Lord but I am glad I lived in the UK where insulin is provided at no cost to diabetics and when I returned to Canada to look after my mother the maximum charge for my insulin was 140.00 dollars for a five vial pack of Novorapid and the same for the Levemir I was taking then. The price is negotiated by the government as to what they will pay for the drugs under the various subsidy programmes like the Childrens Exemption, the Drug Assistance and the Drug Benefit Programme.
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I certainly agree. However, it is not the timid who get into politics. Nor is it usually the timid who make comments on public forums.
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I wanted to clarify a couple of points in this discussion regarding insulin copay and Medicare. Medicare Part B will pay for an insulin pump every 5 years, and the insulin co-pay is $35/VIAL Likewise part B covers pump supplies, and CGMs.
If you INJECT insulin, or use a pen to inject, it is not covered under Part B, but your supplemental plan. The copay for the supplemental plans are $35/Month, 3 months at a time, regardless of how many vials you use in a month.
Mike
Injected Insulin and prescription drugs are covered under Medicare part D.
And it is volountary by the insurance companies. I had to search insurers (and we all know how hard that is) and find out who was volunteering and change my drug coverage to one who would cover it at that $35 per month. 
“Regardless of how many vials you use in a month” is the key, hint, hint 
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The insulin copay for insulin used with a pump is 20% of Medicares negotiated price for insulin, which is less than the "list price.
Medicare is exempt from all state laws that dictate insulin prices.
Part D supplemental plans for “insulin” vary widely in what types they will cover and how much they will pay. There is no national requirement for insulin to cost $35/vial under any plan. A few plans from a few companies claim to offer some forms of insulin for a significantly reduced cost, but none covers every commercially available synthetic insulin analog at a fixed cost.
Even companies that brag about their insulin coverage weasel out of it in various ways.
Here’s an example. Human synthetic insulin is falling out of favor, displaced by faster onset and longer duration forms because of heavy promotion by their makers. This is spite of no large clinical trial ever demonstrating better outcomes from the use of analogs. The cost of Humalog and Novolog have risen from ~$25/10ml vial to more than $150/vial since 1996 and 2000. That’s a 600% increase while the value of the dollar has less than doubles.
Novo Nordisk sells its Insulin Aspart (Novolog)through Walmart at $58/vial and Human synthetic Insulin (Novolin) for $25.
The Human/Walmart Value Medicare D Plan specifically excludes Relion co-branded Novo Nordisk insulins. If you buy Novolin over the counter in a Relion carton, it’s about $26/vial. If you buy it “covered” by Humana, it’s ~$144/vial, and after you pay +$400 annual deductible, its 16% of that, or $23/vial.
This is true of all Humana Part D Illinois plans in 2022, compared to 2021 where they paid for the Relion version at 25% of $25 or $6.25/vial after the copay was met.
So in 2022 you pay more for the same exact product in a different box.
One thing that is pretty cool about the bill is that i think it would require insurance companies to cover Afrezza. I’m not a lawyer, but here’s the text defining insulin products followed by the relevant portion of the bill:
“ SELECTED INSULIN PRODUCTS.—The term ‘selected insulin products’ means at least one of each dosage form (such as vial, pump, or inhaler dosage forms) of each different type (such as rapid-acting, short-acting, intermediate-acting, long-acting, ultra long-acting, and premixed) of insulin (as defined below), when available, as selected by the group health plan or health insurance issuer.
…
SEC. 9826. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN INSULIN PRODUCTS.
“(a) In General.—For plan years beginning on or after January 1, 2023, a group health plan shall provide coverage of selected insulin products and, with respect to such products, shall not—
“(1) apply any deductible; or
“(2) impose any cost-sharing in excess of the lesser of, per 30-day supply—
“(A) $35; or
“(B) the amount equal to 25 percent of the negotiated price of the selected insulin product net of all price concessions received by or on behalf of the plan, including price concessions received by or on behalf of third-party entities providing services to the plan, such as pharmacy benefit management services.“
Here’s a link to the bill: https://www.congress.gov/bill/117th-congress/house-bill/6833/text?r=1&s=1
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In the Medicare group, it was only for seniors who get insulin through Part D.
This. Whatever it is it is still way too much. It’s sickens me to see people with chronic health conditions and who are gravely ill be raped by the for profit medical system in this country.
My co-pay for 90 days novolog just went up by $50 because the pharmacy was changed on my insurance and they’re now saying that it’s not the formulary. I had a letter written about six years ago that said I could stay on NovoLog for life because when I tried the formulary my blood sugar was all over the place. Now I have to go through this whole process of contesting this again and having my doctor write letters etc.
When I started on novolog it was the formulary, but they think they can just switch these around according to whatever deals they’ve made and it has no effect on your health, which some pwd know it most certainly has an effect since they all have different timing and we all react differently to them.
In addition most of my diabetes co-pays have gone up by $30 over the past 2 to 3 years. In addition Doctor co-pays have gone up the same amount. It now costs me $50 to visit a doc and most of the time it’s a waste of time anyway.
Some of these doctors now only require me to go every six months thank goodness. But what effect is that going to have on my health if something is missed.
One doctor I went to in December that did a lot of testing because I had lost a lot of weight is making me come back for an office visit talk to me again. Instead of just getting on the phone with me. I have been sick numerous times and had to cancel most of the appointments and I was wondering if I should even bother going back because I don’t think they are going to help me. There were some results on the tests that could’ve easily been discussed on the phone.
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One thing that this discussion highlights is that for those of us in the US, there are so many insurance companies, plans, coverage rules, formularies, and copays that I would wager that no two of us live under exactly the same set of rules. That is nuts!!! From that perspective, I feel SORRY for our providers and pharmacies that have to navigate literally thousands of different sets of coverage rules and constraints. That, it seems to me, exacerbates the cost of things like insulin.
I am very lucky: I’m old enough to have Medicare … one of the rare cases where being older is an advantage … and have extraordinary supplemental coverage from a former employer. But it is tragic that the OOP costs of being a diabetic are so high for so many Americans. Yes, drug companies bear responsibility … but so does our bizarrely complex insurance system.
Stay safe … and sane … out there.
John
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