Managing diabetes gets tougher as insulin prices rise

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Patients and pharmacists are caught in the middle

The price of insulin has risen drastically in recent years. A new study in JAMA, based on a nationally representative survey, found that the mean price of insulin increased from $4.34/mL in 2002 to $12.92/mL in 2013—a 200% increase. Price increases affected all insulin types, including older, human insulin.

While some patients with insurance may not be seeing much difference in their copays for preferred insulin products, patients with high-deductible health plans and Medicare patients in the doughnut hole are likely feeling the impact of insulin’s high price tag.

“We’ve had so many new insulins approved in the last few years, and we are making such good strides in diabetes management, but if a patient can’t afford them, then we are not moving in the right direction,” said Jennifer Trujillo, PharmD, BCPS, CDE, BC-ADM, associate professor at University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

Insulin is a billion-dollar global industry. The pricing problem is complex, starting with drug companies and PBMs who have recently entered the market.

“I don’t see a great solution in the near future, and the people who are going to suffer the most are the patients,” said Trujillo.

As frontline providers who patients see when the price of insulin changes, pharmacists can help patients navigate  their health plans and understand the letters they might be getting about drug coverage, Trujillo said. Pharmacists can also help patients find assistance programs and rebate cards to help with costs.

Trujillo, who practices in a clinic where the majority of patients are insured, often encounters patients having to change from one insulin product to another due to formulary changes in their insurance plans.

“For rapid-acting insulins, switching from one to another does not create too many problems with glycemic control, but certainly switching from some of the basal insulin products is not a straightforward one-to-one unit conversion, so that’s an issue for our patients,” said Trujillo.

In other cases when rapid-acting insulins are too costly for patients, a pharmacist might have to work with the prescriber to get the patient on an older, human insulin product.

For patients in these situations, Trujillo said, pharmacists can help manage those insulins safely and effectively.

“There are data that older insulins carry higher risk of hypoglycemia and their pharmacokinetic and pharmacodynamics profiles are not as ideal, but they still can be used safely and effectively,” she said.

The full version of this article will appear in the June 2016 issue of Pharmacy Today at www.pharmacytoday.org.

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