State’s Insulin Production Remains To Be Seen

According to the American Diabetes Association (ADA), there are 3.2 million California adults living with diabetes and another 10.3 million living with prediabetes. These facts are taking a huge financial toll on California, the ADA reports, with the combined direct and indirect treatment costs, tipping the scale at more than $39 billion annually.

Treatment and management of diabetes, and the associated costs, are layered and complex, but few things have come to symbolize the financial strain on patients, like the cost of insulin.

The AP reported insulin had a cost as low as $25 a vial in 1995, and the price today has skyrocketed in some cases to hundreds, if not thousands, of dollars per vial.

Dr. Clipper Young, a clinical pharmacist and associate professor at the College of Osteopathic Medicine at Touro University California (TUC), says the examination of cost to patients depends on a number of different factors that cloud the picture in terms of how effective California’s plan might ultimately be.

Dr. Young, part of TUC’s Diabetes Research Education and Management Team, points out the differences between type 1 and type 2 diabetes.

“Patients with type 1 diabetes either produce very little insulin on their own or none at all,” Dr. Young said. “Patients with type 2 diabetes, in general, still produce insulin, but their body doesn’t utilize it the way it should.”

For patients with type 1 diabetes, insulin is lifesaving, Dr. Young said. They need daily insulin injections or infusions (via an insulin pump) to live. The issue here, as far as California’s plan is concerned, is that patients with type 1 diabetes make up less than 10% of diabetes cases. For type 2 diabetes, the ADA has modified the management guidelines to use other injectables (e.g., GLP-1 receptor agonists) as the first injection if needed, Dr. Young said.

One patient with type 1 diabetes, identified for privacy purposes only as Morgan, explained how critical insulin is and how vital cost controls are.

“Insulin is so critical for me. It's basically my lifeline,” she said. “Right now the price for a vial of insulin is absurd. People that do not have insurance have to pay hundreds of dollars for something that is so vital for them.”

Even with good insurance, as Morgan has, the cost and quantity is still a major concern for her.

“There have been times where I have run low on insulin myself. I sometimes get nervous that I won't have enough insulin,” she said. “I shouldn't have to feel nervous about using up a medication that keeps me alive.”  

In more recent years, some clinicians have started shifting to drugs known as GLP-1 receptor agonists for managing type 2 diabetes, some of the most familiar agents being Ozempic, Victoza, and Trulicity.

“Insulin products are being replaced or not being started as the first injection in some patients, depending on the providers’ comfort levels to initiate these new agents.” Dr. Young said. “Some providers are a little reluctant to shift away from insulin agents to a GLP-1 receptor agonist.”

Another big factor is the type of insurance patients have. For those with commercial insurance and those covered under Medi-Cal, the savings might be negligible, Dr. Young said. However, for Medicare patients, with the infamous “donut hole” or a temporary limitation on coverage, or the uninsured, the savings could be significant.

There are some options currently to mitigate costs, Dr. Young explained, but the push by the state could help this situation even more.

“There are OTC insulin options (e.g., Relion R, N, 70/30) that can only be purchased at Walmart that are fairly affordable,” Dr. Young said. These new state options could expand a consumer’s choice, as well as help decrease costs.

“I do think it’s nice the state is stepping up to do something about the cost. California is being progressive in this sense,” Dr. Young said.