of your bloodstream and into your cells. This lowers your blood sugar level.
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The Problems With Walmarts Insulin
Doctors and diabetes advocates point out that while ReliOn may help patients in a pinch, especially those without health insurance, its also a formulation that came on the market in the 1980s, more than a decade before more refined insulins started to emerge.
The newer insulins, known as analogs, appear to be more effective at preventing dangerous blood sugar swings in people with Type 1 diabetes or those at a higher risk for severe low blood sugar.
Theres one more problem: Because its available without a prescription, patients can get the drug without the supervision of a doctor, and they sometimes get into trouble as a result. So stories have surfaced about patients who required emergency care because of severe blood sugar highs and lows after self-dosing with Walmart insulin, or even dying as a result.
Human insulins are a reasonable option for many patients with Type 2 diabetes, said Yale endocrinologist Kasia Lipska, who often prescribes the drugs for patients who cant afford newer formulations. But the drug isnt optimal for everybody. And human insulin sold at Walmart is definitely not the solution to our insulin crisis.
For people with Type 1 diabetes, human insulins are harder to live on, lead to worse control, make it harder to hold down a job, impact quality of life, said James Elliott, a trustee at T1International, an independent patient advocacy group, and not everyone lives near a Walmart.
Why People Sometimes Turn To Otc Insulin For Blood Sugar Control
Dr. Goldstein decided to research OTC insulin because she prescribes ReliOn brand insulin as the least expensive option for people without health insurance in her clinical practice. Insulin prices have risen dramatically in recent years, nearly tripling from 2002 to 2013 according to an article published in April 2016 in the Journal of the American Medical Association . In March 2019, Eli Lilly announced it would sell a cheaper generic version of its Humalog 100 insulin for about $137 a vial, effectively cutting the price of the original in half. Other fixes include Cigna and Express Scripts offering a $25 cap on out-of-pocket insulin costs for its consumers in participating plans.
Jennifer Trujillo, PharmD, CDE, associate professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora, says she also has patients ask about cheaper options. I think we have to accept the fact that some patients dont have an option but to use the least expensive option available, says Dr. Trujillo. For some patients, this is the only alternative they have.
Besides people without health insurance, Trujillo says that people with high copays or high-deductible plans might be considering OTC insulin. People on Medicare in the donut hole, a coverage gap where patients are often pay more for drugs, might be paying more out-of-pocket for insulin and looking for relief.
How Exactly Does OTC Insulin Work and How Does It Differ From Newer Insulins?
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Drug Forms And Strengths
Humulin R comes as a liquid solution. Its available in two strengths:
- Humulin R U-100. This strength contains 100 units of insulin per 1 mL of solution. It comes in 3-mL and 10-mL vials.* In the 3-mL vial, youll have a total of 300 units of insulin human. And in the 10-mL vial, youll have a total of 1,000 units of insulin human.
- Humulin R U-500. This strength contains 500 units of insulin per 1 mL of solution. It comes in a 20-mL vial.* Its also available as a 3-mL KwikPen,** which is a prefilled pen thats meant to be used only by one person. In the 20-mL vial, youll have a total of 10,000 units of insulin human. And in the 3-mL KwikPen, youll have a total of 1,500 units of insulin human.
Both the vials of Humulin R and the KwikPens are meant to be used more than once. However, the actual number of times youll use a certain vial or pen will depend on your insulin dosage.
But keep in mind that youll need to use a new syringe and a new needle for each dose of Humulin R from a vial. And youll need to use a new needle for each dose of insulin from a KwikPen. Using needles or syringes more than once can increase your risk of infection.
Humulin R is given as an injection under your skin . Youll give the injections to yourself once your doctor has shown you how to administer the drug.
What Is The Average Cost For Insulin
Traditional insulin prices in the retail market.Humulin N-10 mL insulin unit $0.42Humulin N KwikPen $0.49
New Government Policy Caps Monthly Cost Of Insulin At $35
Diabetes patients must take insulin as part of their diabetes treatment. It is essential for people with diabetes because it aids in blood sugar control. The government has announced a new policy that caps the monthly cost of insulin at $35, potentially saving diabetes patients hundreds of dollars. Despite the fact that the new pricing policy is a step in the right direction, people with diabetes continue to be priced out of insulin. Diabetes mellitus can be difficult to afford for those who do not have health insurance, and insulin can cost hundreds of dollars per month or more. The American Diabetes Association is working to lower the costs of insulin and other diabetes medications for people with diabetes.
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Scheme Exploits Insulin Laws
To make nonprescription insulin more accessible to patients, one of the top manufacturers of insulin began working with community pharmacy chains. In these partnerships, the manufacturer produces a line of insulin products exclusively for the chain. The private label insulin is labeled to indicate that the product can only be sold by the chain The drugs retail price for patients is often below the wholesale price of other insulin products sold to pharmacies.
Criminals posing as patients purchase this insulin at the retail pharmacies, collect it in large quantities, and resell it into the wholesale market. Wholesalers purchase this diverted insulin and resell it to retail pharmacies and, in some cases, to other wholesalers. This deliberate scheme to subvert the regulated supply chain is exposing patients to the high risk of receiving an adulterated drug in the form of subpotent insulin.
To combat this nationwide problem, Georgia enacted a law that criminalizes the resale of nonprescription insulin that a patient first obtained through an OTC sale. Insulin sold in this manner is deemed adulterated under the law.
The risks with this type of corrupt distribution are very high for patients, as they are receiving and injecting potentially adulterated insulin that is very likely subpotent. The storage and handling of this diverted insulin are completely unknown to patients and should be questioned by distributors.
Fact : The Number Of Insulin Syringe Matters
Although you dont need a prescription to buy an insulin syringe over the counter, thats not the end of the discussion. Without the prescription, you cant buy more than 10 units of insulin syringes at a time in states like Minnesota, New York, New Jersey, Maine, Connecticut, etc.
In some other states, the number of syringes that you can buy might be varied, but there is always a definite number in a particular state. As an example, in Illinois, you can buy up to 20 syringes over the counter without any prescription. In the case of California, the number is a bit raised to 30 or fewer.
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Walgreens To Pay $270 Million For Overbilling Prescription Drugs Insulin Pens
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With all of the attention currently placed on prescription drug prices, its difficult to believe that a major retail distributor of medications would do anything but toe the proverbial line when it comes to sales practices. However, last month, Walgreens was ordered to pay more than $270 million for improperly billing Medicare, Medicaid and other state- and federal-level programs over the course of 10 years.
The suit is broken down into two components. In one part, the company has been ordered to pay $209.2 million for improper billing practices surrounding the dispensation of hundreds of thousands of insulin pens to patients between 2006 and 2017. In the second part of the settlement, the company will pay $60 million for overcharging Medicaid between 2008 and 2017 for failure to disclose and charge the same prices it offered through its Prescription Savings Club program.
But here is the kicker: Walgreens settled a similar lawsuit for upwards of $50 million that resulted from similar offenses with the Prescription Savings Club program last year.
Andrew M. Beato
The Act has a long history of success, according to Beato, and has been involved in the return of more than $45 billion to the government.
Madelaine A. Feldman
Do You Need A Prescription
In short, no, you do not need a prescription to buy Walmarts Regular or NPH insulin. However, you wont find it sitting on the counter next to the Tylenol either.
Youll have to go to a Walmart store and ask a pharmacist for a vial in order to purchase it.
While its considered an over-the-counter medication now, its still managed very carefully by the pharmacy because it needs to be refrigerated and its still a high-value medication despite being only $25 per vial.
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Humulin R Expiration Storage And Disposal
When you get Humulin R from the pharmacy, the pharmacist will add an expiration date to the label on either the box of insulin pens or vials of insulin. This date is typically 1 year from the date they dispensed the medication.
The expiration date helps guarantee that the medication is effective during this time. The of the Food and Drug Administration is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.
Do Pharmacies Have To Accept Goodrx
Are pharmacies required to accept GoodRx coupons? Participating pharmacies are required to accept GoodRx through contracts with their pharmacy benefit managers . An exception is for controlled medications. Accepting a GoodRx coupon for a controlled medication is always at the discretion of the pharmacist.
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I Have Medicare Medicaid Or Veterans Affairs Benefits
Eligibility requirements for many Patient Assistance Programs currently do not allow people with government insurance to enroll. However, some people may qualify for resources under the I am uninsured section below, especially if you are on Medicare Part D. Call your medications manufacturer to determine whether you can qualify for their programs.
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Novo Nordisk’s My$99Insulin Cash Card Program provides 3000-3800 units of Novo Nordisk analog insulin for $99 for up to 12 months. Note: all people are eligible for this program.
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There may be additional eligibility requirements for those covered under Medicare Part D however, this savings program is one of the few that includes government insurance beneficiaries.
Through Lilly’s Patient Assistance Programs , LillyCares, people who are covered under Medicare Part D, have spent $1,100 on prescription medications this calendar year, and meet the income and other eligibility requirements.
Medicare.gov also provides a list of ways to get help with prescription costs.
Limited-income seniors can search for help with medicines, health care, rent, and other needs at Benefits Check Up.