The Impact of Patient Outcomes at the Expense of Insulin Prices
Brief Overview of Potential Problems and Solutions
When the cost of a monthly medication exceeds a certain amount, most of the time, I find myself hesitant to tell the patient, especially when it comes to a medication that manages a chronic condition. It could be a $100 copay, $300 copay, or more, it doesn’t sit right with me to allow my patient to decide whether or not to buy their medications or to buy groceries for their family. Insulin has always been one of the main culprits of high cost therapy. Patients shouldn’t have to go through an ultimatum every month and decide if they can only afford half of their insulin and risk not taking the appropriate amount due to the cost.
Think about how these high prices can negatively affect patient outcomes and may cause permanent, irreversible damage to their overall health. As pharmacists, it is our obligation to counsel patients and assure they are compliant with their medications. However, what do we do when they can’t afford them or when we have no control over the cost they pay; what advice do we tell them? I currently work at a retail chain pharmacy and I often see a lot of patients struggle to keep up with their copays and reaching their deductibles. As I stated before, it is a tough job to be the messenger of bad news.
The Price of Insulin
The pricing of insulin and the supply chain is a very intricate system. Several stakeholders (manufacturers, wholesalers, PBMs, pharmacies, health plans and employers) are involved and an agreed upon price for any insulin formulation does not exist. The price paid by the patient results from the prices, rebates, and fees negotiated among the stakeholders and can vary upon patient and insurance plans. In the U.S. market, there are limited insulin manufacturers which can be an additional reason for high cost insulin. It is thought that if the competition of the market increases, such as the development of biosimilar insulin, it can possibly lower the cost. Another issue that contributes to a high cost of insulin is the usage of more expensive human insulin analogs, which have increased compared to the use of human insulins.
The average U.S. list price (WAC) of the four insulin categories increased by 15% to 17% per year from 2012 to 2016.
Between 2006 and 2013, average out-of-pocket costs per insulin user among Medicare Part D enrollees increased by 10% per year for all insulin types.
Based upon the “Diabetes Care” article, the price of insulin continues to rise each year and in doing so patient out of pocket costs increased as well.
Patient Outcomes and What to do
If the trend of insulin cost continues to trend upward, it will contribute to non-compliance and multiple complications. Insulin is a fundamental part of treating diabetes, especially type I. Without insulin, many complications can arise such as micro and macrovascular complications. With additional complications, follows additional health care costs.
To overcome this burden of high cost insulin, there are some options that we can provide our patients and providers with. We can refer patients to patient assistance programs, especially patients without insurance. Partial supply can also be useful for patients who cannot afford to pay the full month supply all at once. We can give our patients the option to return for the remainder of the partial prescription when they can afford it but advise them not to wait until their last dose. Our role can also influence prescribers to prescribe lower priced insulin, promote the use of biosimilar insulin and inform them of what their patient’s insurance plan will cover.
Conclusion
The affordability of insulin is continuing to decline. For our diabetic population, make sure they are aware of all their options and insulin preparations.
Ramsey Reed, Pharm.D. Candidate
References:
- Cefalu WT, Dawes DE, Gavlak G, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care 2018; 41:1299–1311.
