Does anyone know an approximate price range for insulin? I’m crunching #s to figure out which insurance plan to go with for next year, and most of the price info/threads I’m finding are from a few years ago. Or shady-looking online pharmacy websites….
I’m asking because one of the plans requires paying for everything upfront until hitting the deductible, including medications. Other plans are percentages. But I can’t find the price range for what it would cost in full. (I’m on humalog cartridges and levemir pens, if it matters) So knowing prices will help in my calculations.
Knowledgable estimates would be appreciated. Thanks!
PS - I don’t want to start arguments about insurance and the ACA. Just looking for info.
Pre-ACA, I had some luck determining the OOP prices of medications for my uninsured patients by googling "MSRP for _______________________ " (fill in name of medication).
Actually the answer may be both simpler and more complicated for you. While high deductible plans require you to pay the full cost of medications until you hit the deductible, you actually pay the cost of the medication as negotiated by the insurance plan. My insurance plan doesn’t cover the humalog cartridge but it does cover the humalog pen. I ran the costs against Aetna (and if I interpret the estimates correctly) it costs $435 for 5 pens and $410 for 5 pens of Levemir (Aetna quotes boxes of 5).
I believe you will need to run the prescriptions through the insurance rather than just paying cash. You will still pay 100% until hitting deductible but you will likely be charged a different (and cheaper) price. Perhaps others can chime in with their experiences.
Drug prices are actually quite weird. The market doesn’t operate as a free and open market and there are some significant distortions. There is something called Average Wholesale Price (AWP) but it turns out this number is totally made up. This isn’t actually the AWP is more like a price that drug companies want to get. A good example or recent AWP prices is here. This lists AWPs for Humalog as $168/vial, $325 for 5 box of kwikpens and $313 for 5 cartridges for Humapens. This is information most companies don’t want us to find out. Insulin prices are not as distorted as other drugs so you will probably find that the walk up prices are a bit higher than the AWP.
I am sure you are correct. But I still hadn’t realized how absolutely insane the pricing had become.
I knew enough to be concerned about how much it cost when I filled a script for a box of Enlite sensors. But I never thought to realize that filling my prescription for 4 vials Novolog could cost the VA up to $800. I have no words.
At least now I understand why some folks want to be avoid wasting insulin as much as possible.
I just refilled my Rx for Novolog vials. I was in shock ! But not what you would think. It was $2.50 per vial at local pharmacy.
Last refill it was $9 per vial, and in past as much as $40-50/vial (20% copay).
So the price can vary significantly, even within the same plan year.
If you are checking insurance websites, you may find links to their formulary, which may give you an idea of what brands are covered and what tier they are in.
Several years ago, I had a plan that would charge 30% co-pay, with a max of $130 for 90 day supply, regardless of quantity. My cost averaged 20-30/vial, and a couple times hit the max $130, so was protected from the higher actual prices.
[quote=“roodgirl, post:1, topic:48687, full:true”]
Knowledgable estimates would be appreciated. Thanks! PS - I don’t want to start arguments about insurance and the ACA. Just looking for info.[/quote]This really depends on your location and the available pharmacies to you. I agree with tiaE here who said:
