FOX23 Investigation: Families coping with rising insulin prices

By: Clay Loney

Updated:

Quick Facts:

  • Cost of insulin is rising
  • Insulin is a life-saving drug for millions of Americans with diabetes
  • FOX23 is taking a closer look at why the costs are going up, and how patients can find it for a lower price
  • WATCH Clay Loney’s full investigation above.

 

For millions of Americans living with diabetes, insulin is a lifesaving drug, but the price keeps going up and many patients are struggling to foot the bill.

Some even take a huge risk by skipping doses or not taking them at all.

Insulin has been on the market for almost 100 years, but there's still no generic version. Patients are paying for brand-name drugs at brand-name prices.

Vernon Sumwalt relies on insulin every day to stay alive.

"If I did not take insulin, I can tell a difference. If I’m off insulin for an hour, my blood sugar is spiking," Sumwalt said.

The price is spiking, too.He gets a refill and a big bill every few months.

“About a 3-month supply, it's about between $800 and $900,” Sumwalt said.

He has to pay that out of pocket, up to a point, before his insurance kicks in. He considers himself lucky.

“It makes me wonder how people who don't have insurance can pay for it,” he said.

Some don't, including Kristi Howard's brother, David.

“He would skip his insulin every other day,” said Kristi Howard.

“He would skip just because he couldn't afford to get his insulin refilled."

She said that led to complications, and David died. He was 38.

Medicare tracked two of the most popular insulin drugs over four years.

One went up 27 percent and the other 41 percent.

Eli Lilly (Humulin R), Novo Nordisk (Levemir) and Sanofi (Lantus) make three of the most popular insulin drugs.

Eli Lilly Statement:

"Today's health care system works well for most people, but those enrolled in high-deductible insurance plans and managing chronic conditions face challenges in gaining reasonable access to the treatments they need. Insulin is one example, and we are committed to doing our part. A permanent solution that gives everyone who uses insulin access will require leadership and cooperation across many stakeholders, including manufacturers, PBMs, payers, and policymakers.”

Novo Nordisk Statement:

"We know that patients are looking for answers and we're committed to working towards a future where everyone with diabetes has the medicines they need. There are several factors affecting insulin affordability. Pharmaceutical pricing is complex as there are many intermediaries between the manufacturer and the patient and these intermediaries ultimately determine what premiums, co-pays and deductibles are charged to the patient. Rebates, discounts and administrative fees to PBMs and other intermediaries are all necessary to secure formulary access for patients. While many patients using our medicines have co-pays on average of $1 - $1.40 per day, product affordability is an emerging issue for some patients who pay more up front due to changes in the healthcare system and benefit designs implemented by PBMs/payers. Additionally, patients who obtain their insulins under government programs have nominal co-pays. We're taking action to address that many Americans with diabetes struggle to pay for their healthcare and, in some cases, this includes paying for the medicines we produce. For instance, we negotiate with payers and PBMs to have our medicines on their preferred brand tier. Our co-pay assistance programs helps reduce the burden some high deductible plans create and offer a patient assistance program to make our medicines accessible for as many eligible patients as possible. We also produce human insulin which is an affordable option for patients. The developments in treating diabetes over the last 90 years have had a profound impact on patient outcomes. Price increases are necessary to support our mission to research and develop new medicines. We're committed to continuing our research and development into new therapies and to support our ultimate goal - finding a cure for diabetes.”

Sanofi Statement:

"Sanofi is committed to helping patients get the diabetes treatment that they are prescribed, and we have not increased the price of our basal insulin since November 2014. In setting prices for our insulin medications, we work to balance helping patients manage their diabetes today and developing ways to improve care in the future."

Many blame high-deductible insurance plans. While that does impact how much patients pay, it doesn't change the fact that the companies controlling the price of insulin are charging more.

UNC Charlotte professor Jennifer Troyer, an expert on drug prices, said other countries keep prices down by regulating them more.

But that tends to limit choices, a tradeoff that Americans don't typically like.

“We really value choice really heavily, and we want our physicians to be able to make the choice for us that they feel like is most appropriate for us,” said Troyer.

Brad Wilson, the head of Blue Cross and Blue Shield North Carolina, believes that the government needs to get more involved. He said the federal government should be allowed to negotiate prices for Medicare.

“The data is clear. When that began, the consumption of and the pricing of pharmaceuticals went up, and it's been on the trajectory ever since,” said Wilson.

 

What can patients do now?

 

  • Pharmaceutical Assistance Programs
  • Drug makers offer discounts to people who qualify.  Sanofi Patient Connection is one example.
  • Eli Lilly plans to launch another insulin drug next month.  It's called Abasaglar.  It's not exactly a generic and Lilly hasn't set the price yet, but more competition could mean lower prices.
  • Walmart carries an exclusive line of diabetes products, called Reli-On. Its insulin costs less than $25 for a vial, roughly six times less than the average brand. Walmart's is not for everyone, but, an insider at a competing company said it's every bit as good as the version his own team makes.

 

Other ways to be a savvy patient:

 

  • Do your homework:  Know what drugs are out there and what discounts are available.
  • Ask your insurance ahead of time what your out-of-pocket cost should be:  It may matter which drug you use.
  • Ask your doctor for options:  Blue Cross said bring up the issue with your doctor.  Don't wait for him/her to raise it.

 

The American Diabetes Association says 29 million Americans have the disease, 195,000 in Charlotte, 1 million in NC (13 percent of the population), and 547,000 in SC (14 percent of the population).

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