Jane Dotson
Diabetes is a chronic condition that requires careful management, often with the help of medication. While there are different types of diabetes, the two most common forms are type 1 and type 2 diabetes. The cost of diabetes medication can vary depending on factors such as the type of medication, insurance coverage, and the patient's location. For those without insurance, the cost of diabetes medication can be a significant financial burden, with newer drugs costing up to $800 to $1,500 per month, according to a medical director. However, there are also more affordable options available, with some generic drugs and insulin products costing around $25 per vial or $35 per month. Additionally, various programs and strategies can assist those struggling with the cost of diabetes medication, including patient assistance programs, prescription savings cards, and insurance plan optimizations.
How much is diabetes medication without insurance?
| Characteristics | Values |
|---|---|
| Insulin aspart (Novolog) | Not covered by most insurance plans, but manufacturer and pharmacy coupons can help offset the cost |
| Lantus (insulin glargine) | Covered by some Medicare and insurance plans, but pharmacy coupons or cash prices could help offset the cost |
| Rezvoglar (insulin glargine-aglr) | Covered by some Medicare and insurance plans, but pharmacy coupons or cash prices could help offset the cost |
| Semglee (Insulin glargine-yfgn) | Covered by some Medicare and insurance plans, but pharmacy coupons or cash prices could help offset the cost |
| Pioglitazone (Actos) | Covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower |
| Metformin (Glucophage) | Covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower |
| Glipizide (Glucotrol) | Covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower |
| Glimepiride (Amaryl) | Covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower |
| Medicaid | Provides insulin for free or at a significantly reduced cost for certain lower-income individuals and families |
| Lilly Insulin Value Program | Caps out-of-pocket insulin costs for legal U.S. residents to $35 or less per month, regardless of insurance status |
| Novo Nordisk | Offers a free, one-time, immediate supply of up to 3 vials or 2 packs of pens of Novo Nordisk insulin with a prescription |
| ReliOn (Novo Nordisk human insulin) | Available at Walmart for about $25/vial and for about $44/box of FlexPen |
| SingleCare | Helps patients save on insulin costs, with some paying no more than $35 a month |
| Newer diabetes drugs | Cost a minimum of $800 to $1,500 per month without insurance |
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What You'll Learn
Insulin affordability programs
Diabetes medication can be expensive, especially for those without insurance. For example, insulin aspart (Novolog) is not covered by most insurance plans, and neither is regular insulin. However, there are several programs and initiatives in place to help make insulin more affordable for those who need it.
Firstly, Medicaid is a state and federally funded health insurance program that provides coverage to lower-income individuals and families, including children, pregnant people, elderly people, and people with disabilities. Most Medicaid enrollees receive insulin for free or at a significantly reduced cost. Each state has its own program, so it is worth checking with your state Medicaid agency to see what specific diabetes medications and supplies are covered. Additionally, about half of the states and the District of Columbia have implemented legislation that caps monthly insulin co-payments, and other states are considering similar measures.
Secondly, there are various co-pay assistance programs available. For example, eligible commercially insured patients can use a co-pay card that limits out-of-pocket expenses to $35 for medications like Adlyxin, Apidra, Lantus/Insulin Glargine, Toujeo, and Soliqua 100/33. Similarly, Lilly's Insulin Value Program caps out-of-pocket insulin costs at $35 per month for all legal US residents, regardless of their insurance status. Participating pharmacies will automatically cap costs at $35, while a savings card can be downloaded for non-participating pharmacies. Additionally, Novo Nordisk offers a free, one-time, immediate supply of up to three vials or two packs of pens of Novo Nordisk insulin with a prescription. Copay savings cards are also available for commercially insured patients facing high out-of-pocket costs, with potential savings of up to $150 per 30-day supply of Tresiba and $100 per 30-day supply of Novolog for up to 24 months.
Thirdly, Sanofi offers two programs to improve insulin affordability. The Sanofi Insulins Valyou Savings Program and the Sanofi Co-pay Assistance Program are available to qualified low- and middle-income patients, with the latter providing a one-time 30-day supply of medication at no cost for those with urgent needs.
Finally, interchangeable biosimilar insulin may be a more cost-effective option for some individuals. Biosimilars are biologic drugs that are similar in effectiveness and safety to the original medication, and interchangeable biosimilars can be substituted by a pharmacist without needing to contact the prescribing healthcare professional.
In summary, while diabetes medication can be costly for those without insurance, there are various programs and initiatives, such as Medicaid, co-pay assistance programs, savings cards, and manufacturer initiatives, that aim to improve insulin affordability for those who need it.
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Medicaid coverage
Medicaid is a health insurance program funded by the federal and state governments for people with low incomes and few assets. It provides health coverage to certain lower-income individuals and families, including children, parents, people who are pregnant, elderly people, and people with disabilities. Each state has its own Medicaid program, and while it is partly funded by the federal government, decisions about coverage are left to each state. This means that each state decides what types of diabetic supplies are covered through Medicaid.
Most Medicaid enrollees receive insulin for free or at a significantly reduced cost. However, each state's Medicaid program may have certain "preferred" diabetes drugs or supplies that are covered more fully. For example, some states have enacted legislation that caps co-payments on monthly insulin, and some also limit cost-sharing for supplies. If you are not eligible for Medicaid, there may be other ways to get your insulin and supplies for free or at a reduced cost. The American Diabetes Association recommends that you check with manufacturers to see if there are any discounts available.
When choosing a health insurance plan, it is important to ask about every service and supply you will need to manage your diabetes. Does the plan cover the medicines, supplies, and devices that you are using, and, if not, what are the alternatives? It is also important to consider the cost; how much will you need to pay out of pocket? Additionally, consider your healthcare providers—do they participate in the plan, or will you have to change providers or pay more to see your current providers because they are out of network?
Medigap plans help pay costs that are not covered by Medicare, such as deductibles, copayments, and coinsurance. You can buy a Medigap policy from a licensed insurance company in your home state.
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Medicare coverage
Medicare is a federal health insurance program for people aged 65 or older. However, you may be eligible for Medicare earlier if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS).
Medicare covers various medical services, including hospital stays and doctor visits, and supplies like blood sugar test strips. Prescription drug coverage is also available under Medicare. It is important to note that Medicare does not cover everything, and for many covered services, you may pay a portion of the cost.
There are two main ways to get Medicare coverage: Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C).
Medicare Part A:
Medicare Part A, also known as hospital insurance, provides coverage for medically necessary inpatient hospital stays, skilled nursing facilities, hospice care, and some home health care. Most people do not have to pay a monthly premium for Medicare Part A because they or their spouse paid Medicare taxes while working. However, if you do not qualify for premium-free Part A, you may need to purchase the coverage. In 2019, the Part A deductible was $1,364 per benefit period, and additional coinsurance may apply depending on the length of your hospital stay.
Medicare Part B:
Medicare Part B, or medical insurance, covers medically necessary doctors' services, outpatient care, durable medical equipment, lab tests, preventive care, and some medically necessary services not covered by Part A. This includes some physical and occupational therapy services and some home health care.
Medicare Part B covers blood sugar monitors, blood sugar test strips, lancet devices, lancets, and glucose control solutions for beneficiaries with diabetes, whether or not they use insulin. The amount covered varies, and beneficiaries with diabetes who use insulin may be able to get up to 300 test strips and 300 lancets every three months. Those who do not use insulin may be able to receive up to 100 test strips and 100 lancets during the same period. If your doctor determines that it is medically necessary, you can get additional quantities of testing supplies.
Continuous Glucose Monitors (CGMs):
Since 2017, Medicare has covered continuous glucose monitors (CGM) classified as "therapeutic CGMs." A therapeutic CGM is approved by the Food and Drug Administration to replace a blood glucose monitor for making diabetes treatment decisions without the need for a fingerstick blood sugar test to confirm the CGM results. To be eligible for coverage, a beneficiary must meet specific criteria set by Medicare.
Diabetes Medication Costs:
The cost of diabetes medication can vary depending on the specific drug and whether you have insurance. Some drugs, such as metformin, glipizide, and glimepiride, are inexpensive and covered by most Medicare and insurance plans. However, other drugs may not be covered by Medicare or insurance, and patients may need to rely on pharmacy coupons or cash prices to offset the cost.
Additionally, some insulin medications may not be covered by Medicare or insurance plans, and patients may need to explore other options to obtain these medications at a lower cost. Some pharmaceutical companies offer programs that provide discounted or free insulin to patients who meet certain criteria, such as low-income or urgent need.
Medicare and insurance plans can significantly impact the cost of diabetes medication, and it is essential to understand your specific coverage to make informed decisions about your treatment options.
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Pharmacy coupons
The cost of diabetes medication without insurance can vary depending on the specific medication and dosage required. Some diabetes medications are available as generic versions, which tend to be more affordable than brand-name drugs. Additionally, there are various assistance programs, coupons, and discount cards that can help offset the cost of diabetes medication for those without insurance.
The Diabetes Research & Wellness Foundation also provides a drug discount card that offers savings of up to 75% on prescription medications for diabetes management. This card is accepted at over 54,000 pharmacies nationwide and can be used by anyone, regardless of income, insurance status, age, or residency. Similarly, Inside Rx offers a discount card that provides savings on select Lilly insulins when used at participating pharmacies.
For those who require insulin to manage their diabetes, there are additional options available. Lilly's Insulin Value Program caps out-of-pocket insulin costs at $35 per month for commercially insured and uninsured patients at participating pharmacies. Additionally, Novo Nordisk offers a free, one-time supply of up to three vials or two packs of pens of their insulin, ReliOn™, which can be purchased at Walmart for about $25 per vial or $44 per box of FlexPen®. Furthermore, approximately half of the states in the US have implemented legislation capping monthly insulin costs, providing additional financial relief to those without insurance.
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Switching insulin products
The cost of diabetes medication without insurance can vary depending on the specific medication and the dosage required. However, it is generally expected to be expensive. For example, insulin products like Novolog (insulin aspart) are not covered by most Medicare and insurance plans, which means that patients without insurance will have to bear the full cost of the medication.
To help make insulin more affordable, some companies offer discounts and savings programs. For instance, Novo Nordisk Pharma, Inc. offers follow-on brand insulins that are 50% off the current list prices of branded medicines. They also provide a free, one-time, immediate supply of up to three vials or two packs of pens of Novo Nordisk insulin with a prescription. Additionally, Lilly has expanded its Insulin Value Program to cap out-of-pocket insulin costs at $35 or less per month, regardless of insurance status.
Medicaid is another option for individuals who cannot afford their diabetes medication. It is a federally funded health insurance program that provides coverage to lower-income individuals and families, and most enrollees receive insulin for free or at a significantly reduced cost.
In terms of switching insulin products, it is important to consult a physician and have medical supervision when making any changes to your insulin regimen. This is because different insulin products have varying strengths and durations of action, and the dosage may need to be adjusted to avoid dangerous drops in blood glucose levels. For example, when switching from a once-daily long-acting insulin like Lantus or Levemir to an intermediate-acting insulin, the dose should be halved and administered as two injections, one in the morning and one in the evening. Similarly, when moving from an intermediate-acting insulin to a long-acting insulin, the total daily dose of the intermediate insulin should be given as a single long-acting insulin dose.
In emergency situations, one brand of regular insulin may be substituted for another or for a rapid-acting insulin on a unit-per-unit basis. Insulin mixes, such as Humulin 70/30 or Novolog Mix 70/30, contain a specific ratio of intermediate- and short/rapid-acting insulin, and these can also be substituted for one another in emergency conditions. It is important to note that insulin mixes containing a rapid-acting insulin analog should be injected closer to the start of a meal, typically within 15 minutes.
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Frequently asked questions
The cost of diabetes medication without insurance varies. The price of insulin is still in the hundreds of dollars and newer drugs are three to four times the price of regular insulin. However, some Americans pay no more than $35 a month for insulin.
If you are uninsured, you may be eligible to get your diabetes medicine free of charge through Medicaid. You can also check with your healthcare provider about switching to a more affordable insulin product, as there are cheaper generic versions of Humalog and Novolog.
The cost of insulin with insurance depends on your insurance plan and where you live. Most Medicaid enrollees receive insulin for free or at a significantly reduced cost. Lilly insulin is available for $35 or less per month for those with or without commercial insurance.
Metformin is an inexpensive drug used to treat type 2 diabetes. It is available in both brand and generic versions. The generic version is covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower.
Glipizide is an inexpensive drug used to treat type 2 diabetes. It is available in generic and brand versions. The generic version is covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower.
