An insulin supply can cost as much as $105 without insurance, but you could potentially save money through patient assistance programs and discounts.
Insulin manufacturers are cutting their prices due to public pressure, new competition from new players and changes in law that affect drug rebates. Insulin producers also seek to avoid paying billions in Medicaid rebates by cutting prices.
Costs for Generics
Insulin costs have skyrocketed in recent years, making the drug unaffordable to many with diabetes. Advocates are calling for price caps while some companies have taken steps to help. Insulin manufacturer Eli Lilly reduced its popular generic mealtime insulin vial list price from $50 in 1999 to $25 per vial this May; making it easier for people covered by commercial insurance policies to obtain the prescription insulin they require.
Insulin costs vary significantly based on how it’s purchased; those purchasing their prescription out-of-pocket often face much higher prices than those with health insurance due to insurers passing along discounts from manufacturers to their customers, which don’t always cover the full price of prescriptions; leaving patients responsible for paying any difference that might be quite significant.
People who are insured often face high copays or deductibles, which can be particularly burdensome for those on Medicare as they must meet the deductible before their insurance begins paying; sometimes this deductible exceeds $500, making insulin access difficult.
Pharmaceutical companies frequently assert that pharmacy benefit managers (PBMs) providing prescription benefits for commercial insurers drive up drug costs by mandating rebates to be included on an insurer’s formulary list of covered drugs. Unfortunately, however, that fails to take into account that some PBMs might omit low-priced generics from coverage lists if they can’t collect big enough rebates from pharmaceutical manufacturers.
Sanofi and Novo Nordisk have taken steps to address this issue, with Novo Nordisk’s MyInsulinRx program offering insurance-eligible patients access to 30-day supplies of insulin for $35; additionally, uninsured can use savings cards for three vial supplies at $99.
Advocates are pushing for legislation that would cap out-of-pocket insulin costs at no more than $20 per vial; Bernie Sanders, chairman of the Senate Health Committee has put forth such legislation.
Costs for Biosimilars
People without health insurance often pay over $300 for one vial of insulin, making it prohibitive to afford medication. But insurers and governments are taking steps to bring down prices; California legislators, for example, has called upon manufacturers to produce biosimilar versions that cost less. Blue Shield of California has taken further steps by teaming with non-profit drug makers in starting its own manufacturing operations.
Researchers from RAND Corporation estimated in 2023 that biosimilars could reduce annual spending on biologics by an estimated annual savings of $38.4 billion. Their estimate was derived using an alternative upper-bound scenario with faster biosimilar entry, increased volume share for new drugs, and more robust price competition.
Eli Lilly made an aggressive effort this spring to reduce insulin costs by offering non-branded insulin at $25 a vial – the lowest list price among mealtime insulin options and even less than what Humalog cost back then. Furthermore, the Insulin Value Program caps patient out-of-pocket costs at $35 or less monthly.
However, many patients still struggle to locate affordable options. When Lilly reduced the list price of its generic insulin, Whitney Daniels looked for it at local pharmacies but one told her they didn’t carry Lispro; another offered her bottles of their branded version at $70 a vial instead.
Insulin costs can also be affected by insurance deductibles and co-pays, with some plans charging flat co-pays per prescription while others charge a percentage of medication cost known as coinsurance – both can be waived once an individual reaches their annual out-of-pocket maximum limit.
Semglee and Basaglar (insulin glargine) biosimilars approved thus far have not significantly reduced costs for those without insurance, due to various barriers such as lacking enough data supporting interchangeability with Lantus/HuMALOG as well as resistance from middlemen controlling market share. When combined with inadequate competition and rebate issues discussed earlier, prices only tend to drop 15-20% from Lantus/HuMALOG prices.
Costs for Sliding Scales
Insulin prices depend on both your insurance coverage and payment method; whether paying cash or using drug discount programs; you can find the most cost-effective insulin price by shopping around and comparing pharmacy prices as well as taking advantage of savings programs readily available to you – one vial of Humalog could cost as little as $25 without insurance or opting out of an insurer’s prescription drug benefit plan.
Insulin costs have increased steeply, due to both patients being unable to afford it and pharmaceutical companies raising their list prices. A major cause is pharmacy benefit managers (PBMs), which administer prescription benefits for commercial insurance plans and pass along net cost of drugs to insured patients (often paying less than listed price). Pharmaceutical companies claim PBMs are driving up prices despite providing lower net prices than set by manufacturers for products they administer prescription benefits for.
As part of their efforts to increase insulin affordability, some major insulin makers are reducing list prices and expanding existing programs. Lilly announced in March that it would reduce its most popular insulin products, Humalog and Humulin by 70% and limit out-of-pocket costs for patients with commercial insurance to $35 monthly at participating pharmacies; additionally it has introduced the Lilly Insulin Value Program savings card which caps out-of-pocket expenses at $25 monthly at participating pharmacies.
Novo Nordisk and Sanofi also offer programs to ease the financial strain caused by high insulin costs. Last summer, Novo partnered with Walmart to sell generic versions at similar prices as the brand-name version; and in January Sanofi said its out-of-pocket costs would be capped at $35 a month for those covered by insurance and $99 monthly for those without health coverage.
Costs for Other Drugs
Insulin is a type of hormone that works by helping your body process glucose (sugar) in your blood. Without it, blood sugar levels could become dangerously high and lead to permanent damage of various parts of your body like eyes, kidneys, and nerves. Therefore it’s vital that insulin be taken correctly in order to keep blood sugar at healthy levels; your healthcare provider will prescribe an appropriate dosage.
Insulin costs vary greatly between patients depending on your pharmacy of choice and any available savings programs, but GoodRx drug coupons offer additional savings opportunities when purchasing insulin – though keep in mind these coupons do not cover copay or deductible costs.
Sliding scales offer another affordable way of accessing insulin, but can be restrictive in that they impose strict guidelines regarding when you should eat and exercise. Sliding scales may not be suitable for those traveling frequently or needing to alter their diet frequently.
Insulin manufacturers frequently offer patient assistance programs or discount cards to help people afford their medication, with some programs limiting out-of-pocket expenses to as little as $35 a month for insured individuals and lower costs for uninsured people. Some programs are run directly by manufacturers while others collaborate with pharmacies or organizations in helping patients afford their prescriptions.
San Francisco Department of Health has joined with pharmaceutical giant Eli Lilly to offer insulin free of charge to low-income residents under MedAssist program, in response to rising insulin prices that many individuals cannot afford their medication for diabetes. This initiative provides free insulin to anyone meeting specific income criteria. This response to rising prices provides much-needed assistance for people living with the condition who otherwise cannot afford their prescription.
Insulin prices have become an ongoing topic of discussion in both Congress and state legislatures. A Senate bill called the Affordable Insulin Now Act proposes capping how much people with Medicare Part D prescription drug coverage must pay each month for insulin at $35 or 25% of their plan’s negotiated rate, whichever is lower. But experts note that such cost-sharing caps only serve to address insurance side issues rather than decreasing actual prices of insulin.