Navigating the Exorbitant Cost of Diabetes Medications | Corwell Health

The high cost of insulin is a major concern for people with diabetes, having risen dramatically in the past 20 years. And while the changes underway reduce the price – at least for some patients – the new drugs add to the confusion.

The good news is that help is on the way, including new laws that cap costs for seniors and generic insulin that may be available as soon as next year.

The bad news? It takes real work to unearth the complexity of cost and get the best possible deal on these life-saving drugs.

“Sometimes it feels like unwrapping the biggest ball of yarn ever,” said Stephanie Field, director of pharmacy business services at Corewell Health.

That’s why Corewell now has a Medication Care Coordination team to help patients solve insurance conundrums, doing everything they can to simplify coverage for complex drug regimens.

“We make sure that this is the most cost-effective approach for the patient and that they get the right medication that is covered by their insurance,” she said.

Sometimes, this isn’t possible.

“In those cases, we help with Medicaid, which could be a copay card or a grant. There are opportunities for us to help get coverage,” she said.

Some drug companies offer relief.

Companies like GoodRx also help patients find money-saving coupons and discounts on medications.

Field says Corewell Health is working with patients to help them find out as much as possible before they become stunned by sticker shock in the pharmacy window.

And it works. The average time from prescription to pickup at the pharmacy has gone from seven and a half days to three days, Field said.

“We’ve seen a significant reduction in out-of-pocket cost to the patient,” she said.

Understand the complexity of cost

It is helpful to understand how diabetes costs have spiraled out of control. Insulin was discovered more than 100 years ago — and for the 1.9 million people in the United States with type 1 diabetes, it’s essential.

Insulin is a hormone that occurs naturally in the body, and is secreted by the pancreas. People with type 1 diabetes don’t produce it at all.

People with type 2 diabetes make their own insulin, but their bodies don’t use it properly. They can usually manage this with lifestyle changes and oral medications. But in some cases, they also need insulin injections.

more than 37 million Americans About 11% of the population has diabetes, according to the American Diabetes Association—and it’s growing at epidemic proportions.

An estimated 8 million people in the United States are insulin dependent.

As that number increases, it puts more pressure on the insulin supply, a market dominated by three pharmaceutical giants.

“These three manufacturers make insulin for the whole world,” he said. Gregory Deans, DO, Internal Medicine physician, Corewell Health Spectrum Medical Group. “It takes a significant investment to build manufacturing facilities that can safely make the drug molecule.”

Semglee, a biosimilar form of insulin made by a fourth company, was launched on the market recently. (Biological drugs are defined as biologic formulations so similar to the drugs they mimic that there is no clinical difference. On the other hand, generics are identical to the brand-name drugs they mimic.)

While this has improved affordability for some patients, many advocates are disappointed with the limited effect.

The field shares patients’ frustrations. While the average price patients pay within the Corewell Health system for insulin is $20.70, some patients pay $165, depending on their insurance.

“This is worrying,” she said.

And people with different levels of insurance and education have varying degrees of health care literacy.

Even for experts like her, navigating that maze was a challenge.

“I’ve done this for 13 years and I still struggle with my parents, to get the right choices,” she said.

Some patients face bills of up to $2,100 per month.

“No middle-income person can afford that,” she said. “You gotta be a millionaire. At some point, you’re probably going to give up.”

Unfortunately, many people are forced to make unsafe choices.

newly Stady It found that 17% of insulin users either skipped insulin doses, took less insulin than needed, or were late filling prescriptions due to financial constraints.

Among black Americans, legalization was more common, affecting 23%, compared to 16% of white and Hispanic Americans.

New medicines add to the confusion

Insulin isn’t the only expensive diabetes drug. Newer type 2 diabetes medications, such as Ozempic, Trulicity, and Mounjaro, are highly effective in obesity-related diabetes. But they can cost patients up to $1,000 a month.

The publicity about these costs adds to the perception that all diabetes medications are very expensive, Field said.

“A lot of people got lost in the nuances, and it became a kind of muddled story,” she said.

Groundbreaking legislation recently capped the cost of insulin at $35 for Medicare, which covers seniors in America.

But this life-saving procedure comes with a price. A recent study from the Congressional Budget Office shows that it also raises the cost to the government and increases the cost of insurance premiums.

Taxpayers and consumers bear these costs, too.

Michigan is cutting costs by manufacturing insulin in the state. It is one of several states calling for investigations of Eli Lilly & Co. and Sanofi and Novo Nordisk with respect to their pricing policies.

The same vial of insulin that costs $98 in the US is available for $12 in Canada, $8 in the UK and $7 in the US, according to an analysis from rand.

On average, insulin prices in the United States are eight times higher than in 32 high-income countries.

However, most pharmaceutical companies defend the prices of their products.

“The philosophy of the pharmaceutical industry has always been that they have the right to do this because it costs billions of dollars to produce a new drug — and since so many new drugs fail,” said Dr. Daines.

Managing the high cost of medicines

Relief is coming – eventually. Eli Lilly recently lowered the price of insulin, limiting it to $35 for everyone. Civica, a nonprofit organization, has plans to introduce three insulin biosimilars starting in early 2024.

Until then, he said, the most important step “is making sure you understand your insurance benefits.”

It is essential to know which drugs are covered, which are not, and how to get the lowest co-pay possible.

This entails checking with your insurance company annually because plans often change.

Unfortunately, he said, many people may be paying less and not know it. And although plans are required to notify patients of changes, “often, the letter came three months early, and the effect isn’t clear until it’s time to pay for their medication at the pharmacy.”

It’s also important to ask your provider how the new prescription fits into coverage.