To stay healthy, I require a continuous drip of insulin to manage my type one diabetes. The price of insulin in the United States has received a lot of press these days. However, unless you live on insulin, it’s hard to really understand how broken our system is.
As a type one diabetic, I try to keep my blood sugars in a healthy range. With too much insulin, my blood sugars go low. With too little insulin, my blood sugars go high. It’s a delicate dance between low and high that requires a specific titration to keep me healthy. I take about .1 teaspoon or .6 mL of insulin. Double that tiny amount would be fatal. Insulin can’t get too hot or too cold; otherwise, it loses its potency.
Every time is high, I need to understand why. Reasons often include:
- Not enough insulin to cover the carbohydrate required
- Food does not absorb like I think it should
- Basal rate changes dictating more background insulin.
- Insulin pump with a kinked cannula
- Poor absorption at the injection site
- Lack of sleep induced insulin resistance
- Bad insulin
- Shit happens…
Often times these things happen away from home. There are many, many times, I want to try fresh insulin. Let me tell you a tale of two countries:
In the United States
I walk up to the pharmacy:
Pharmacist: “Do you have a prescription?”
I call my endocrinologist on call, wait for a callback, tell the endocrinologist the medication I need (or can work based on what the pharmacy has), and send the endocrinologist the contact information for the pharmacy. I then wait for the pharmacy to receive the prescription and process the order.
After all the time and energy of multiple people, Pharmacist: “Your insurance has denied this request due to the fact you have already filled this prescription.“
Me: “But I’m away from home and don’t have access to that insulin.“
Pharmacist: “Your prescription drug plan may be able to offer you a vacation override.”
Another 1-800 call happens explaining to the pharmacy benefit manager why I need insulin to stay alive, as they can’t be expected to understand type 1 diabetes and all of the other conditions for all the medications they carry. I also try to explain that the wrong answer is to go to the ER, which costs everybody a ton of time and money that doesn’t need to get spent.
Pharmacist: “Your total comes to $400 if you pay with cash.”
Pharmacist: “I may be able to find a random discount code to reduce the price a bit.”
Me: “What is that?”
And it goes on and on. Once I pay for the medication the pharmacy benefit manager then tries to say that they only reimburse insulin at a contracted rate, not the rate I paid even at a contracted pharmacy. The insulin manufacturers inflate the price of insulin so the pharmacy benefit managers can heavily discount it to the insurance companies saying, “Look, we got the best ‘deal!’” The cash buyer then gets screwed when they just need a vial of insulin to stay alive.
It’s a massive amount of headache.
Meanwhile in Canada
Me: “May I purchase a vial of Novorapid?”
Pharmacist: “Sure! That will be $40 (US$30)” (and yes, it’s the exact same medication).
Me: “Thank you. If it was only this easy in the US.”