The only word that I find appropriate to describe the maze of price and restrictive rules raising the price of life-saving drugs is deadly. The New York Times, August 22, 2016. detailed the EpiPen Price Rise for Allergy Sufferers. Allergy sufferers require an EpiPen to respond quickly to an external attack on their bodies and need immediate medication to counter the external attack on their bodies.  As a type 1 diabetic, (T1D), I find the maze of price and restrictive rules which are raising the price of insulin is far more insidious. Denise Roland and Peter Loftus wrote in a Wall Street Journal article dated October 7, 2016, entitled; Insulin Prices Soar While Drugmakers Share Stays Flat. If the manufacturer of insulin is not profiting from the price rise of insulin than who is?

The diabetes community is taking actions to deal with this pressing issue. Mike Hoskins from DiabetesMine wrote about a stay-at-home mom from Mississippi with her attempt to crack the code on insulin profits. The American Diabetes Association, (ADA) has stepped forward and is launching a petition for affordable insulin. The petition can be signed at the ADA website. Peter Loftus wrote in a Wall Street article dated October 28, 2016, entitled; Backlash against Drug Prices Hits Manufactures and Middlemen. It is interesting to note that in simple terms insulin is a manufacturer product. What is the best timely inexpensive processes to deliver the manufactured product insulin to the T1D patients?

The management of glucose levels with insulin for diabetics entails far more than just access to insulin. It demands an ongoing monitoring of the multi-factors that impact a person living with diabetes.

The starting point is the preparation of insulin for person with a body that no longer produces insulin.

The drug companies first turned to animal refined insulin. Back in 1966, at the start of my T1D career the choices were bovine, beef or porcine, pig insulin products. These early choices were predicated on the ability to lower glucose levels and minimize personal body irritants with the given choices. In the late 1980’s an insulin pump was added to my care. It is now 2016. My history with insulin pumps and blood glucose meters has expanded. I have selectively used each of the three different fast acting analogue derivatives of insulin. Currently, the three choices of fast acting insulin are Humalog, Novolog, and Apidra. The current best choice for me in coordination with my insulin pump, blood glucose meter, continuous glucose meter and continual consultations with my endocrinologist is Apidra.

What is the current landscape regarding the patient choice of insulin?   Each year over the last four years my health care provider (HCP) has sent me notifications. The notification dictates what singular choice of fast acting insulin that I should use. Really? How was this determination made? Who made the decision?  Where is the clinical data to support the fact that T1D users should be forced to comply with an assigned choice due to cost and deductible coverage factors without discussion with the patient’s doctor? For 2017, my only Formulary choice is Novolog. The operative question is: What is the point of having T1D patients potentially have to change their use of rapid acting insulin each and every year without any medical discussion of the impact and coordination of all necessary equipment supplies, other medications and necessary medical appointments?

The starting point is the retail price for each of the three in 100 Unit/ml injection vials. In October 2016, the local pharmacy supplied to following data. If I had to purchase insulin on a retail basis and absorb the entire cost of the medication without the purchase being applied to a deductible is:

 

Humalog                              $309.99               Eli Lily Company, USA

Novolog                                   310.99                Novo Nordisk, Denmark

Apidra                                      333.99                Sanofi US

 

The question at hand is the procedural choice of a singular bidding process with the only focus being the lowest cost for insulin. Did anyone give consideration to the question of what is best for type 1 diabetic patients? T1D patients run the range in age from eleven (11) months after birth to eighty years as type 1 diabetics. Can any of you fit into your baby shoes for an entire life? There is a reason for the multiplicity of insulin type products. What is best for the patient is a critical question to ask. One singular choice is not the best answer.

Upon further examination the three fast acting insulin listed above are not identical. They are structurally different with subtle differences. Humalog is a rapid-acting human insulin analog. It is an Insulin lispro produced by recombinant DNA technology. Novolog is rapid-acting human insulin analog and is an insulin aspart. It has an rDNA origin. Apidra is a rapid-acting human insulin. It is an insulin glulisine with an rDNA origin in which is different from the other two. The short answer is the fact that all three insulins are different with different structural components. Yes, they are insulin in the general sense in that each will facilitate the ability to lower blood sugar. However, each has a different set of characteristics and warnings which can be very critical to the T1D patient. The three insulins listed are not generic drugs!  Each is unique.   They were approved by the Food and Drug Administration at different times due to the fact they are different.  How well does the choice work with an approved pump and necessary supplies? How fast will the choice bring down a meal glucose rise? What is the impact upon the onset of hypoglycemic events? A search on the internet can list various factors that can affect the ability of each to optimize the patient’s goal for a desired normal glucose. What really is the reason that Medicare and many other insurance providers have been attempting to dictate a singular insulin choice for coverage on their Formulary list of approved drugs which can be changed during the upcoming given year or the future years?

There are diabetic focused organizations along with the federal government who support research for a possible cure for diabetes. The search for a cure has led to and will continue to lead to advances which have improved and will continue to improve the management of our diabetic condition. The dichotomy of dollars for research being offset by the petty denial of the use of new tools is both stupid and dangerous to diabetic patients’ lives. Let’s take the time to file any and all appeals for coverage and work to change a broken system. As a diabetic patient it is my desire for the opportunity to live the best possible life as a diabetic patient!  It is my belief that this is your desire as well.

 

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