Factors That Impact The Price Of Insulin
How much is insulin in Canada annually? It can be through the roof when you consider that some people with diabetes go through several insulin vials per week. The cost of insulin in Canada can be high for those without private insurance and eats up a considerable part of a typical household budget. Many Canadians will pay close to $7,000 annually for insulin.
Those with Type 2 diabetes will generally pay more. The insulin cost in Canada is too much for some people, and they opt to skip doses of their insulin rather than pay massive out of pocket fees. This practice is dangerous both for individuals and the Canadian healthcare system.
Although insulin itself is far more sophisticated than ever, many people with advanced diabetes find that they need more and more insulin just to feel okay. While some people with diabetes only need three doses a week, severe cases require close to ten. These people are often the ones who have problems when the price rises.
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Other Ways Diabetics Can Take Care Of Themselves
Getting your insulin is only one piece of the pie. People with diabetes need to take care of themselves in different ways, including sticking to a healthy lifestyle and ensuring that their condition does not worsen.
If you are diabetic or prediabetic, please consider taking the following steps to improve your health and decrease your need for extra insulin.
Alternative Ways To Cover Diabetes Costs
- Traditional Health Insurance: There may be partial coverage for some diabetes related expenses through private insurance, such as prescriptions.
- Crowdfunding: An option some Canadians have turned to is crowdfunding. There are several platforms that allow you to set-up a crowdfunding account to tell your story, and get support from your community.
- Health Spending Account : A Health Spending Account is a cost effective alternative to insurance. There are no premiums and you are able to deduct 100% of diabetes related costs, including: insulin, insulin pumps, test strips, glucose monitors, syringes, and more.
A Health Spending Account Can Help with Diabetes Related Costs.
A Health Spending Account is an alternative to traditional health insurance. Used by thousands of small business owners across Canada, an HSA is a special account established to exclusively pay for health care services for you and your family members.
An HSA enables a small business to deduct 100% of their family health and dental expenses – without paying standard premiums typically associated with traditional health insurance plans.
The ability to write-off health and dental expensescan create savings of more than 30% on medical and dental related expenses. For contractors, consultants, and other incorporated small business owners, this is an effective tool to cut your taxes and reduce your medical costs.
Note: An HSA is only available for incorporated small businesses and is not available in Quebec.
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Executive Orders On Drug Prices
After the first presidential debate, President Donald Trump claimed of insulin, Im getting it for so cheap its like water. The statement prompted questions about insulin prices following a spate of executive orders that Trump signed over the summer. These orders included language aimed at lowering insulin and other drug prices for Americans.
Regulation Of Drug Prices
PMPRB
One way that Canada maintains the cost of insulin is through something called the Patented Medicines Prices Review Board . PMPRB was established in 1987 and amended in 2019 . In a nutshell, the PMPRB ensures that patented drug prices are not excessive . To do so, the board considers a products therapeutic benefits relative to existing comparable drugs, consumer price index changes, and the price of the drug in a group of reference countries . The board also reports trends in pharmaceutical sales and pricing for all medicines . The 2019 PMPRB amendments include analyzing new factors such as cost-effectiveness, changing the group of reference countries to be more comparable to Canada, and changing reporting requirements .
The PMPRB has limitations, though. For example, it only regulates the factory gate price of prescription drugs or the price that patent holders charge wholesalers, hospitals, or pharmacies for their drug. The factory gate price is not the price that a person actually pays at a pharmacy . The final price depends on how much wholesalers and retailers mark up, how much pharmacists charge for filling the prescription, and how much insurance is willing to cover . The hidden costs contributing to the total prescription drug cost are very hard to analyze due to lack of transparency in the industry and variability between province, payment plan, and drug type.
pCPA
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Ways Canadians Can Offset Insulin Costs
Since the price of insulin in Canada is relatively steep, many Canadians with diabetes are looking for ways to offset their insulin costs without damaging their health.
Traditional health insurance can cover some prescriptions, but many Canadians find that its not enough. Often, they turn to other creative avenues for getting money, like GoFund me accounts or fundraisers.
One somewhat effective way to offset the insulin price in Canada is to open a Health Spending Account, or HSA. Theres no need to pay any premiums upfront, and patients can write off all their costs.
Its like a separate tax-free bank account strictly for insulin costs.
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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How Much Does Insulin Cost In Canada
The amount of insulin needed depends on each person’s metabolic requirements, blood glucose monitoring findings, and type of diabetes. The daily insulin need for type 1 diabetes patients is usually between 0.5 to 1 units/kg. While the initial daily insulin need for type 2 diabetes patients is between 4 and 6 units of insulin.
Can I Buy Insulin Needles Over The Counter
Yes, insulin is also sold over the counter, and you can get it at your medical stores as well. But it is to be noted that over-the-counter insulin types are less, and only human insulin, not analog insulin, is sold over the counter.
A lot of times, over-the-counter insulin are cheaper than the insulin that experts prescribe. It is, although, a safer option to go for prescribed insulin supplies as suggested by your doctors.
You need to be very aware and well-informed about the type, uses, effects, and risks of the insulin that you decide to buy over the counter. It is best to consider all informatory options and be clear about the insulin choices that you are buying without a prescription over the counter.
Over the counter, insulin is generally synthetic human insulin. They differ from the modern varieties that are known as insulin analog. You usually get regular, NPH, and 70-30 insulin at over-the-counter facilities.
The primary distinguishing factor between modern insulin and over-the-counter insulin is that the former act quicker on the body to release proper insulin for blood sugar control. These insulin types can be taken a right before having any meal.
On the other hand, over-the-counter insulin is known to work slower than newer varieties of prescription insulin. They tend to take more time before activation and have to be taken an hour or so before meals to ensure their stimulation at the right times.
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Hanie Redmond Pharmd Cde Bc
Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
If someone has type 1 diabetes or if someone has had damage to their pancreas, these are instances where their body doesnt produce any insulin, Stephanie Redmond, PharmD, CDE, BC-ADM, founder of Diabetes Doctor, tells Verywell. Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
Is Walmark Insulin A Good Option For You
Considering that todays most modern insulin options cost at least $300 per vial, the affordability of Walmarts insulin is appealing. Unfortunately, the rigid schedule and limitations of these insulins truly make them a last resort option.
They are especially challenging for younger children who have unpredictable eating habits and an inevitably lesser understanding of how important it is to eat a specific amount of food at a specific time of day.
These insulins will help you stay alive if you truly cannot afford more modern insulin. If they are the only type of insulin you have access to, then yes, it is a good option for you.
If you can get more modern insulin through your health insurance or one of the many financial assistance programs that exist today, youd be better off going that route.
Sure, its nice that these older insulins are easily accessible but they are not the solution for a long, healthy, full life for a person with diabetes. They are the last resort.
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Whats Fueling The Rapid Increase In Insulin Prices
There is no doubt that the prices of insulin have reached a tipping point where some people cant afford their medication. In a presentation for the ADA, Irl B. Hirsch, MD, explains that from 2013 to 2016, a vial of glargine insulin had a price increase of 593%, and a box of five insulin lispro pens rose 522%. During that time, inflation rose by only 8.3%. In 2014, drugmakers increased the price of insulin twice, each time for approximately 16%. That means insulin prices rose by over 30% in one year.
There isnt just one reason for the high cost of insulin. Pharmaceutical companies complain that pharmacy benefit managers administering prescription benefits for commercial insurance companies drive the cost up by requiring rebates to have their brand of insulin included in the insurance formulary. They claim their net price is lower than the list price. But the PBMs say its the pharmaceutical companies who set the list price.
Several factors keep insulin prices high:
Higher levels of competition would lower prices, increasing the affordability of insulin.
The rising cost of insulin has real-world consequences. A group in Minneapolis reportedly take a bus to Canada to purchase insulin at a fraction of the price as it sells for in the United States.
Case 1successful Pump Therapy Implementation
SQ is a 19 year old female with type 1 diabetes since the age of 12. She was referred by her pediatrician to transition care to adult endocrinology. She was hospitalized upon diagnosis for the treatment of diabetic ketoacidosis . In the first few years, SQ struggled to adjust to her new diagnosis. Despite frequent changes in her multiple daily insulin injection regimens, she continued to have erratic glycemic control, with HbA1c ranging from 8.6% to 10.8%. Her menstrual cycles started at age 13 and the patient had normal growth for her age however, on her healthy child follow up visits, the patient frequently complained of chronic fatigue. Her school grades fell and her participation in extracurricular activities waned. While in high school, SQs parents enrolled her in a diabetes summer camp where she was taught how to count carbohydrates properly and learned the importance of good glycemic control along with her peers who had the same disease and challenges. SQ began checking her blood glucose prior to each meal and her blood sugars improved greatly with proper pre-meal bolusing. Concurrently, her energy level and grades improved, and she began participating in school activities again. Over the last year, her HbA1c has ranged from 7.4% to 7.8% and she has had no episodes of DKA. She is a counselor at the same diabetes camp that she attended. Now in college, she is interested in learning more about insulin pump therapy.
Questions:
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Why Is Insulin So Expensive
For the past few years, the price of insulin has skyrocketed â due in large part to the extended monopoly a handful of companies have over insulin manufacturing.
While annual out-of-pocket costs are expected to rise with inflation, the annual price increases for insulin are disproportionate to overall inflation. Studies demonstrate that diabetes is the most expensive chronic disease in the United States, costing more than $327 billion in 2017.
Generics And Biosimilars Are Driving Down The Overall Price Of Insulins
Since 2019, the overall retail price of insulins has declined by about 5%. Most of this decline can be seen as a result of recent approvals of generics and biosimilars.
In 2019, Eli Lilly released the first generic insulin, insulin lispro, the counterpart to the popular rapid-acting insulin Humalog. Since then, the FDA has approved generic versions of Humalog 75/25 , , , and most recently, Lantus .
Retail prices for generic insulin lispro and insulin aspart are currently about half that of Humalog and Novolog, respectively. The same goes for the generic mixed insulins, insulin lispro 75/25 and insulin aspart 70/30, compared to Humalog 75/25 and Novolog 70/30, respectively.
Generics have been instrumental in bringing down costs for some patients. Instead of paying a retail price of over $700 for a package of 5 Humalog KwikPens, for example, patients can now pay closer to $300 for a package of 5 generic insulin lispro KwikPens. However, weve seen that limited insurance coverage can prevent some patients from accessing these savings.
Like generics, follow-on products have also helped to bring down insulin prices overall. Generics contain the exact replicas of the active ingredients in a brand-name medication. But biologic drugs like insulin are nearly impossible to recreate. So sometimes, manufacturers make close copies of them instead, known as follow-ons or biosimilars. Biosimilars tend to be more expensive than generics but less expensive than brands.
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The Current Insulin Price In Canada
Insulin in Canada typically costs $30 to $40 per vial, with most diabetics using between one and ten vials per month. While that price is much lower than many other countries, it is still a higher price than most Canadians are willing to pay, and it has gone up in recent years. For example, between 2010 and 2015, the average price of insulin in Canada jumped more than 50%.
There are several reasons for the leap. Primarily, the demand for insulin is on the rise. More and more Canadians are diabetic than ever before. Additionally, theres plenty of cross-border need for Canadian insulin. Americans from border cities and towns regularly cross over to buy insulin, which can cost more than 900% more in the US, increasing the price even further.
Finally, the formula for insulin changed over the past several years. It is more effective now than in the past and is also more expensive to make.
Traditional Insulins Are Cheaper Than Modern Insulins
Average retail prices of Novolin and Humulin have gone down, or held steady, while prices of modern rapid- and long-acting insulins continue to go up. On average, traditional insulins now cost less than half of what modern insulins cost.
Why? Traditional insulins have historically been cheaper than their newer competitors. Modern insulins offer better blood sugar control but are synthetic analogs of traditional insulins, which makes them more difficult to produce.
Additionally, when patents on Humulin and Novolin expired around 2000, manufacturers Eli Lilly and Novo Nordisk had to test new pricing strategies to remain competitive.
In 2017, for example, Novo Nordisk partnered with CVS to offer Novolin at roughly 80% less than its list price. Both Novo Nordisk and Eli Lilly have also worked with Walmart to heavily discount Novolin and Humulin under Walmarts ReliOn line of insulin products.
Retail partnerships havent been their only strategy, though. Eli Lilly had been increasing prices for Humulin every 6 months until May 2017, when they decided to stop further increases. In fact, prices of traditional Humulin and Novolin insulins have held fairly steady since then.
and are currently the cheapest traditional insulins, with average unit prices as low as $0.03.
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Ways To Save On Insulin
Its difficult to predict where drug prices will be in the future, but if you take insulin, we hope our analysis gives you some ideas for how to talk to your provider about affordable options. Here are more ways you can save:
1) Use a manufacturer savings card or patient assistance program. Major insulin manufacturers Eli Lilly, Novo Nordisk, Sanofi-Aventis, and MannKind offer copay cards and patient assistance programs for patients with and without insurance coverage. In many cases, these programs can reduce out-of-pocket costs to as little as $0 per month. For more information, just search for your drug on goodrx.com, and click on Savings Tips for details.
2) Shop around. GoodRx offers discounts on insulin drugs, which can save you as much as 50% off the full retail price. At goodrx.com, you can also compare insulin prices at different pharmacies in your area and find information about discount programs at specific pharmacies.
3) Appeal your coverage. If you have insurance and your plan doesnt cover the insulin you need, ask your doctor about submitting an appeal. Your insurance company may require a prior authorization or step therapy before you can fill your prescription, but its worth trying if you want to get your insulin covered.
Co-contributors:Diane Li, Hannah McQueen, Swetha Pola
Methodology
A note about insulin use