Diabetes is no small issue in the United States. There are approximately 30.3 million people with diabetes in the U.S., according to the Diabetes Research Institute. Five percent of them—or about 1.5 million people—have type 1 diabetes and require insulin to survive. Some people with type 2 diabetes can control blood sugar with diet and activity. Still, many need insulin, especially as the condition progresses.
And, unfortunately, insulin prices have risen dramatically over the past 10 years. Between 2012 and 2016, the price almost doubled, according to the Health Care Cost Institute. In 2012, the average cost of insulin per diabetes patient was $2,864 per year. By 2016, it had risen to $5,705. Today, one vial of insulin can cost $250, and some people need six vials per month.
In addition to that, there are other diabetes supplies, such as a glucose monitor, test strips, lancets, and a safe place to store used syringes or pens. It could easily cost someone without insurance $1,300 per month to care for the condition. Even with insurance, copayments and supplies can eat away at your monthly budget. Luckily, there are savings options.
How much is a bottle of insulin?
The cost of one insulin vial varies depending on the type of insulin you use and how you are paying for it. But, no matter the cost, there are alternatives to paying cash price.
“If you do not have insurance, the pharmaceutical companies that make insulin products offer patient assistance programs,” explains Michael Carnathan MD, a board-certified family physician in Bethlehem, Pennsylvania. “Most of the time, the patient can get the insulin for free or at a very reduced cost.”
For those without health insurance, the older human insulins cost anywhere from $25 to $100 per vial; for example, Walmart has human insulin available at $25 per vial. The newer human analog insulins cost between $174 to $300 per vial, according to a report published in 2018.
How much does a bottle of insulin cost with insurance?
It is difficult to say how much a vial of insulin costs when paying through your health plan. Each insurance plan covers insulin products differently.
“It is when you actually have health insurance coverage that getting the insulin for a decent price becomes a problem,” says Dr. Carnathan. “In those cases, the patients are sometimes forced to switch to a different and cheaper type of insulin called NPH or 70/30 among a few others. These insulins have been around for a long time and are affordable. The patient needs a primary care doctor or endocrinologist who is comfortable using these older insulins and adjusting them safely.”
Each health plan has varying copays and deductibles, too. For example, for people with a high-deductible plan, the cash price for insulin is paid until you meet the deductible. Some copays can be as high as 50% of the cost of the medication.
It can also sometimes be difficult for people on Medicare to afford insulin. “Many patients who are faced with the high cost of insulin find themselves caught in the Medicare donut hole,” says Gail Trauco, RN, the principal CEO of The PharmaKon LLC.
Like uninsured customers, patient assistance programs might be of help to Medicare customers. However, these programs require an application, which can take 30 to 60 days for review and approval, and documentation with receipts to confirm your monthly cost-of-living expenses.
Due to the public uproar concerning the high prices of insulin, some insurance companies and drug companies are taking steps to lower the monthly cost. For example:
- Cigna and Express Scripts are capping the monthly out-of-pocket costs at $25 per month. ExpressScripts estimates around 700,000 people with diabetes will be eligible for these savings. However, employers must opt into this program.
- Sanofi, one of the major suppliers of insulin, is creating a program for cash payers. This program costs $99 per month and provides either 10 vials, 10 boxes of pens, or a combination of the two. People with Medicare, Medicaid, or other federal and state programs are not eligible for this program. Anyone else, regardless of whether they have health insurance, can participate if they pay cash for their insulin. The $99 may not cover all the costs, and supplies might cost extra.
- Eli Lilly recently came out with a generic version of Humalog that sells for half the price, at $137.35 per vial.
Are insulin vials cheaper than pens?
There is a significant difference in insulin prices between insulin vials (via syringes) and insulin pens. Using vials is less expensive than pens. However, some people feel that using pens as a delivery system provides a higher quality of life. The pens come prefilled, and when using the analog medications, the number of doses could be lower. The pens make it easier to take insulin with you, providing more freedom.
Using pens is safer, more convenient, and offers better glycemic control, according to a study published in 2018. However, this study also noted that people who use pens were spending significantly more each month for diabetes control. In some cases, it was three times more expensive to use pens.
How much does a month of insulin cost?
Everyone has different insulin needs. There isn’t a “one size fits all” approach to determining how much insulin you need. Those taking analog insulin take a background or basal dose once or twice a day. In contrast, those taking regular human insulin take it three to four times a day.
This cadence is the only insulin some people with type 2 diabetes need. But for type 1 diabetes, and some with type 2, additional insulin is needed at mealtime. Depending on which insulin you are using, it should be taken 10 to 30 minutes before your meal. The amount of insulin depends on what you plan to eat. For example, you might need 1-3 units per carbohydrate portion (15 grams).
People with type 1 diabetes generally use two different types of insulin per day. They start with two injections per day and progress to three to four doses per day, according to the American Diabetes Association (ADA). People with type 2 diabetes might start with 0.5-0.8 units per kilogram of body weight per day and eventually take 1-2 units per kilogram of weight. For a person weighing 150 pounds, this would be 68 to 136 units per day. For a person weighing 175 pounds, this would be 80-160 units per day.
One vial of insulin contains 1000 units, and pens contain 300 units.
The following table compares drug prices of different types of insulin for a 30-day supply based on three vials or 10 pens per month. The table includes average insulin prices; though, you might pay a different amount based on your area and your pharmacy. Adjust the costs up or down, depending on what you require.
* Based on three vials or 10 pens
In addition to the above costs, you might also require additional supplies, such as:
- Syringes: $15-$20 for a box of 100
- Test strips: $25-$60 for 50 test strips (may require anywhere from 1 to 10 per day)
- Pumps: Can cost $6,000 to purchase a pump plus $3,00 for supplies such as batteries
What’s fueling the rapid increase in insulin prices?
There is no doubt that the prices of insulin have reached a tipping point where some people can’t afford their medication. In a presentation for the ADA, Irl B. Hirsch, MD, explains that from 2013 to 2016, a vial of glargine insulin had a price increase of 593%, and a box of five insulin lispro pens rose 522%. During that time, inflation rose by only 8.3%. In 2014, drugmakers increased the price of insulin twice, each time for approximately 16%. That means insulin prices rose by over 30% in one year.
There isn’t just one reason for the high cost of insulin. Pharmaceutical companies complain that pharmacy benefit managers (PBM) administering prescription benefits for commercial insurance companies drive the cost up by requiring rebates to have their brand of insulin included in the insurance formulary. They claim their net price is lower than the list price. But the PBMs say it’s the pharmaceutical companies who set the list price.
Several factors keep insulin prices high:
- There are only three major insulin makers worldwide. With little competition, they can set whatever prices they want.
- It is difficult and cost-prohibitive to develop a generic version. In the drug industry, drugmakers can submit research to the FDA for other medications if they can prove that the two drugs are chemically the same. But the FDA does not allow you to use the same research for biologic insulin products. That means bringing generic insulin to market becomes a costly endeavor, leaving only brand-name drugs available.
- As with the pharmaceutical companies, there is a lack of competition in the PBMs, giving companies, such as CVS Caremark and Express Script, the ability to make their own rules. Hirsch indicates that in 2013, CVS Caremark had revenues of $123 billion, and Express Script was at $94 billion.
Higher levels of competition would lower prices, increasing the affordability of insulin.
The rising cost of insulin has real-world consequences. A group in Minneapolis reportedly take a bus to Canada to purchase insulin at a fraction of the price as it sells for in the United States.
Some people are also rationing their insulin by either splitting or skipping doses. Both have serious health consequences. After aging out of his mother’s health insurance, one 26-year-old man was informed by his pharmacist that his insulin and supplies would be $1,300 per month. It was more than he could afford on his restaurant manager’s salary. Less than a month after losing his insurance, he died. His family believes he started rationing his insulin, and that is what killed him.
A few state governments are also trying to lower the prices of insulin. Colorado capped the insulin copay at $100 per month for insured people. Nevada passed a law to increase transparency in drug pricing, looking to combat not only the rising cost of insulin but the increasing cost of all prescription medications. Twenty-three other states have proposed legislation aimed at tackling the high costs of prescription drugs.
How much does it cost to produce insulin?
A 2018 study estimated that one vial of human insulin costs $2.28-$3.42 to produce, and one vial of analog insulin costs $3.69-$6.16 to produce. The study revealed that a year’s supply of human insulin could cost $48-$71 per patient, and analog insulin could cost $78-$133 per patient per year.
The study measured the manufacturing cost only. It did not include administrative fees, sales, and research and development for improving medications. However, insulin manufacturers have not provided an adequate explanation for this large discrepancy between production costs and retail costs.
How to save on insulin prices
Contact your insurance company (for those who are insured) and find out how your policy pays for insulin. Do they pay more for certain types of insulin? Do they exclude certain types? If their payments or exclusions don’t work with what you are taking, talk to your healthcare provider about options. Some insurance companies will accept what is called a prior authorization, which means your doctor writes a letter explaining why you need a specific type of insulin. Find out what your deductible is and how you will need to pay out of pocket. Ask if they have any special programs for insulin, such as the one offered by Cigna.
If paying cash, take advantage of programs offered by pharmaceutical companies, such as the one provided by Sanofi. Add in additional costs of supplies to see what you will need to pay each month.
Look into patient assistance programs offered by most major pharmaceutical companies, like Eli Lilly and Novo Nordisk, and some non-profit assistance programs, such as Rx Hope, that provide prescriptions for free or low cost to low-income and uninsured.
Take advantage of a prescription savings card from Singlecare. Over 35,000 pharmacies accept SingleCare coupons. You can enter your zip code online or on our mobile app to find the pharmacy with the lowest price for your insulin. Then, bring in your prescription and your SingleCare card to receive the discount. Joining SingleCare is free.