A trip to Canada [to buy cheaper insulin] celebrates the achievement of Dr. Banting and his colleagues who discovered insulin nearly a hundred years ago. But for most patients with diabetes, a trip to Walmart is a better way to save money.Dr. Robert Misbin, retired FDA scientist, to SharylAttkisson.com
Important information about insulin cost and availability comes from a retired FDA scientist who reviewed several modern insulin treatments for diabetes.
Inexpensive, safe and effective insulin is available for purchase in the U.S. over the counter without a prescription.
Insulin prices have been skyrocketing, and diabetic patients are said to sometimes ration their prescription insulin as a result.
A recent tweet from presidential candidate Sen. Bernie Sanders (D-Vermont) raised concerns about the health impact of high cost insulin. "Americans are dying because drugmakers like Eli Lilly charge $300 for a vial of insulin," wrote Sanders. The following day, Sanders traveled to Canada to purchase insulin at a lower cost to try to demonstrate the need for price reforms in the U.S.
However, Dr. Robert Misbin says it's not necessary to go to Canada, as Sanders suggests. Inexpensive options are available to any patient "over the counter" without a prescription in the U.S.
Dr. Misbin is a retired FDA scientist who conducted the original FDA medical review of the newer, synthetic "analog" insulins Humalog in 1996-97 and Lantus (glargine HOE 901) in 2000. He says they can be more convenient for patients than older, over the counter "human" insulin such as Humulin, but are also more expensive.
I do not accept the idea that people are dying for lack of expensive insulin analogs. Many patients get better control with the analogs but the older preparations work quite well. Humulin and Novolin are human insulin, identical to what comes from the pancreas. Before 1997, there were no analogs. According to Walmart's website, it sells a vial of Novolin for $25 without a prescription.Dr. Robert Misbin, retired FDA scientist, to SharylAttkisson.com
The big escalation in price of insulin came after the introduction of synthetic or "analog" forms of insulin beginning in 1997. According to Dr. Misbin, the analogs are much more expensive and not that much better except for convenience.
Convenience factors in because some of the new analogs can be injected immediately before a meal, in contrast to regular human insulin that should be injected 15 minutes in advance of a meal for best effect.
Also, long acting analogs can be given once a day. The older version of insulin is administered twice a day. Some patients and doctors also believe analogs are more predictable.
"Some patients claim the new insulins are better, but if one looks at the data--and I did that-- there was really no difference in effectiveness between the old and the new," says Dr. Misbin. "Of course, randomized trials do not allow for individual preferences."
And that's the important part amid the concern over cost: the "old" insulin is widely available over the counter for a fraction of the cost of the "newer" insulin.
Some patients already know this inside secret. Human insulin is available over the counter in every state except Indiana, according to Medscape.
Medscape notes Walmart sells its own brand of over the counter insulin, ReliOn (made by Novo Nordisk) for approximately $25 for a 10 mL vial.
Other over the counter human insulins, says Medscape, sold at other pharmacy chains, run approximately $152-$163 for a 10-mL vials [Novolin (Novo Nordisk) or Humulin (Eli Lilly).
That's considerably less expensive than newer, prescription insulin analogs such as lispro (Humalog, Eli Lilly), aspart (Novolog, Novo Nordisk), and glargine (Lantus, Sanofi), according to Medscape. The medical publication conducted a survey and estimates Walmart sells 18,000 vials of over the counter insulin daily.
Dr. Misbin says the FDA knew that approval of synthetic analogs of insulin would eventually lead to higher prices for patients. "We knew this would increase the cost of this form of treatment," he remarked. The FDA did not have the authority to take cost into account when determining whether a drug should be approved as safe and effective.
"I think there could be a lot of change if more people were aware" of the availability of the over the counter insulin," says Dr. Misbin.
Dr. Misbin says it is true that the inventors of insulin sold the patent to the University of Toronto for just $1 so that insulin would be available to all. He points to additional background as reported in "The history of Insulin" by Michael Bliss:
Indeed, Fred Banting refused to be on the original [insulin] patent feeling it was contrary to the Hippocratic oath he swore as a physician. The original Canadian patent was taken out by the chemist James Collip and Charles Best (who was still only a medical student). The patent was taken on by the University of Toronto, which later entered into arrangements with Eli Lilly to manufacture and market insulin in the USA.
Other findings from Medscape's Miraim Tucker:
- Findings from surveys of nearly 600 US pharmacy chains in 2018 were published online February 18 in JAMA Internal Medicine by Jennifer N. Goldstein, MD, assistant program director of Internal Medicine at Christiana Care Health System, Newark, Delaware, and colleagues.
- The results showed that OTC insulin is sold more commonly at Walmart than at other pharmacy chains and that inability to afford co-pays for prescription insulin was noted as a common reason for purchase, particularly at Walmart pharmacies.
In Medscape's article, experts caution use of over the counter insulin without medical supervision is "never recommended and could be very dangerous."