Insulin over the counter

VERIFY: Can diabetics buy $25 ‘over-the-counter’ insulin at Walmart?

WASHINGTON — QUESTION:

Can diabetics buy $25 ‘over-the-counter’ insulin at Walmart?

ANSWER:

Yes, but it’s technically ‘behind-the-counter,’ because even though you don’t need to show a pharmacist a prescription, you still need to get it from a pharmacist. Currently the only insulin offered OTC is Human Insulin, NOT Analog.

SOURCES:

Marilee McInnis- Corporate Affairs, Global Communication at Walmart

Sandy Walsh- U.S. Food & Drug Administration Press Officer

PROCESS:

Rising prescription drug prices are soaring, creating a national outcry and the very real decision to choose between food and life-saving medicine.

More than 30 million people in the U.S. are living with Diabetes, according to the American Diabetes Association.

One of you asked us whether insulin could be bought for a fraction of the price over the counter at one major retailer.

“Would you and you team please verify this post from Facebook?,” a Viewer wrote to the Verify team. “If this is not true, I feel so bad for the people who might be duped.”

I don’t use this but I hope it helps someone that does. Please talk with your Dr before making any changes in medications.

With more than 135,000 shares, this Facebook post shows a a TV news graphic which quotes a viewer who claims you can purchase $25 insulin from Walmart without a prescription.

This appeared during the TV stations “Viewers’ Voice” segment, and the anchor ends by saying, “try it, if it works I’d like to hear from you.”

So is it true?

Our researchers reached out to a spokesperson from Walmart; they confirmed, yes, they offer less expensive insulin without a prescription.

“ReliOn is the only private brand insulin on the market, retailing at $24.88 per vial, and $42.88 per box for the 70/30 pens,” Marilee McInnis, a Walmart spokesperson, said.

The drug is technically considered, ‘behind the counter,’ since you can’t pick it off a shelf, but have to get it through the pharmacy.

“It is the only insulin available over the counter, but it is kept behind the pharmacy counter,” McIniss said. “There is a quantity limit of 4 vials or 4 boxes per transaction. We sell ReliOn insulin in all states, in all stores, that have a Pharmacy.”

The rising cost of insulin is no joke. The American Diabetes Association found that an uninsured person with diabetes could pay up to $480 a pop for insulin.

But keep in mind what you’d be paying for, this behind-the-counter insulin is called Human Insulin, it’s the older version, which takes slower to metabolize than the newer Analog version.

“All of our Relion Insulin is Human Insulin,” McIniss said. “We currently do not offer Analog insulin OTC.”

Different insulin differ in how soon they start working, when the insulin works its hardest, and how long it lasts.

The FDA says it’s very important that people with diabetes never stop taking medication or switch medications without discussing it with a health professional.

Insulin can have different strengths and trigger different reactions with your body.

So yes, we can Verify, you can purchase ‘over-the-counter’ insulin at Walmart for a fraction of the price, but always consult your doctor first.

You Can Buy Insulin Without A Prescription, But Should You?

Carmen Smith now gets the insulin she needs via her doctor’s prescription. When she lacked health insurance, buying a version of the medicine over the counter was cheaper, she says. But it was hard to get the dose right. Lynn Ischay for NPR hide caption

toggle caption Lynn Ischay for NPR

Carmen Smith now gets the insulin she needs via her doctor’s prescription. When she lacked health insurance, buying a version of the medicine over the counter was cheaper, she says. But it was hard to get the dose right.

Lynn Ischay for NPR

As anyone with diabetes can tell you, managing the disease with insulin usually means regular checkups at the doctor’s office to fine-tune the dosage, monitor blood-sugar levels and check for complications.

But here’s a little known fact: Some forms of insulin can be bought without a prescription.

Carmen Smith did that for six years when she didn’t have health insurance and didn’t have a primary care doctor. She bought her insulin without a prescription at Wal-Mart.

Once the pharmacist says yes, the clerk just goes to get it, Smith says. “And you purchase it and go about your business.”

But it’s still a pretty uncommon purchase.

Smith keeps the tools for controlling her diabetes in this kit, which contains metformin, syringes, fast-acting insulin for daytime use and slow-release for overnight. Lynn Ischay for NPR hide caption

toggle caption Lynn Ischay for NPR

Smith keeps the tools for controlling her diabetes in this kit, which contains metformin, syringes, fast-acting insulin for daytime use and slow-release for overnight.

Lynn Ischay for NPR

Smith didn’t learn from a doctor that she could buy insulin that way. In fact, many doctors don’t know it’s possible. When she no longer had insurance to help pay for doctors’ appointments or medicine, Smith happened to ask at Wal-Mart if she could get vials of the medicine without a prescription. To figure out the dose, she just used the same amount a doctor had given her years before.

It was a way to survive, she says, but no way to live. It was horrible when she didn’t get the size of the dose or the timing quite right.

Smith says her guesswork put her in the emergency room a handful of times over the years.

The availability of insulin over the counter presents a real conundrum. As Smith’s experience shows, without training or guidance from a health care provider, it can be dangerous for a patient to guess at the best dosage and timing from version to version of insulin. On the other hand, being able to afford and easily buy some when she needed it may have saved her life.

There are two types of human insulin available over the counter; one made by Eli Lilly and the other by Novo Nordisk. These versions of the medicine are older, and take longer to metabolize than some of the newer, prescription versions; they were created in the early 1980s, and the prices range from more than $200 a vial to as little as $25, depending on where you buy them.

Dr. Jorge Calles, an endocrinologist at MetroHealth, Cleveland’s public hospital, is alarmed to think that some people are self-medicating with any sort of insulin.

“It’s a very serious situation if they are selling it over the counter — without any control with a prescription, specifically,” Calles says.

According to the medical consulting firm IMS Health, about 15 percent of people who buy insulin in the growing U.S. diabetes market purchase it over the counter without a prescription.

The U.S. Food and Drug Administration declined multiple requests by NPR for an interview on this topic. But, in an email, an FDA representative said that the versions of insulin now available over the counter were approved for sale that way because they are based on a less concentrated, older formulation, “that did not require a licensed medical practitioner’s supervision for safe use.”

The broader availability of this form of insulin allows patients with diabetes to obtain it “quickly in urgent situations, without delays,” the FDA says, and is intended to increase patient safety.

Still, some people with diabetes, as well as some doctors, doubt that the benefits of that greater availability outweigh the risks, especially for patients who switch from one type of insulin to another without telling their doctor.

“This is not something that should be done without the help of a professional,” says David Kliff, who has Type 1 diabetes and writes the Diabetic Investors blog. Kliff has followed and written about the expanding business of diabetes for years.

FDA officials are “basically sticking their heads in the sand” on this issue, Kliff says, and making a lot of assumptions.

“They look at insulin as a drug,” he says, “and say, ‘There’s this enormous body of evidence that shows that the drug is safe.’ But, you know, there’s a little asterisk at the end there. What the little asterisk basically says is: ‘You know, that’s assuming that the patient is trained on it.’ “

When asked about safety concerns, the FDA told NPR that the agency welcomes more research into the safety of over-the-counter insulin.

One state does require prescriptions for all insulin. Dr. Kevin Burke, a health officer for Clark County, Ind., led the effort to require prescriptions in his state.

“I didn’t realize that insulin was over the counter in Indiana until two of my patients, who were in good control, suddenly had increased glucoses,” Burke says. He asked them if they had changed their diet, lost weight, altered their workout routines. They had not.

“They both admitted that they had decided to switch to over-the-counter insulin,” Burke says, “which was different from what I had prescribed.”

Over time, taking the wrong dosages destroys your body, Burke says. Poorly managed diabetes is the cause of a host of complications, such as high blood pressure, kidney disease, nerve damage, loss of eyesight and stroke.

Burke says he took his concerns to the American Medical Association. But the national doctor’s association told him there are no data showing that the drug’s over-the counter availability is a public health hazard. In fact, the AMA’s board noted, getting insulin without a doctor’s prescription may be an important way for some insulin-dependent patients to get access to the medicine they need.

Dr. Todd Hobbs is chief medical officer of Novo Nordisk in North America, which makes Novolin, one of the two versions of insulin sold over the counter. His company partners with Wal-Mart to sell its version under the brand name ReliOn. (Wal-Mart declined to be interviewed for this story.)

Hobbs says Novo Nordisk’s version of insulin is for people who don’t have insurance, or who have to pay a lot for their other prescriptions — “people who just, for whatever reason, have fallen through the cracks and either don’t have insurance coverage at the time or are without coverage.”

With ever-rising copays and premiums, he says, many patients are turning to nonprescription insulin because it’s cheaper and all they can afford.

“But we hope to try to help them to not have to do that,” Hobbs says.

“We clearly think the newer versions are more close to what the body would do on its own,” he says. The prescription versions are better and safer, he agrees, because they make it easier for patients to avoid wild fluctuations in blood sugar.

Carmen Smith doesn’t blame the insulin she was taking for her emergency room visits.

“Insulin is not the problem,” she says. “It is getting the insulin that is the problem. Once I got connected with my physician, life as a diabetic got a lot less complicated for me.”

Smith is now on Medicaid. She has a doctor — and a prescription for one of the newer generations of insulin.

This story is part of NPR’s reporting partnership with WCPN ideastream and Kaiser Health News.

Commentary

Some people don’t understand why people with diabetes get upset at the price of insulin. They see insulin for sale at a relatively reasonable price in Walmart and don’t see the problem. What they don’t know is that these Walmart insulins just don’t perform nearly as well as the more expensive insulins, and that gap in performance can have a very negative effect on the health of people with diabetes.

There are three insulins available at Walmart for the price of $25 – NPH, Regular, and 70/30 (a mix of the two). NPH was first approved by the FDA in 1950, Regular was approved in 1982, 70/30 in 1989. That means NPH has been around for 66 years, Regular for 33 years, 70/30 for 27 years.

Take a moment and think about what healthcare was like in 1950.

Now, I’m sure someone is saying, “Well, they must still work if they are still being sold.” And they do, but they don’t work in the same way. These insulins are not interchangeable.

If a person with Type 1 diabetes were to switch from a Humalog/Lantus insulin regimen to Regular and NPH, it would drastically alter their lifestyle, making blood sugar control more irregular and raising A1C scores.

The biggest issue is that whereas Lantus is steady, NPH peaks. A person using NPH must keep a very set dietary schedule, making sure to eat meals and snacks at certain times to correspond with peak times of an insulin dose.

The strict schedule is difficult for everyone, but especially for children. They are unable to alter their daily schedules and must always be sure to eat at specific times. Even if they’re not hungry, they must eat to avoid low blood sugar. And if they are hungry, they often cannot have more than the required amount.

Quite frankly, this sucks. When my child was first diagnosed, she was on NPH. It was incredibly difficult to limit a growing child’s diet to such a strict schedule. Here’s what it looked like:

I cannot tell you how many times my child refused to eat the 45 carbs in her dinner. There is something wrong when you are fussing at your 5-year-old to stop eating her green beans and to eat her bread, or mashed potatoes, or pasta.

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She also was eating dinner between an hour and an hour and a half before the normal family dinner because her insulin required it; her father wasn’t even home yet. And she was unable to have cake at a birthday party because she couldn’t deviate from her schedule. We switched to Lantus as soon as we could.

We have always used Humalog for meal-time insulin and for correcting high glucose levels in a timely manner. The closest comparison to this insulin that Walmart sells is Regular. This insulin is not a rapid-acting insulin, but a short-acting insulin; the two aren’t the same. Where Humalog and Novalog begin lowering glucose levels within 15 minutes, Regular insulin can take up to an hour to alter glucose levels.

Because Regular has such a delayed response time, a person must inject insulin for meals an hour before they eat. Going out to dinner? You must decide on your meal before you leave the house. If you’re hungry for a snack, you must bolus the insulin and then wait an hour. This also means that a correction dose for high blood sugar has delayed results.

And then there’s the issue of duration. Humalog and Novalog burn off within four to five hours, while Regular remains in the system for eight to 10 hours. At eight hours, all the food that the Regular covered is long gone.

All of these factors affect quality of life and the regulation of blood sugar levels, and up the risk of hypoglycemia. It’s not impossible to stay healthy using Walmart insulins, but it is more difficult and requires a very strict adherence to dietary regimen and schedules.

So, yes, Walmart sells twenty-five-dollar insulin. It can save you money today, but it can result in higher costs and poorer health in the long run. These insulins are not the answer to the rapid rise in prices for more popular insulins.

Editor’s Note – This article was excerpted by permission from a longer and more detailed Facebook post about the rapid rise in insulin prices. The original post is part of the #MYLIFEISNOTFORPROFIT social media campaign. A new intro was added and text has been edited for length and clarity. To read the original text, go to facebook.com/worldofteststrips.

In early February 2019, amid continued public outcry over the soaring cost of life-saving pharmaceuticals, readers shared a screen-captured image on social media of a local news station’s reporting on the story of a woman who said she bought inexpensive insulin without a prescription at Walmart:

Readers asked us whether this was true. It is true, although you should note Walmart sells human insulin, an older version of the glucose-moderating hormone, whereas most insulin-dependent diabetics are currently prescribed insulin analogs that have evolved to help prevent dangerous swings in blood-glucose levels.

The screenshot above was taken from a 4 February 2019 news broadcast from Dallas–Fort Worth television station KDFW:

We confirmed with Walmart that the retail chain does indeed sell human insulin without a prescription (except in Indiana). That product is Novo Nordisk-manufactured Novolin, which Walmart has branded as ReliOn and sells for $24.88 per vial. Walmart spokeswoman Marilee McInnis confirmed to us that the company has “maintained, through negotiation, the same retail to patients since 2011.” To say that the insulin is sold “over-the-counter” isn’t quite accurate, however, as customers must ask a pharmacist for it.

Although this revelation might be important, life-saving information for diabetics, an important caveat is that human insulin behaves differently than the newer analog insulin currently retailing for more than $300 a vial.

Dr. Todd Hobbs, chief medical officer for Novo Nordisk, wrote that the different types of insulin have the same effect of lowering blood-glucose levels, but, “Training is required whenever someone is prescribed insulin, whether that be human insulin or the newer analog insulin products. Differences in the timing of all types of insulin must be considered for patients to effectively use them … The difference in the types of insulin is related to how slowly or rapidly they are absorbed once injected. Scientific advances over the years have made improvements on the speed and length of time this absorption occurs.”

Diabetes Forecast, a health-oriented magazine associated with the American Diabetics Association, explained the history of the two types of insulin and the difference in health benefits this way:

In the 1970s, researchers discovered how to program bacteria in the lab to manufacture human insulin, and in 1982, regular human insulin became the first “recombinant DNA” drug product. “It’s a very pure, clean product, and it’s exactly what we as humans make,” Sisson says. Human insulin is now available as short-acting “regular” (or “R”) insulin, which is used at mealtimes, and intermediate-acting NPH (or “N”) insulin, which is used as a basal insulin …

While the development of human insulin was a major advancement, it wasn’t perfect. Regular insulin didn’t hit the bloodstream quick enough to cover the rapid absorption of carbohydrates after meals, and it stuck around too long after meals, causing hypoglycemia . In 1996, Eli Lilly introduced the first rapid-acting insulin analog to the market: insulin lispro (Humalog). Insulin aspart (Novo Nordisk’s Novolog) and insulin glulisine (Sanofi’s Apidra) quickly followed. With rapid-acting insulin analogs, onset occurs 10 to 20 minutes after injection, instead of the 30 to 60 minutes it takes for regular human insulin to take effect. This allows people to inject their insulin right before a meal, rather than having to dose 30 minutes or more before eating …

Deliver a dose of NPH insulin, and it’ll reach its peak about six to eight hours later. This means your insulin may peak while you’re sleeping, posing a serious danger if you don’t wake up to treat. Long-acting analogs, on the other hand, don’t peak, resulting in more-stable blood glucose levels and fewer unexpected highs or lows. In fact, one study showed that long-acting analog insulin glargine reduced overnight bouts of hypoglycemia by up to 48 percent compared with NPH. In another study, detemir reduced nighttime hypoglycemia by 34 percent. This is especially beneficial for people with type 1, who need to be much more precise about matching insulin dosages with their insulin needs to avoid nighttime lows, says Sisson.

Note, there are two types of diabetes. Type 1 diabetics’ bodies cannot manufacture insulin, the hormone responsible for glucose absorption. Type 2 diabetics’ bodies, on the other hand, become resistant to insulin. In most cases, Type 1 diabetes starts in childhood, whereas Type 2 is sometimes referred to as “adult-onset” diabetes.

Writing for Insulin Nation, Nicki Nichols explained why the older form of human insulin is difficult to control in children:

When my child was first diagnosed, she was on NPH. It was incredibly difficult to limit a growing child’s diet to such a strict schedule. Here’s what it looked like:

I cannot tell you how many times my child refused to eat the 45 carbs in her dinner. There is something wrong when you are fussing at your 5-year-old to stop eating her green beans and to eat her bread, or mashed potatoes, or pasta.

The screen shot from the KDFW report no doubt went viral as a result of an ongoing controversy over the cost of analog insulin, which as of 7 February 2019 soared to a retail price of more than $300 per vial. Americans have been awash in medical horror stories such the death of Jesse Lutgen, a 32-year-old Type 1 diabetic who lost his job at a distribution center in Dubuque, Iowa, and with it, his health insurance. He was found dead in his home in February 2018, having run out of insulin. His last vials of the medication were given to him by a friend.

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Walmart’s $25 insulin can’t fix the diabetes drug price crisis

Health care executives faced the ire of lawmakers on Capitol Hill Wednesday, amid a growing outcry from patients who’ve been forced to ration insulin because of soaring prices.

“I don’t know how you people sleep at night,” Rep. Jan Schakowsky (D-IL) told a panel of insulin manufacturers and drug industry intermediaries assembled for a House Energy and Commerce Committee hearing on insulin prices. “I just want you to know your days are numbered.”

While the executives fumbled to explain themselves over the course of two days of questioning, one “solution” to the insulin access crisis resurfaced on social media: Patients should just buy cheap insulin at Walmart.

For context, the cost of the four most popular insulins has tripled over the past decade, forcing many of the millions of Americans with Type 1 or Type 2 diabetes who rely on the drug to skimp on or skip doses.

Walmart indeed offers a relatively inexpensive choice, essentially over the counter. People can go to pharmacies in stores nationwide and, without a prescription, purchase a vial of Novo Nordisk’s Novolin ReliOn Insulin for less than $25. (People with diabetes can require between one and six vials of insulin per month.)

But there’s a problem here: This low-cost option is far from ideal for all patients. Ultimately, “Walmart-ism,” as diabetes advocates call it, reveals a lot about what the debate around the insulin drug pricing crisis has become: a big blame game, filled with distractions from what’s really driving up drug prices.

The problems with Walmart’s insulin

Doctors and diabetes advocates point out that while ReliOn may help patients in a pinch, especially those without health insurance, it’s also a formulation (known as “human” insulin) that came on the market in the 1980s, more than a decade before more refined insulins started to emerge.

The newer insulins, known as analogs, appear to be more effective at preventing dangerous blood sugar swings in people with Type 1 diabetes or those at a higher risk for severe low blood sugar. (The evidence of insulin analog’s benefits is less clear for Type 2 diabetes, but the studies are also low quality so it’s difficult to make conclusive statements.)

There’s one more problem: Because it’s available without a prescription, patients can get the drug without the supervision of a doctor, and they sometimes get into trouble as a result. So stories have surfaced about patients who required emergency care because of severe blood sugar highs and lows after self-dosing with Walmart insulin, or even dying as a result.

“Human insulins are a reasonable option for many patients with Type 2 diabetes,” said Yale endocrinologist Kasia Lipska, who often prescribes the drugs for patients who can’t afford newer formulations. “But the drug isn’t optimal for everybody. And human insulin sold at Walmart is definitely not the solution to our insulin crisis.”

For people with Type 1 diabetes, human insulins “are harder to live on, lead to worse control, make it harder to hold down a job, impact quality of life,” said James Elliott, a trustee at T1International, an independent patient advocacy group, “and not everyone lives near a Walmart.”

A Novo Nordisk spokesperson said the low-cost formulation is also available at CVS and Express Scripts, though patients have to apply for a discount program first. “We have taken numerous steps to help make insulin more affordable for people living with diabetes,” the spokesperson said. “Approximately 775,000 people in the US use our human insulin.”

So while it’s true that Walmart offers insulin at a competitive price reminiscent of the days before insulin costs tripled and that it can be helpful for some patients, it’s not great for everybody with diabetes, and it can be dangerous for some.

Walmart-ism is part of the insulin drug pricing blame game

The Walmart solution first went viral in February, after it was featured on TV in Texas and then posted to Facebook. It continues to be bandied about on social media whenever people mention rising insulin prices. According to the meme, the problem isn’t that insulin is too expensive. The problem is that patients are too picky to take advantage of an affordable insulin option.

According to the pharmacy benefit managers testifying before Congress Tuesday, it’s the insulin manufacturers’ companies that are driving up the cost of the drug. At another congressional hearing Wednesday, pharmaceutical company executives blamed pharmacy benefit managers for helping inflate prices and boasted about their financial assistance programs as solutions to the access crisis.

The blame game involves many fingers pointing in many directions, but make no mistake: What’s driving up insulin costs is that drug companies have raised prices because they can.

As I recently explained, the US is an outlier in insulin costs and spending. America represents only 15 percent of the global insulin market and generates almost half of the pharmaceutical industry’s insulin revenue.

Although insulin was discovered a century ago, manufacturers have made incremental changes to their formulations that have allowed them to extend the patents for these drugs. Even where patents have expired, the road to getting generic insulin on the market is so complicated and expensive that recent attempts have failed.

So how did we get here? Unlike other countries, America gives drug companies free rein to set prices. The result is that the cost of the four most popular types of insulin has tripled over the past decade, and the out-of-pocket prescription costs patients now face have doubled.

Let’s break that down with some dollar figures. By 2016, the average list price of insulin rose to $450 per month. Patients can wind up paying out of pocket anything from $25 per month, if they have generous health insurance coverage or buy older insulin versions at Walmart, to more than $1,000 if they don’t have insurance or have a high deductible plan, according to T1International.

One quick fix to improve insulin access

Lately there’s been more attention on the insulin pricing problem. Members of Congress have been pressuring drug companies and pharmacy benefit managers to bring insulin costs under control. Last Wednesday, the insurance behemoth Cigna, and its pharmacy benefit arm Express Scripts, announced a new program that’ll cap the 30-day cost of insulin at $25. That’s a 40 percent reduction from the $41.50-per-month fee people with Express Scripts benefits were paying in 2018.

This week, Sanofi announced it will offer its insulin products at $99 per month for uninsured patients.

But like the Walmart option, these programs amount to Band-Aid solutions, said Elizabeth Pfiester, the founder and executive director of T1International.

With Walmart, patients are “having to revert to an older insulin that can damage you,” she said. Meanwhile, the Sanofi and Cigna programs “can be shut down or rescinded at any time. That’s not any kind of assurance for patients.”

“Patients will not fall for these fake measures that do nothing to solve the crisis we are facing,” she added.

There’s one way the insulin drug pricing problem could be fixed, however: lowering the price of insulin, said Yale’s Lipska. “Ultimately, it’s the list price that’s hurting patients. I keep going back to that: Just fix the list price.”

Companies could decide that instead of launching one-off programs or doling out discounts, they’ll forgo profits and lower list prices once and for all. Or lawmakers could decide to regulate drug pricing.

“We have a big problem here,” Lipska said. “People are hurting and people are dying. How much more will it take for them to regulate this? Clearly what’s in place now is not working. This is a place where our legislators can step in and help protect the patients with diabetes.”

Update, April 11: We’ve updated the story with quotes from Novo Nordisk, who responded to our request for comment after the story first published.

NovoLog FlexPen is an insulin aspart pre-filled, discreet, dial-a-dose pen that can be conveniently brought anywhere. The pen comes prefilled with NovoLog insulin and is ready for use. All that is needed is to determine the right amount of insulin with the dial and delivery is as simple as pressing a button.The Flex Pen can deliver anywhere from 1 to 60 units of insulin, adjustable in one unit increments.

Prefilled with 300 units of Novolog, the Flex Pen can be used for up to 28 days without needing refrigeration. The Novolog Flex Pen can be used with Novofine needles, known for having ultrfine needles as small as 5 mm, which users say gives little to no pain at all during injections.

Novolog Flex Pen Cost Information

Prices of the Novolog Flex pen system may vary depending on the pharmacy or online drug store selling it. The price for one carton containing five Flex Pens of Novolog 3 ml range from $317.14 to $327.39.

Dosage Quantity Price Without Insurance

CVS Pharmacy

3ml 1 flexpen $72.00
3ml 5 flexpens $361.00
3ml 10 flexpens $722.00

Kmart

3ml 1 flexpen $67.52
3ml 5 flexpens $356.00
3ml 10 flexpens $711.00

Kroger

3ml 1 flexpen $67.52
3ml 5 flexpens $343.00
3ml 10 flexpens $682.00

Publix

3ml 1 flexpen $67.52
3ml 5 flexpens $352.00
3ml 10 flexpens $704.00

Rite Aid

3ml 1 flexpen $89.00
3ml 5 flexpens $396.00
3ml 10 flexpens $792.00

Target

3ml 1 flexpen $74.00
3ml 5 flexpens $372.00
3ml 10 flexpens $745.00

Walgreens

3ml 1 flexpen $74.00
3ml 5 flexpens $381.00
3ml 10 flexpens $764.00

Walmart

3ml 1 flexpen $67.43
3ml 5 flexpens $323.69
3ml 10 flexpens $640.03

Common Side Effects

The most prominent side effect would have to do with the injection site. Due to the minor skin trauma of injection, some itching, swelling, and redness can be expected, although this can be expected to fade after a short while. If these symptoms do not fade and appear to persist, consult with your doctor.

Serious Side Effects

Side effects of the Novolog Flex pen treatment are most commonly associated with hypoglycemia, which does tend to occur when too much is administered. Symptoms include profuse sweating, shakiness, confusion and anxiety, and headaches. Severely low blood sugar can, due to complications, result in unconsciousness, seizures, and even death. A reaction may occur if Novolog is taken alongside thiazolidinediones (TZDs), resulting in vision issues, low potassium levels, weight gain, and possible heart failure.

Important Product Information

Eating a meal five to ten minutes after administering Novolog is recommended, mainly to avoid a sudden drop in blood sugar levels. Novolog must never be mixed with any other insulin solution or be administered using an insulin pump. Dosage must not be changed unless specified by the doctor. People with possible heart, kidney, or liver issues and those who are pregnant or breastfeeding must first consult with their doctor before using Novolog Flex pen. The doctor must also be informed of any and all medications being taken, including food supplements, before using the Novolog treatment.

Novolog maybe injected under the skin of the stomach, upper arms, or thigh area, but never into a vein or into the muscle. Constant monitoring of blodd sugar levels while taking Novolog must be done so as to foresee a sudden and drastic drop in blood sugar levels. Take note that the sudden symptoms of hypoglycemia can be very hazardous for those who are driving or operating heavy machinery, particularly those that induce dizziness, disorientation, and unconsciousness. Alcohol, supplements, and an active lifestyle may affect a person’s blood sugar level. The doctor must be informed of these factors so that they would be factored in when considering the rate of blood sugar level drop.

Generic Alternatives

The generic name of Novolog is insulin aspart recombinant – injectable; subcutaneous. As of right now, however, there is no generic equivalent of Novolog available in the US.

What to Know Before You Use OTC Insulin

Schedule a phone call or an appointment to discuss your concerns. She says drug makers also provide assistance programs for insulin. Not taking your prescribed dose of insulin can make you extremely ill, and people have gone to the hospital and even died, says Antinori-Lent.

Antinori-Lent, who works in a hospital setting rather than an outpatient clinic, says that sometimes patients may take newer insulin in the hospital, but then find out at discharge that they can’t afford it and they may need to switch to older insulin. Ideally, these discussions about cost can happen well before discharge so patients get the opportunity to learn how these insulins work and how to use them.

Trujillo says: “The most important thing is to be honest and upfront about your situation. I think we have a lot of patients who are rationing their insulin or not taking it as prescribed because of cost issues.” One in four people with diabetes report having rationed or not used insulin because of cost, according to an article published in January 2019 in JAMA Internal Medicine.

You can work with your provider to use these older insulins in a safe and effective way, says Trujillo. “But it’s a different approach for sure. And the patient and provider have to be on the same page,” she says.

As anyone who needs insulin to treat diabetes can tell you, that usually means regular checkups at the doctor’s office to fine-tune the dosage, monitor blood-sugar levels and check for complications. But here’s a little known fact: Some forms of insulin can be bought without a prescription.

Carmen Smith did that for six years when she didn’t have health insurance, and didn’t have a primary care doctor. She bought her insulin without a prescription at Wal-Mart.

“It’s not like we go in our trench coat and a top hat, saying, ‘Uh I need the insulin,’” says Smith, who lives in Cleveland. “The clerks usually don’t know it’s a big secret. They’ll just go, ‘Do we sell over-the-counter insulin?’”

Once the pharmacist says yes, the clerk just goes to get it, Smith says. “And you purchase it and go about your business.”

But it’s still a pretty uncommon purchase.

Smith didn’t learn from a doctor that she could buy insulin that way. In fact, many doctors don’t know it’s possible. When she no longer had insurance to help pay for doctors’ appointments or medicine, Smith happened to ask at Wal-Mart if she could get vials of the medicine without a prescription. To figure out the dose, she just used the same amount a doctor had given her years before.

It was a way to survive, she says, but no way to live. It was horrible when she didn’t get the size of the dose or the timing quite right.

“It’s a quick high and then, it’s a down,” Smith says. “The down part is, you feel icky. You feel lifeless. You feel pain. And the cramps are so intense — till you can’t walk, you can’t sit, you can’t stand.”

Smith keeps the tools for controlling her diabetes in this kit, which contains metformin, syringes, fast-acting insulin for daytime use and slow-release for overnight. (Photo by Lynn Ischay for NPR)

Smith’s guesswork put her in the emergency room of MetroHealth, Cleveland’s public hospital, several times across six years.

The availability of insulin over the counter presents a real conundrum. As Smith’s experience shows, without training or guidance from a health care provider, it can be dangerous for a patient to guess at the best dosage and timing from version to version of insulin. On the other hand, being able to afford and easily buy some when she needed it may have saved her life.

There are two types of human insulin available over the counter: one made by Eli Lilly and the other by Novo Nordisk. These versions of the medicine are older, and take longer to metabolize than some of the newer, prescription versions; they were created in the early 1980s, and the prices range from more than $200 a vial to as little as $25, depending on where you buy them.

Dr. Jorge Calles, an endocrinologist at MetroHealth, is alarmed to think that some people are self-medicating with any sort of insulin.

“It’s a very serious situation if they are selling it over the counter — without any control with a prescription, specifically,” Calles says.

According to the medical consulting firm IMS Health, about 15 percent of people who buy insulin in the growing U.S. diabetes market, purchase it over the counter without a prescription.

The U.S. Food and Drug Administration declined multiple requests by NPR for an interview on this topic. But, in an email, an FDA representative said that the versions of insulin now available over the counter were approved for sale that way because they are based on a less concentrated, older formulation, “that did not require a licensed medical practitioner’s supervision for safe use.”

The broader availability of this form of insulin allows patients with diabetes to obtain it “quickly in urgent situations, without delays,” the FDA says, and is intended to increase patient safety.

Still, some people with diabetes, as well as some doctors, doubt that the benefits of that greater availability outweigh the risks, especially for patients who switch from one type of insulin to another without telling their doctor.

“This is not something that should be done without the help of a professional,” says David Kliff, who has Type 1 diabetes, and writes the Diabetic Investors blog. Kliff has followed and written about the expanding business of diabetes for years.

FDA officials are “basically sticking their heads in the sand” on this issue, Kliff says, and making a lot of assumptions.

“They look at insulin as a drug,” he says, “and say, ‘There’s this enormous body of evidence that shows that the drug is safe.’ But, you know, there’s a little asterisk at the end there. What the little asterisk basically says is: ‘You know, that’s assuming that the patient is trained on it.’”

When asked about safety concerns, the FDA told NPR that the agency welcomes more research into the safety of over-the-counter insulin.

One state does require prescriptions for all insulin. Dr. Kevin Burke, a health officer for Clark County, Ind., led the effort to require prescriptions in his state.

“I didn’t realize that insulin was over the counter in Indiana until two of my patients, who were in good control, suddenly had increased glucoses,” Burke says. He asked them if they had changed their diet, lost weight, altered their workout routines. They had not.

“They both admitted that they had decided to switch to over-the-counter insulin,” Burke says, “which was different from what I had prescribed.”

Over time, taking the wrong dosages destroys your body, Burke says. Poorly managed diabetes is the cause of a host of complications, such as high blood pressure, kidney disease, nerve damage, loss of eyesight and stroke.

Burke says he took his concerns to the American Medical Association. But the national doctor’s association told him there are no data showing that the drug’s over-the counter availability is a public health hazard. In fact, the AMA’s board noted, getting insulin without a doctor’s prescription may be an important way for some insulin-dependent patients to get access to the medicine they need.

Dr. Todd Hobbs is chief medical officer of Novo Nordisk in North America, which makes Novolin, one of the two versions of insulin sold over the counter. His company partners with Wal-Mart to sell its version under the brand name ReliOn. (Wal-Mart declined to be interviewed for this story.)

Hobbs says Novo Nordisk’s version of insulin is for people who don’t have insurance, or who have to pay a lot for their other prescriptions — “people who just, for whatever, reason have fallen through the cracks and either don’t have insurance coverage at the time, or are without coverage.”

With ever-rising copayments and premiums, he says, many patients are turning to nonprescription insulin because it’s cheaper and all they can afford.

“But we hope to try to help them to not have to do that,” Hobbs says.

“We clearly think the newer versions are more close to what the body would do on its own,” he says. The prescription versions are better and safer, he agrees, because they make it easier for patients to avoid wild fluctuations in blood sugar.

Carmen Smith doesn’t blame the insulin she was taking for her emergency room visits.

“Insulin is not the problem,” she says. “It is getting the insulin that is the problem. Once I got connected with my physician, life as a diabetic got a lot less complicated for me.”

Smith is now on Medicaid. She has a doctor — and a prescription for one of the newer generation of insulins.

This story is part of a reporting partnership that includes WCPN ideastream, NPR and Kaiser Health News.

Related Topics

Medicaid Public Health Diabetes FDA

A man who switched to more affordable insulin died. Here’s what happened in the viral story

An uninsured man with Type I diabetes switched from prescription insulin to a less expensive over-the-counter product last year. He died months later due to complications from the disease, according to his obituary.

The story gained national attention this week, widely seen as an example of the dangers faced by those living with a chronic condition and without access to affordable health care.

When Josh Wilkerson, 27, aged out of his stepfather’s insurance plan last year, he was no longer able to afford his prescription insulin that cost around $1,200 a month, according to The Washington Post. The insurance offered by his job did not cover insulin treatments.

Wilkerson turned to an affordable alternative to prescription insulin available at national retailers such as Walmart and CVS.

That treatment is safe and effective according to its makers and multiple experts consulted by USA TODAY. However, patients transitioning from traditional insulin to over-the-counter insulin — also known as human insulin — should have regular access to a health provider.

Wilkerson, along with his fiancée Rose Walters, who also has Type 1 diabetes, began taking an over-the-counter solution called ReliOn last year. Manufactured by Novo Nordisk, it currently costs just under $25 for a 10-mL vial.

A 10-mL vial of the prescription insulin Novolog, also manufactured by Novo Nordisk, retails at over $350.

A report by the University of California, San Francisco states that forms of human insulin such as ReliOn are less commonly prescribed by doctors because of their unpredictable rate of absorption, which can result in “more frequent low and high blood sugars.”

Patients can save money by switching to over-the-counter insulin. But safely switching is more complex. Doing so incurs other costs, according to Elizabeth Pfiester, the founder and executive director of Type 1 diabetes advocacy group T1International.

“The unpredictability of human insulin means that a person would need to afford additional blood glucose testing strips,” Pfiester told USA TODAY.

Wilkerson, she said, struggled to afford the strips.

Wilkerson made $16.50 an hour at his job as a kennel attendant at Old Mill Boarding Kennel in Leesburg, Virginia, according to The Washington Post.

In June, Wilkerson was tasked with supervising the kennel while his boss was on vacation. On his second day there, he was unresponsive to calls from his fiancée – who later found him unconscious a few hours after taking the over-the-counter insulin, said the Post.

He died five days later.

Struggling to stay alive:Rising insulin prices cause diabetics to go to extremes

After losing his insurance, he rationed his prescription insulin until it ran out, Erin Weaver, his mother, told USA TODAY. When that supply was used up, he switched over fully to ReliOn.

“It just didn’t work for him,” said Weaver, who noted her son and his fiancée wanted to save money to pay for expenses, contrary to other news reports that they were saving up for an upcoming wedding.

ReliOn is a safe and effective option for people who can’t afford prescription insulin, according to Dr. Todd Hobbs, the chief medical officer for ReliOn maker Novo Nordisk.

Patients should work with a medical professional when switching to over-the-counter human insulin products such as ReliOn, Hobbs said.

“This tragic story highlights the need for education concerning the appropriate use of human insulin,” Hobbs said in a Thursday statement to USA TODAY.

Dr. Silvio Inzucchi, an endocrinologist at Yale School of Medicine, said that while the product is safe, affordable and effective, its formulation is less reliable hour-to-hour for patients.

If cost weren’t an issue, said Inzucchi, prescription “analog” insulin would be preferable for people with diabetes.

Follow Joshua Bote on Twitter: @joshua_bote

Insulin costs have been in the public eye recently, with hearings taking place on Capitol Hill in April regarding pricing practices for this medicine. In light of the potentially high price tag, some are speaking with their doctors about the possibility of using Walmart’s ReliOn insulin brand, which is available for $25 a vial. The human insulin, which is manufactured by Novo Nordisk, is available in the following versions:

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• ReliOn Novolin Regular
• ReliOn Novolin NPH
• ReliOn Novolin 70/30 mix
• ReliOn Novolin 70/30 mix pens

Although the medicines can be purchased over the counter without a prescription, anyone considering ReliOn insulin should speak with his or her health-care provider about the pros and cons before starting: Because it is a type of human insulin formulation, which were first released in the 1980s, it can affect blood sugar levels in very different ways from newer insulins, with potentially dangerous consequences (including severe or even fatal blood glucose highs and lows). “It’s really, really important to work hand-in-hand with a health-care provider to help modify and adjust dosing and to understand how these insulins behave differently than other insulins they might have taken before,” says Jennifer Goldstein, MD.

According to Novo Nordisk, the formulation is also available at CVS and Express Scripps, though, per Vox patients must first apply for a discount program to purchase the medicine through these avenues.

Want to learn how to save money on your insulin? Read “Insulin Prices: Four Ways to Pay Less.”

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