Copay Assistance

I have insurance through my employer, but my copay for the Humulin U500 my endo wants me on is $1100. There’s no way I can afford that. My first stop for assistance was Lilly but they only have programs for the uninsured. In fact, I can’t find any programs that offer copay assistance for Humulin. Any suggestions are greatly appreciated. I’m doing much better on U500 than I was on U100 and I don’t want to go back.

there might be something to help you on this page

and we have a U500 Group here fyi

I really sympathize with you on this. In my view there is some serious price gouging going on with U-500. Under my insurance I can get this as a 90 day supply as a branded preferred for $40. And the negotiated price is $243 from a retail pharmacy and $174 from mail order. How in the world are people being stuck with prices I hear about is beyond me. How can anyone possibly be asked to pay a co-pay of $1100 when the street price is well below $250.

What insurance do you have? Have you appealed? Have you gotten a letter of medical necessity from your doctor? As a last resort you can also complain to you state insurance commission.

Can you schedule a follow-up phone conference with your endo to discuss and explain your situation? Maybe he can write a letter to the insurance company explaining why it is medically necessary so they can adjust the copay?

I had no idea about this. While I can't directly address your problem, I did find this article that sheds some light on what's going on: Price Tag on Old Insulin Skyrockets (Medpage Today)

How much insulin are you using day to day? How does your copay for u100 compare? Not many people could afford a copay like that very often, is u100 not an option for you?

Thank you everyone! My solution to this dilemma will be to go back on u100. This whole insurance thing makes me nuts. I will get reimbursed 80% for my copays, but I don’t have the $1100 to begin with. My u100 copay is $198. The whole thing is ridiculous. I’ve talked to countless people about this and the bottom line seems to be that Lilly is protecting their corner of the market and does nothing to help people with the cost of Humulin. I’ve also considered looking into supplemental prescription insurance, if that’s even an option.

Actually, according to the article I linked above, Lilly is bringing the cost per unit consistent across their various insulins. At these much higher prices, the U500 is the same cost as U100.

So, unless you consume MORE insulin when using U500 than you do with U100, the cost of treatment should be about the same. You'd need 5 vials of U100 to cover the same insulin need that a single vial of U500 covers.

In the past, U500 was incredibly cheap compared to U100 for providing the same amount of treatment. Because of the sharp increase in T2 diabetics, with a concomitant increase in moderate to severe insulin resistance, U500 use is skyrocketing. Because of this, Lilly is bringing prices in line with other concentrations.

None of this helps, nor is it comforting. And when you're facing having to pay up front out of pocket and get reimbursed, the huge initial outlay is certainly very difficult for many to absorb.

However, in terms of your overall cost for insulin it will about the same whether you use U500 or U100. Whatever period of time a bottle of U500 would last you, you're still going to have to spend the same amount over that period, just in 5 chunks instead of one.

Sounds to me like you just need to get one bottle "free" up front, then bank the $$ necessary to buy the next one while you're using the first, buy the second and get reimbursed, rinse and repeat. I'd lay this out for your endo/doctor, and see if they can wrest a "sample" vial from their Lilly sales rep for you.

Finally, for simple Humulin R do not but Lilly's overpriced stuff. You can get a 10ml vial of R at Walmart for $25, over the counter, and it's just as good :-)

That's a good option you brought up. Whenever I need a bottle of Lantus to have on hand in case of emergency while traveling, my endo or CDE can usually give me one of their sample bottles.