Friday, 24 May 2019

With high insulin prices, some diabetics debate whether to pay bills or fill prescriptions – Waco Tribune-Herald

There have been times when Lucy Faulkner considered ignoring the reminders to pick up the insulin prescription she needs to manage her Type 2 diabetes because she simply could not afford it.

There have been times when the 53-year-old Waco resident skipped a dose or rationed her insulin to make her prescription last just a little longer, and there have been times when she has fretted until she was in tears over the exorbitant cost of a medication she must take to survive.

Faulkner certainly is not alone in her struggles. More than 30 million Americans have diabetes, and about 7.5 million of them rely on insulin to survive, according to the American Diabetes Association. The paralyzing price of insulin has been the topic of national conversations and the subject of a congressional hearing earlier this month in which lawmakers sought answers for the high cost of a hormone that was discovered almost a century ago.

No alternative medication to insulin exists to treat diabetes, Type 1 or 2, and the cost nearly tripled between 2002 and 2013, according to the American Diabetes Association. Diabetes cost Americans more than $327 billion in 2017, including $15 billion for insulin, making it the most expensive chronic illness in the U.S.

U.S. Sens. Chuck Grassley, R-Iowa, and Ron Wyden, D-Oregon, sent letters to the three top pharmacy benefit managers this month, as part of a bipartisan investigation into insulin prices. The senators are working on a bill to address rising drug prices, The Hill reported.

In the meantime, patients are left waiting for a resolution.

Paying the price

Without federal assistance, Lisa Bridges knows she would not be alive. There is no way the 56-year-old Waco resident could afford the insulin and other supplies necessary to treat her Type 2 diabetes.

“If I didn’t have help, I’d be dead,” Bridges said. “There’s no doubt in my mind.”

Diagnosed with diabetes in 1987, Bridges managed to control the disease with her diet for a while before taking oral medication, but she did not check her blood glucose levels like she should have because she was in denial about her condition for years.

“I’m paying the price,” she said.

In 2016, 11.6 percent of Waco adults reported having diabetes, according to the City Health Dashboard website. That compares to 11.2 percent of Texans and 9.4 percent of Americans who reported having the disease.

Some pockets of Waco have greater rates of diabetes. For instance, between 18 and 20 percent of residents in the 76704 and 76705 ZIP codes reported having diabetes.

Two years ago, Bridges got an insulin pump, a device that provides a continuous supply of insulin directly through her skin. She also got a continuous glucose monitor that reads her blood glucose level and sends an alert to her phone if her glucose is too high or too low.

If Bridges did not have federal disability benefits, she would have to pay about $2,000 a month for the insulin and other supplies she needs to check her blood glucose levels. That does not include costs for other medications she uses to treat the effects of diabetes, such as supplements or a cream to relieve neuropathy.

“Without insurance, it’s not affordable at all,” she said.

There is some help for patients without insurance. The Family Health Center offers affordable insulin to patients without health insurance, and Walmart sells human insulin, a less refined form of insulin introduced in the ’80s, for $25.

While a healthy diet, exercise and weight loss can help people with Type 2 diabetes, those with Type 1 diabetes must have insulin to survive because their bodies do not produce the hormone, said Ben Wilson, a doctor at the Family Health Center.

Generally, doctors attempt to treat Type 2 diabetes with other medications or lifestyle changes before prescribing insulin to patients, Wilson said. Metformin is a common anti-diabetic medication prescribed to patients.

Faulkner used Metformin for years before her doctor switched her to insulin. She remembers paying $5 to $10 a month for Metformin and how shocking it was to change to insulin, which can cost her $300 to $700 a month.

“I told my husband, ‘That’s our house payment,’” she said. “You have to live. So, do I make my house payment, or do I get my insulin?”

She and her husband pay for health insurance through his job at Domtar Personal Care. But the plant is closing, so Faulkner’s husband will lose his job and insurance at the end of August. That means the Faulkners will have a new deductible to meet and have to pay full price for insulin and other medications until it is met.

Still, Faulkner said her husband makes too much money for them to qualify for help to pay for her prescriptions. She wishes there were help for average people like her.

“The other day, I was sitting there in tears because I was at the point where I was just going to say, ‘Forget it. If diabetes kills me, it kills me.’ because I couldn’t afford the $4,400 at the time,” Faulkner said.

Living in the middle

The three major pharmacy benefit managers in the U.S. are Express Scripts, CVS Health Corp. and Optum.

Family Health Center Director of Pharmacy Services Judd Ramsey believes those three companies play a significant role in the soaring prices of insulin.

“Drug manufacturers typically get most of the blame when it comes to high drug prices,” Ramsey said. “However, they definitely are not the only ones to blame. PBMs are in a position to leverage their size to lower drug prices, or at least that’s what we were told when they were created. That has not been the case.”

Ramsey said prescription drugs were more affordable before the introduction of prescription insurance companies and pharmacy benefit managers. Now, drug manufacturers lobby to get their products on pharmacy benefit managers’ preferred drug lists, creating a complex pricing mechanism, he said.

“PBMs likely are using their size to leverage against both drug manufacturers, pharmacy wholesalers and pharmacies to gain profit, not help their patients,” Ramsey said.

When Faulkner’s diabetic cousin died, his family gave Faulkner what was left of his insulin supply. A friend also gave her some insulin when her doctor changed her prescription. Faulkner said these gifts saved her money because she did not have to refill her insulin prescription as often. Her pharmacist also provided her with a prescription drug coupon that reduced the cost of her insulin for months.

Faulkner wishes the medication were more affordable. She does not want it for free, but she believes people like her, “in the middle,” should be able to afford it.

“This is a life-and-death medication,” she said. “If I don’t take it, my sugar could go up real high, and I could go into a coma. Lord knows what the outcome of that would be.”


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