Why does insulin require a prescription in the US?

#61

In several states, legislation to help ensure diabetics (and others) get an emergency refill of medicine (often specifically insulin) has passed, and in other states it’s been shot down.

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#62
#63

The only time that I heard about such a crime in the news was when the husband allegedly gave his wife, Sunny von Bulow insulin (he beat the rap) that put her into a 28 year coma until she died.

#64

I bet a baseball bat has been used more often to kill someone. What about a candlestick? Sorry, couldn’t help myself.

I suppose the theory insulin would be that it could be hidden better. But can’t a lot of poisons be hidden better and you can inject quite a few things that would cause death?

#65

This just seems like another one of those things people don’t think through fully, and then just accept it as being legitimate. On the surface, sure that makes sense, but when you think about it harder there are plenty of things that can be used to kill someone and even plenty that could make it look like natural causes. Also, I think it would be safe to say that if someone isn’t insulin dependent diabetic then a life threatening low caused by insulin injection would be suspicious. And if they were insulin dependent, well, not only would they already have insulin available for a likely killer to use (many if not most crafty killings are done by someone the victim knows), but it would be safe to say they know how to use it correctly. There are always exceptions, but I don’t think that is a good enough reason to disallow OTC sales.

#66

On the other side of the coin, couldn’t we kill people by taking the insulin away? That, frankly, seems to kill more people than actual insulin murders (although, I have heard of that).

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#67

It is not just an issue of money but public safety. For the record there are several documented cases where insulin was used as a murder weapon. Like many other medications too much of a good thing can prove lethal.

#68

Meanwhile, from Canada …

A system set up to protect patients instead allowed a nurse to go on killing the frail and elderly in her care for almost a decade, a public inquiry into the province’s long-term care system has heard.

… Wettlaufer continued working at half a dozen other facilities in the next two decades, killing eight patients in her care by injecting them with insulin, and trying to kill or harm six others.

#69

In many states human insulin (i.e. Regular and NPH) is available over-the-counter. At one time, many decades ago, I think this was true in all of the States.
The insulin analogs are all relatively new. They have come onto the market in the last few decades. These are treated similarly to drugs – they are novel to the body. That is the regulatory rationale, to a large extent, I believe.
More interesting to me than the regulatory treatment of human and analog insulins is that of injectable glucagon and epinephrine. This has become a big racket, I think, because these have become so profitable as emergency supplies for anaphylaxis and similar acute immunlogical reactions. They used to be available as emergency supplies for diabetics, I think. They still are so for animals, but require a medical license to purchase at any reasonable price as such. This, I think, is purely racketeering produced by coopting of government regulatory agencies by the manufactured-hormone suppliers.
Anyone know more about the market history of these emergency hyperglycemics?

#70

P.S. Admittedly, the advent of CGMs and suchlike has made dependence upon emergency hyperglycemic injectables less common or frequent. I think the injectables became more strictly regulated (and exorbitantly expensive) well before the CGMs were widely available, though.
And CGMs are also prohibitively expensive for most, unless well covered by insurance. I don’t have one, and probably never will. I am a lifelong diabetic and require insulin.
I think that CGMs are only common for T1Ds. I am HNF1-alpha (monogenic).

#71

My recollection from nearly 40 years ago is that a glucagon kit was about $20 and came in a wooden box with glass syringe and had to be refrigerated. Like today’s kits it is mixed up at usage time. Life in refrigerator was short, just a year? I got mine back then with prescription but do not know if it was also available without prescription.

Today a glucagon kit is closer to $300.

On epinephrine: bulk epinephrine in a vial is just $5. It is available by prescription. Epi-pens are $600 for two of the brand name ones, or $200 for the cheaper ones.

#72

Yeah, I have only been diagnosed (initially by self) for less than a decade, and my own recollection has to do with diabetic friends and colleagues. What you say sounds right. A year in the 'frig is pretty good – not what I would call short. I guess $20 was more four decades ago than today, but at least not prohibitive for most. I was in college then, and my annual living expenses were maybe $2k in the mid '70s. But I was very frugal too.

You mention “bulk” epinephrine. I have CVID (a polygenic, or primary, immunodeficiency) and now infuse (antibodies, of which I make none of my own) weekly, and I must have epinephrine available at all times for the infusions. It is paid for by insurance, but many hundreds of dollars, and has to be renewed after one year at most. This is what I am referring to as the “racket”. Glucagon is much more effective than adrenaline for quickly raising BG, being the “primary” hormone, whereas adrenaline is only a secondary response (endogenously).

I looked into all of the options for obtaining vial epinephrine, whch indeed is sold widely for < $10. But only to licensed pro’s, including vet’s. Furthermore, even if I had found a source (and I did not) for myself, it would not have satisfied the requirement of verified purchase, with prescription, of one of the pen-forms of epinephrine. My “specialty pharmacy” and immunologists’ office regularly verify that I have the in-date pen. So all of this is some background for my comments. Even as a diabetic I cannot access either hormone in a vial. Patients taking beta blockers and having various common conditions can be refractory to epinephrine, moreover, but glucagon is still effective for emergency treatment of acute immunological reactions.

Tim12

    April 12

Mac2:
More interesting to me than the regulatory treatment of human and analog insulins is that of injectable glucagon and epinephrine. This has become a big racket, I think, because these have become so profitable as emergency supplies for anaphylaxis and similar acute immunlogical reactions. They used to be available as emergency supplies for diabetics, I think.

Anyone know more about the market history of these emergency hyperglycemics?

My recollection from nearly 40 years ago is that a glucagon kit was about $20 and came in a wooden box with glass syringe and had to be refrigerated. Like today’s kits it is mixed up at usage time. Life in refrigerator was short, just a year? I got mine back then with prescription but do not know if it was also available without prescription.

Today a glucagon kit is closer to $300.

On epinephrine: bulk epinephrine in a vial is just $5. It is available by prescription. Epi-pens are $600 for two of the brand name ones, or $200 for the cheaper ones.

#73

That can be an issue with many legal things so it is not a valid reason. Older Insulin is available without rx although at a pharmacy as I recall so otc is the next logical step.

#74

This is so stupid.

If they ever refused to give me an Rx I would go in with a weapon and take it before I would just give up and die from keto acidosis.

Its extortion being required to buy an insulin purchase permission slip. Pay or die is what they are saying.

Paying for the product, that’s different and not problem.

#75

You don’t need go to the pharmacy with a weapon. You sound like my best friend. Its frustrating. But, its just as satisfying to make a scene…you just don’t want to end up in jail. That can’t happen to you as a diabetic.

What you need is a good pharmacist, who you trust. There are bright, young things out there. You gotta shop around. Find the best ones in the area and remember them. Your favorites will not always be working. Establish a relationship with one or two. They will help you.

I am lucky, now. There is a really, really good one in my town and also an excellent, much-beloved one in the neighboring town. The much-loved one has a nephew who is a diabetic and asks me lots of question about diabetes.

Before I knew these two, I had to drive around and around to different pharmacies a lot. There is an endless stream of pharmacists. If one gives you an answer that you dont like, you can go find another.

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#76


https://en.wikipedia.org/wiki/Uruguayan_Air_Force_Flight_571

I know but I also know what people do when the reaper is near by.

It was just my first initiation to this, my ID was at home someplace and they asked for it to buy needles and that little bit of terror “what if I can’t find it?” I had this habit of chopping my syringe with these wire cutters after use, weird I know but using a used one was not an option so that breif but pretty intence terror of what if, what am I going to do really made me feel so helpless. I still resent the hell out of it.

image

Show me your papers or go get sick and die is what I heard.

#77

Thanks, I can see that. We both have fighting spirit rebellious posts. Some of us have to, imagine how bad they would treat us all if no one made noise and started sh*t.

“I need my needles, my medicine”

image

No, not me. Not happening.

#78

Although I’m in a “good place” right now, being in my 50’s with a grey buzz cut and a steady job, things weren’t always so easy to get a good working relationship with health care professionals. It was substantially harder for me when I was college age.

Part of it is how I look now, but another perhaps larger part was attitude and interpersonal skills. I sucked at those when I was 20 but have some experience today.

Perhaps an important part of transitioning to adulthood that would help a lot of T1’s, would be some sort of boot camp on how to get prescriptions filled and doctor’s appointments. This is not something I was ever taught in school and to tell you the truth having my pediatrician do everything for me when I was younger made it super hard for me to transition to adult healthcare system when I was college-age.

I don’t know how old our member IgotT1 is, but I would not be surprised if he is having some of the same struggles that I had.

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#79

@IgotT1. I’m pretty good about keeping a stash of important stuff. You might already be doing it now. So because it’s smart anyway and should make you feel better, why not have a couple of packs put away in a cupboard as emergency back up? Lol, I always had an extra box or two. I still do as I use them for my dog. Since syringes keep forever you don’t have to worry about expiration dates. Ask your doctor about needing more, you can tell her what happened or say you’re giving yourself extra shots nowadays. It’s great, I’m now in a state you can buy them OTC if I need too!

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#80

It took me 25 years to figure out how to buy insulin. It still doesn’t always work. There are always new hang-ups. I blame system complexity. I, honestly, wish I had better advice for him. Some things get better and some things get worse. Its so dynamic. Like, I used to keep paper Rx on file and up to date to deal with repeated computer system failures. But, that doesn’t work anymore because no one allows paper Rx because of opioid stuff.

Hey, @IgotT1, how old are you…if you don’t mind me asking? Lots of people complain they profiled more heavily at a younger age. Maybe you look younger than you are. That happens to me. Super frustrating. I keep thinking I’ll hit some sweet spot where I have some type of innate authority from my age. Hasn’t happened yet. I am 37. Today, the accountant called me a ‘millennial,’ and my heart just sank.

How long have you been diabetic?