Generic Insulin Substitutions

I heard on the evening news last night that the FDA has approved a generic insulin called Semglee. That alarmed me a bit. I am all for a less expensive insulin alternative, but I am not big on generics that I may be forced to take. Since I am on Medicare now, I can see them jumping on the boat with other insurance companies, trying to give us all the cheapest thing around.

Today I read an article in the Chicago Tribune from July 28 that had the following headline (and I have quoted part of the article):

FDA allows automatic ‘generic’ swap for brand-name insulin, making it easier and cheaper to get insulin at the drugstore

"Wednesday’s move by the Food and Drug Administration will allow pharmacists to automatically substitute the cheaper version, just as they do with generic pills for other kinds of drugs.

It’s the FDA’s first approval of an “interchangeable” biosimilar, a near-copy of an injected biologic medicine that’s manufactured inside living cells. It could save diabetics and health plans millions of dollars annually and encourage other drugmakers to create more biosimilar medicines. Health data firm IQVIA projects U.S. savings from increasing use of biosimilars from 2020 through 2024 will top $100 billion.

The FDA agreed that Viatris Inc.’s Semglee was interchangeable with widely used Lantus, a fast-acting insulin.

Approval of a second such interchangeable biosimilar of a long-acting insulin appears imminent from the same developers, Pittsburgh-based generic giant Viatris and its partner, India’s Biocon."

What are your reactions to this development?

They could cut costs by just cutting the price of insulin that costs them pennies to make. Big pharma is out of control and our government is in cahoots with them.

I also noted that the reporter did not know much about insulin. Lantus is a LONG-acting insulin, not a fast-acting insulin. I need to go check to learn what type of insulin Semglee apparently is able to replace. I don’t want to fill my insulin pump with something that may not work!

UPDATE: We know that the article was incorrect in calling Lantus a fast-acting insulin. Research shows that Semglee can replace Lantus since both are long-acting insulins.

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I certainly am not happy either as I notice a difference between Novolog and Humalog and yet was told by an endo once they are the same. And they actually are chemically different. Many people have a preference for one or the other, some don’t notice a difference and some lose complete control when switching.

I can’t imagine us all getting lumped into the same generic and possibly it being another chemical make up. Especially when control of our BG levels is so important to us. And for us mail order customers I sure hope we are given some kind of notice before we get sent 3 months worth of a totally different insulin.

Big Pharma is out of control on charges of costs of drugs in the US and some push is being made in trying to control those costs. But us as the users that need insulin to stay alive will pay the price for a pharmacist being able to substitute your long acting or fast acting with an alternative that they have decided is okay for all.

I am not a fan of Amazon pharmacy. I was checking out the list of drugs
they carry and their so-called substitution equivalent. I was not pleased. If anyone chooses to use them be careful.

I am sorry, but I disagree. Thank goodness the FDA approved Semglee as a generic equivalent for Lantus. I welcome the approval and I welcome the pharmacy swapping for generics.

Generics are equivalents and should be treated as such. If the generic does not work, your doctor will need to make the case to the insurer for substitution. Like all generics.

I am T1 and like Humalog. I will welcome the day we have a completely generic equivalent for Analog insulin’s.



I think it’s a great thing. It will drive down the cost of all insulin.
To the point where humalog and novolog and a few others will be the same cost.
If you notice both Lilly and novo began making their own generic insulin’s pretty recently because they saw this coming.
They are made the exact same way. It’s the same stuff with a different label.
This new product might not be as good but maybe it’s better.
Maybe we will have more choices.



Maybe back to the days when one vial of Lente cost about $4 (in 1965 $).

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It also forces innovation. Except for Afrezza, the insulin market has been painfully stagnant for many decades now. There’s no reason to invest in research when they can just keep making minor changes to extend their patent protection.

They’re going to have to come up with something new if they want to keep their market share and investors.

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Many of the current cohort of *journalists * completely ignorant of what they are writing or speaking about. Probably the editors or lack of editors compounds the problems.

It is ironic that they are writing their copy on a computer with a search engine to fact check. I get the sense they just don’t care.

A type 1 diabetic man I know was the head of the journalism department at Texas A & M in College Station, TX. He is quite bitter about the state of journalism today. Quoting him, “There are no journalists anymore!”

That is my concern. I don’t mind generics, and I applaud that something is happening which may lower the price on insulin for all of us. My concern is twofold. First, I want to be in control of my medications. I don’t agree that a pharmacist had the power to substitute one brand for another. That pharmacist does NOT know my medical history or my reaction to insulin, nor should he or she. I want to be asked which insulin I prefer, and perhaps if I want a single bottle to try before I have a three-month supply that may not work.

Secondly, because I have hypothyroidism, I am taking Synthroid. A generic came out for Synthroid, and doctors and patients soon learned that it did NOT work for many, many people even though it was supposedly chemically the same. My doctor has to write my prescription that says “no substitutions” each time she orders it just so I get the brand name drug that works for me. My daughter also has hypothyroidism, and a pharmacist gave her the generic since that is what her insurance covers. She had multiple doctor visits just to get the dosage of the generic right for her, and she still has numerous problems staying in control. In the end, the doctor visits cost more than just letting her have the name brand drug!

I don’t want the same thing to happen to us with insulin since we all rely on insulin to stay alive. I am willing to try a generic, but it must be MY decision and my right to go back to name brand if generic does not work.


MOST generics are equivalents, but they do not always work for all people. (See my comment above regarding Synthroid.) I am happy with generics, but I want to be in control of when I get one. I will try one, if necessary, but I don’t want someone with a four-year degree in Pharmacy to have more control over my medications than my doctor.

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Pharmacist, are Doctors of Pharmacy. Much like vets they are trained for all medical conditions with regard to prescriptions.

We will need to agree to disagree and that is OK. Both are opinions and preferences. All generics have the possibility of overrides and of course doctors can prescribe a name brand only. The issue is really insurance and what they will and will not pay for. Like I said I like Humalog, but if my company said they would only pay for Novolog, then I would need to seek a specific override to have them pay for it. They may or may not allow that depending on the case my doctor presents.

Novolog and Humalog are functional equivalents. So my case for an override would have to be strong. The same will be true here. The only thing the FDA did is make it so a pharmacist at the counter can make the decision to substitute based on price preference. It just simplifies the process at the counter when a pharmacists suggests your insurance will not pay for brand, but they will pay for the generic. Still it will be be the patient’s choice, albeit a very expensive one.

The introduction of generic and biosimilar drug formulations into the market can provide vital market alternatives that help make drugs more affordable. I applaud this development.

What I strongly object to, however, is any undermining of the power of the prescribing doctor or her/his patient to easily and effectively veto the preference of insurance companies and pharmacy benefit managers.

The important factor in this whole discussion is the primacy of clinical effectiveness versus chemical equivalency. Valuing the clinical judgment of the doctor over the economic interests of payers seems to be a no-brainer to me.

Drugs can exert effects beyond their known mechanism of action. So much discussion of this has taken place in the statin debate that they’ve made popular the term, pleiotropic effects, to describe unknown and unexpected benefits of a drug.

We’re familiar with this phenomena since we’ve all read about or witnessed very different glucose management results with the exact same insulin given to people of similar weight, fitness, and social experience yet ending in much different effects.

In short, I heartily support the development of generics and biosimilars as long as patients and their doctors have the clear power to retain the more clinically effective treatments when in conflict with payer policies.


Exactly. Well and eloquently said, Terry.


Because drugs, and in particular, insulin is grossly overpriced,something needs to give. Insurance companies don’t want to pay the completely unreasonable prices. We are therefore stuck in the fold.
We need to break the grip.
When I was diagnosed, my insulin was $17 per bottle list price. My insurance paid all but $1.70
A bottle now is over $400 and my copay is $30 per 3 months.

It’s gotten so out of control. Humalog and novolog have been around for 20 years. Don’t buy the line that we need to pay for the research. We are being gouged.

We are being taken advantage of by 2 companies who pricefix

We may want what we want, but the insurance company is not going to pay$400 for something that should be $50 max. Not if there is a reasonable alternative.

Lilly came out w non branded humalog. It’s half price, but exactly the same. How can they afford this?

Oh yea they still make $150 profit on a bottle of half priced insulin.
They also only make a few thousand bottles available, so we can’t really even buy it.

We have been hoodwinked. We’ve been taken advantage of.
We have been sold the bill of sale taht keeps us on a certain brand based mostly on lies.

I notice some difference in humalog vs novolog, but they are so similar it doesnt matter to me.

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Apidra was awful for me, I would have crashes in the middle of the night. I tried it for a month at the time. When I tried Novalog it was harder getting the timing down and after Apidra I didn’t want to try it much longer than a week when I knew Humalog worked so well. I have now tried fiasp as I wanted a faster insulin. I tried it several times. The first couple of shots it was great, then it quickly became like water. I was using 4 times the amount of insulin and still not dropping like I should and I used it by pen. So different areas, different pens etc were used.

I am not the only one that has a problem with fiasp, so how about you being told you have to use fiasp, whether it works as well or hardly at all or you have to pay a lot more for humalog? Because they are “functionally” the same? But Novalog (and Fiasp), Humalog and Aprida, while all fast acting insulins are made chemically different.

I would have to point out that the same issue of functionality can be used for blood pressure control drugs.

So I’m for generics being developed because we all know the Big Pharma companies are out of control and until they are made to do something, they obviously won’t. We do need the cost of insulin to come down. And for some who don’t notice a difference or care, it will be a great alternative. But to say all fast acting insulin is the same, so now you all will have to take the generic because it’s cheaper or you have to pay a lot more for a different one, to me, is insane.


Its always easy to spend someone else’s money. Why not go for the gold when insurance is paying the bill. No one will be forced to change insulin against their will, this new development brings the possibility that you may have to pay more for your brand of choice. Sadly some may be forced to make choices they do not want for economic reasons.

I had the same problem with Losartan( Cozaar). I can only use one of the generic forms from one particular manufacture not any other of the generic form from other manufactures.
I worry about when or if my pharmacy will stop ordering it, if it gets a better deal elsewhere.

The same hype came out with Basaglar that it was going to be less expensive and would result in end user savings. My Medicare insurance switched me from Lantus but my copays stayed the same and when I reached the donut hole, my out of pocket was almost the same as with Lantus. A year later my insurance dropped Basaglar.
Insulin is too critical to our health for Big Pharma to use us in the PR arena. Just cut the prices to what it costs to manufacture + 15% profit.