Medicare and Insulin

Why does a drug cost $25 without insurance and $110 with Medicare Part D?   Novolin N and R can be bought at Walmart for $24.88 without insurance.  With a Part D plan, the cost is $110.  Why?

I have a client who has diabetes.  She uses Novolin N and Novolin R.  If she uses her Medicare Part D plan to purchase this insulin, she would go into the donut hole/coverage gap because the “negotiated price” is $110 per vial and she uses four vials per month.  So she goes to Walmart and buys Novolin N and Novolin R without using her Part D card.  Her cost is $24.88 per vial.

How is it possible that the insurance company that runs her Part D plan has “negotiated” a price of $110 for Novolin when it sells at Walmart for $25?

Although the insurance companies that provide Part D plans “negotiate” drug prices, it is Medicare that actually pays the bill.  So why is Medicare paying $110 instead of $25 for Novolin?

Medicare will spend 70 billion dollars on Part D in 2015.  How much lower would that incredible figure be if Medicare was not overpaying for drugs like Novolin?

I looked up up Novolin N or Novolin R on the Medicare.gov Plan Finder.  Here is just one of 30 stand-alone Part D plans available in Arizona.  Some Medicare Advantage plans offer better co-pays for Novolin ($9 or $0), but the retail price is always over $100.

 

 

 

 

 

 

I have written previously about my clients with high drug costs, and insulin has been part of the story: https://medicareblog.org/high-drug-costs/

Medicare and Insulin:

The retail price of insulin using a Part D plan ranges from $70 for a vial of Humalog to $395 for the Novolog Flexpen.  Novolin is not the best insulin for managing diabetes, but it is the lowest-cost method if purchased at Walmart for $25.

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When I googled “the cost of novolin” I found an article from Phoenix Diabetes and Endocrinology:

Preferred basal insulins are Lantus and Levemir. These 2 insulins are expensive, costing about $100 a vial. For those that cannot afford these preferred insulins, consider Novolin N as an alternative, which costs about $25 per vial at Walmart.

Novolin N is an effective alternative, but be aware of the following considerations:
Lantus and Levemir start working in about 2 hours and continue to work without a peak of action for up to 24 hours. Novolin N will require 2 injections and peaks 6-8 hours after it is given. It generally will stay in the body for about 12 hours but one needs to watch for low blood sugars 6-8 hours after it is given. It is very important to time Novolin N with eating. Novolin N is much harder to use for this reason. However, it is half the cost. Some patients on Lantus and Levemir do very little home glucose monitoring because the risks of low blood sugars are small. This is not the case with Novolin N so be very careful. Make sure you have a working glucose monitor and test strips before starting Novolin N.

Novolin N insulin and syringes should be available in Arizona without a prescription. To switch from Lantus or Levemir to Novolin N insulin can be difficult but in general, this is what we recommend:

Home Glucose Monitoring
On the basis of cost, Wal-Mart’s home glucose monitor Reli On appears to be the most affordable product. This also does not require a prescription if you are not going through your insurance.

If you were going to use Novolin N insulin, plan on monitoring at least 2-3 times daily. Low blood sugars can happen unexpectedly with Novolin N insulin so always carry a source of glucose with you. This is especially important when driving. This insulin is more affordable and depending on how many vials of insulin you require monthly, this insulin maybe much more affordable, but Novolin N will require much more glucose monitoring. Using a more affordable test strip and meter really makes sense.

Again this information is provided to our patients who may have lost their health insurance and are cannot afford preferred therapies. This information is not intended to replace our in-office diabetes care but to help our patients cut some of their medical costs.