Insulin Access: The Haves and Have-Nots

This content originally appeared on Beyond Type 1. Republished with permission.

By Alexi Melvin

In the United States, the complex healthcare system acts as a barrier for many people who require insulin to live. Without insurance, one vial of insulin can cost up to $350 – with most people requiring multiple vials of insulin each month. The high list price makes insurance coverage a matter of survival. It also sets up deep inequalities – depending on the status of each person’s health insurance coverage, people who need insulin are either able to get access to more insulin than we actually need, with multiple avenues to help facilitate that access (patient assistance lines, 24/7 nurse support, etc.) or we struggle to obtain enough insulin to keep ourselves alive, with little to no access to support resources. Given our current healthcare system, we are forced into one of two categories: the “Haves” or the “Have-Nots.”

This is not to say that the “Haves” do not also struggle with barriers – insulin access generally is often complicated, requiring an immense investment of time and energy to navigate insurance coverage, formularies, referrals, etc. But the situation for the “Have Nots” is often dire, with frequent and consistent roadblocks to adequate care just to stay alive.

Socioeconomic disparities are exaggerated in the healthcare system – those with lower socioeconomic status experience more frequent barriers to healthcare. This creates a situation in which those with less access to financial and social resources are also faced with fewer healthcare resources, compounding their unmet needs. People with diabetes who fall within a lower socioeconomic group struggle, in varied ways, to get a sufficient amount of insulin to efficiently manage their disease.

In 2019, the International Journal for Equity in Health conducted a study to gain more clarity on this issue. The journal conducted “in-depth face-to-face interviews” with 28 patients and the 6 healthcare professionals who cared for the patients. The framing of the study centered around access to healthcare for “vulnerable groups.”

The results showed that access to insulin and other management support was indeed difficult for those within a lower socioeconomic group, due to a number of factors including “non-alignment with healthcare professional goals, poor health literacy, psychosocial problems and poor quality communication.” These factors were thought to also hinder the patients’ ability to obtain support and maintain communication with hospital staff that could vastly improve their diabetes management and knowledge, such as nurses, diabetes specialists and diabetes educators.

Let’s imagine, for example, a person who was raised by an upper-middle class family, in a nice neighborhood, and had the means to obtain a higher education from a well-respected institution. Statistically, that person would have had an upper hand when it comes to establishing a steady career path, when compared to someone who may have been born into a family that was less economically stable.

Reliable health insurance in the US is only afforded to us if we are able to do one of two things: secure a job with a stable company that recognizes the importance of comprehensive healthcare benefits – or be in a financial position to pay for it out of pocket. For those few, the “Haves” who were raised amidst or propelled into some element of privilege, they can wind up with an excess of insulin – even letting their backstock expire before they’ve had the chance to use it.

Those people living with diabetes who fall into the “Have Nots” may find themselves in a position where they ration insulin or are forced to obtain supplies from others. There are resources available for those who are in immediate need of insulin, but they require qualification and navigation, and many people may not know where to look for help because of lack of connections within the very system that has already excluded them. Our healthcare system is not easily accessible by design.

It is truly baffling how this situation is not reversed – how the healthcare system in the United States does not prioritize those who urgently need supplies due to financial and socioeconomic hardship. Reliable and consistent insulin access should not be a luxury reserved for the few. It should be the standard.

Source: diabetesdaily.com

What to Do If You Need Insulin Right Now

This content originally appeared on Beyond Type 1. Republished with permission.

By Lala Jackson

What to Do If You Have No Insulin at All

Go to the emergency room. Under US law (The Emergency Medical Treatment and Active Labor Act), the emergency room cannot turn you down in a life-threatening emergency if you do not have insurance or the ability to pay.

If Emergency Room staff is telling you they cannot treat you, stay put. Be clear that you are in a life-threatening emergency because you have type 1 diabetes (T1D) but do not have insulin. Do not leave. Please note that urgent care centers are not required to abide by the same laws.

Once you are stabilized and before you leave the hospital, hospital staff is required to meet with you to make sure you understand that you are leaving the hospital of your own accord. At this time, let the hospital staff person know about any financial situation you are in. Some hospitals are aligned with charities that can help you pay. Other hospitals offer payment plans based on your situation. No matter your financial situation, know that your life is the most important thing.

What to Do If You Have Some Insulin, But Are About to Run Out

Utilize Kevin’s Law

If you have an existing prescription at your pharmacy, but have not been able to get ahold of your healthcare provider to renew the prescription, you may be able to take advantage of Kevin’s Law. Kevin’s Law was named for a man with T1D who passed away after not being able to access his insulin prescription over the New Year’s holiday. Under the law, pharmacists are able to provide an emergency refill of insulin in certain states, without the authorization of a physician to renew the prescription. Rules around the law vary from state to state and not all states have the law in place. Kevin’s Law only applies to those who have an existing prescription and, depending on where you live, your insurance may or may not cover the refill. Learn more about Kevin’s Law, including whether or not your state has it, here. Please note, your pharmacist may not know the law by name, or know that the law exists. If you are in a state with Kevin’s Law and working with a pharmacist who is unaware, stay put and ask to speak to someone else in the pharmacy.

Ask Your Physician for Samples

While this is not a long-term access option, your care provider may be able to provide you with a few vials/pens for free, and bringing your HCP into the access conversation means that they can help direct you to other options that might be available to you, like local community health centers with insulin available.

Utilize Patient Assistance Programs – Standard out of Pocket Cost $0

  • If you take Lilly insulin (Humalog, Basaglar) call the Lilly Diabetes Solutions Call Center Helpline at 1-833-808-1234
    for personalized assistance. You may be eligible for free insulin through LillyCares.
  • If you take Novo Nordisk insulin (Fiasp, NovoLog, NovoRapid, Levemir, Tresiba) and demonstrate immediate need or risk of rationing, you can receive a free, one-time, immediate supply of up to three vials or two packs of pens by calling 844-NOVO4ME (844-668-6463) or by visiting NovoCare.com
  • If you take Sanofi insulin (Admelog, Lantus, Toujeo): the Patient Connection Program provides Sanofi insulins to those who qualify, which is limited to those with no private insurance and who do not qualify for federal insurance programs and who are at or below 250% of the federal poverty level – with a few exceptions.

Utilize CoPay Cards – Standard out of Pocket Cost $35 – $99 per Month

Copay cards that reduce the out-of-pocket cost you pay at the pharmacy exist for most types of insulin. Some copay cards can be emailed to you within 24 hours. Currently, copay programs exist for:

  • Lilly, capping copays at $35 per month for those with no insurance or with commercial insurance
  • Novo Nordisk, capping copays at $99 for those with no insurance or with commercial insurance
  • Sanofi, capping copays at $99 for those without prescription medication insurance
  • Mannkind, capping copays at $15 for some of those with commercial insurance

Unfortunately, copay cards are typically not available for those insured through Medicaid or Medicare. Use the tool from the Partnership for Prescription Assistance to search in one place for discount programs and copay cards you qualify for here. Please be aware that you will need to search by brand name (i.e. Humalog, Novolog), not just “insulin.”

Get R & NPH Human Insulins – Standard out of Pocket Cost $25-$40 per Vial

R (Regular) and N (NPH) human insulins are available over-the-counter in 49 states and cost much less ($25-$40 per vial at Walmart) than analog insulins such Novolog, Humalog, Lantus, or Basaglar. They also work differently than analog insulins – they start working and peak at different times – but in an emergency situation can be a resource. Speak with the pharmacist or your healthcare provider if possible before changing your regimen and keep a very close eye on your blood sugar levels while using R & N insulin.

Research Available Biosimilar (Generic) Insulins

The biosimilar insulin market is changing rapidly as the FDA adopts new regulatory pathways to more efficiently approve interchangeable insulins that may be available for a lower price. Ask your healthcare provider for the most up-to-date options for you. A few options available are:

  • A generic version of Humalog — Insulin Lispro — is available at pharmacies in the U.S. for $137.35 per vial and $265.20 for a package of five KwikPens (50% the price of Humalog.) If you have a prescription for Humalog, you do not need an additional prescription for Lispro; your pharmacist will be able to substitute the cheaper option. Insulin Lispro is not currently covered by insurance.
  • Authorized generic versions of NovoLog and NovoLog Mix at 50% list price are stocked at the wholesaler level. People can order them at the pharmacy and they’ll be available for pick up in 1-3 business days

If you have enough insulin to last you a few days, but need to figure out where to get a more reliable, consistent supply, visit our Get Insulin page to find further resources.

Source: diabetesdaily.com

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