There are more than 460,000 diabetics in Minnesota – roughly 10% of the population has diabetes, and another 37% have prediabetes. This is according to the MN Department of Health (2015 data).
It doesn’t stop there: Diabetes rates are expected to increase rapidly to 1 in 3 people (33%) by 2050, which means we need to address prevention and the cost of diabetes care immediately. Attention needs to be focused, specifically, on medications.
The most costly of these? Insulin.
What is insulin?
Insulin is a hormone made in the pancreas with an incredibly important role to play: It lowers blood sugar (glucose) within the body when carbohydrates are consumed. Without insulin, glucose remains high. As a result, major health complications can occur, which is why some diabetics rely on manufactured insulin for survival. Type 1 diabetics do not produce insulin, and with Type 2 diabetics, their bodies production of insulin may slow down or become defective overtime. Therefore, many people with type 2 diabetes may require the use of insulin as the disease progresses or when blood sugars can no longer be managed through diet and lifestyle. Knowing these differences is important, because the level of care and cost varies drastically, especially if you have type 1 diabetes. With these individuals, no insulin means you will not live. Period.
Diabetes is a progressive disease, and requires life-long treatment. This means that, once you get your blood sugars under control, you will always need to manage and monitor them to make sure they stay that way. If not, your risk for serious complications like neuropathy (loss of feeling due to nerve damage), nephropathy (loss of kidney function and ultimately kidney failure), retinopathy (loss of vision), and heart disease, amongst other diseases, increases dramatically.
Treatment also depends on your diet, lifestyle, and, of course, finances. Having diabetes is not cheap – especially if you do not have insurance. Thus, the fight for reduced-cost insulin continues as more Americans, including many Minnesotans, struggle to afford health care and manage their diabetes.
Read more about that here: Insulin’s high cost leads to lethal rationing
To give you an idea on cost, take a look at this Minnesota formulary from 2017 of cash price medications (those that are uninsured, underinsured, or cannot get coverage):
The cost of insulin, and other diabetes drugs
|Insulin Pens||$81-193 with each 15 ml, avg. 5.4-12.87 per ml|
|Oral Diabetes Medications||$0.08-14.18 each (range 1-4 pills/day)|
|Non insulin Injectible Medications||$148.91-627.39 each (up to one month supply)|
|Test Strips||$0.76-1.78 up to 4 times a day = $0.76-7.12|
|Lancets||$0.10-0.39 each (4-8 times a day, $0.10-3.12/day)|
Note: All injectible medications require a new lancet (needle) each time it is used, as well as every time a blood sugar reading is required, up to 4 times a day.
We often hear about the cost of insulin as being a barrier to care, certainly, but the oral medications and testing supplies are important to note as well. Those costs add up quickly as well, especially when most type 2 diabetics are taking two or more of these medications to control their blood sugars.
According to a recent Yale study (Yale University, study from a single clinic), as many as 1 in 4 don’t use the full prescribed dose due to high costs.
How does pricing work?
Insurance companies negotiates pricing with drug companies to determine the cost of medications, including testing monitors and supplies. These formularies of medications often get updated and changed yearly and sometimes more frequently. Therefore, it can be difficult and/or time consuming as a healthcare provider to know which medications will be covered. Pro Tip: When picking up medications, ask about coverage before you pay. There may be a cheaper option available.
How much you pay for medications and care is based on income when you are uninsured. Which means that the middle class income group is hit the hardest. They are ineligible for Medicaid, which is government insurance for low-income individuals, and they do not earn enough to afford better health insurance or pay out of pocket.
But everyone is affected: Uninsured patients pay cash directly to high insulin and insured patients become affected as well when they are still in the deductible period, when drug is not covered in the insurances formulary. Also, when those with Medicare part D are in the “donut hole” – in which they will pay out of pocket even with coverage – they too will be paying a high cost for their medications.
Ultimately, this is why affording the cost of healthcare in America is a problem. The specific issue with insulin is that there aren’t generic versions of insulin, which means no competition, resulting in skyrocketing prices.
What is being done on a national level?
The American Medical Association issued a statement calling for the FTC and justice department to monitor insulin prices as a response. Other grassroots initiatives are working hard as well, like TruthinRx.org. They attempt to show transparency on the process that pharmaceutical companies, Pharmacy Benefit Managements, PBMs, and health plans engage when pricing prescription drugs.
On the local level?
MN Attorney General Lori Swanson filed a lawsuit against 3 insulin manufactures, alleging that they committed deceptive trade practices and consumer fraud to inflate prices. Lawsuit claims “artificially high” list prices to negotiate large rebates with PBMs. Ultimately, the list prices are drastically more than the actual cost, which fail to reflect the true cost.
Read more about that here: Minnesota accuses insulin makers of deceptive drug pricing
What is the response from drug companies?
Danish Pharmaceutical company Novo Nordisk has stated that its “business practices are consistent with legal and regulatory requirements.” Indiana-based Eli Lilly echoed these statements, saying that they believe “the claims are without merit.”
Here in Minnesota, we are also lucky to have Mike Howard, House DFL- Richfield, work on a new bill that would offer people free or low cost insulin to diabetics who cannot afford it. His hope is to make insulin more available in neighborhood pharmacies to those who cannot afford it and require pharmaceutical companies to pay for some of the cost.
So, what can I do?
Write to your representatives in congress and sign the petition for affordable insulin. For yourself, so that this never becomes something you have to deal with personally, reduce your risk for developing diabetes, and, if you already have diabetes, control your blood sugars as best as possible by limiting carbs (and overeating in general), getting regular sleep, and exercise. As a diabetic educator, I can help you strategize.
Feel free to reach out and get in touch with me, and find where I’ll be teaching free classes through Blue Cross Blue Shield: www.ranellekirchner.com
For more information on the growing diabetes epidemic, and what can be done to help, read this article next: Diabetes Awareness Now