Tuesday, October 13, 2020

Get Humalog or Novolog for About $50/vial TODAY

First, this is NOT another page dedicated to bogus manufacturer Patient Assistance Programs. Having lived with Type 1 diabetes for nearly 50 years, I can honestly tell you I have never met a person who qualified for those fake programs. Ever. 

Yet as we head into a new year, for people with high-deductible insurance plans, the deductible reset dates often start at "open enrollment" which is in November at many organizations (although some plans use the calendar year as the reset date for deductibles, which means January 1 -- a lousy way to wish patients a happy new year and that's slightly over a month away). Other companies have different plan dates, so if you have employer-based insurance coverage, you can verify with HR to determine the start date for your particular healthcare plan. 

In recent years, we've heard of horror stories about caravans of Americans headed to Canada or Mexico to buy less-costly insulin because prices in the U.S. are so out-of-control. It finally became a PR disaster for manufacturers like Eli Lilly & Co., Novo Nordisk and Sanofi. Even while those same companies bankrolled trade groups like PhRMA to fight/litigate any and all state initiatives to regulate what they were doing behind-the-scenes, enough pressure forced the two biggest insulin manufacturers (Lilly and Novo Nordisk) to offer a response to a problem they had created. Their solution: to introduce supposedly half-priced versions which they call "authorized generics". Although the nation's largest pharmacy chain CVS simply refuses to even carry the cheaper versions, its biggest rival Walgreens (which recently acquired another chain known as Rite Aid) does sell them. The curious thing is that in spite of Lilly and Novo Nordisk slashing insulin prices in half, their own bottom lines were not impacted at all. 

Nada. Zilch. 

To be sure, insulin-makers aren't exactly sitting pretty. We know that the realized "net" prices that Lilly, Novo Nordisk and Sanofi make on insulin have not risen after all the big fat rebates of  >70% given to some entity other than patients (see an article published in the Wall Street Journal on March 4, 2020 entitled "Sanofi, Fighting Back in Insulin Price Debate, Says Its Net Prices Fell 11%" at https://www.wsj.com/articles/sanofi-fighting-back-in-insulin-price-debate-says-its-net-prices-fell-11-11583340721 for detail) to pharmacy benefits managers ("PBM's") hired by or owned outright by the largest healthcare insurance companies. I described that in a recent post I did entitled "It's the Rebates, Stupid". 

Rebates are a problem of pharma's own creation, yet ironically, they seem to defend the practice. I suspect they likely could fix it if they really wanted to, so its odd, but its not patients' problem to worry about pharma's problem with rebates. The problem is that mergers have created insurance companies who are as big as pharma and now the shoe's on the other foot. But pharma has been more than willing to take care of themselves while patients have suffered from runaway prices. Price caps simply force insurance companies to give the rebates to the individual who generated those rebates. I don't necessarily think they are the best solution, but many red and blue states are doing them, and they work. 

But what if you live in a place that hasn't capped insulin prices and your deductible resets in November or January? 

The good news is that you can readily get the "authorized generics" of  rapid-acting insulin analogs for about $67/vial or $68/vial with coupons. Today, I found a coupon to get the authorized generic version of Novolog (insulin aspart) for about $67/vial. Key is to search using "insulin aspart" not Novolog. RxSaver (which was acquired by RetailMeNot in 2018) seems to be the low-price winner for that type of insulin. Its sold in Walgreens and some smaller pharmacies, just not at CVS because that pharmacy chain refuses to even carry the lower-priced versions, which means you should go to Walgreens instead (at least until you've satisfied your deductible). Just be sure to ask your doctor to prescribe your insulin with the generic drug name rather than the brand-name (ask them to prescribe either U-100 Insulin Lispro or U-100 Insulin Aspart).

Rival Humalog (insulin lispro) also sells for $68/vial today with a readily-available coupon. I first found a coupon at that price available from GoodRx today (also at Walgreens, Rite Aid or some other pharmacies, just not CVS). The low-priced GoodRx coupon for "insulin lispro" is pictured below.

For insulin aspart at GoodRx was a mere $4 higher, but why pay that much for it? Just use the app that offers the lowest-cost insulin product for your needs. The prices for both authorized generics are quite a bit less than the "half-price" advertised by the insulin makers (Novo Nordisk introduced its version with hardly any fanfare, but the fact that it copied Lilly's move is validation that it concluded that was the best way to respond to the pricing price crisis it perpetuates, but you will need a free coupon from either GoodRx.com or RxSaver by RetailMeNot. 

The apps (or online using a browser) are free and they work. Catch my post about the first time I discovered them at https://blog.sstrumello.com/2020/09/more-games-more-games-with-us-insulin.html if you want more background about how they work. But the key to it is the coupon. there are a lot out there including some advertising on TV, but some don't offer insulin discounts, so you have to do some homework, but these are readily available in the U.S. today without having to provide any personal info (unless you want them to email or text it to you).

Author P.S., May 13, 2021

On May 13, 2021, Bloomberg News reported that GoodRx Holdings had acquired the discount drug company known as RxSaver which was owned by the marketing firm Vericast for $50 million, citing people with knowledge of the matter. Vericast is controlled by billionaire Ronald Perelman. The actual sale took place in April 2021, GoodRx revealed to investors on a private call. 

The digital coupon firm RetailMeNot, which had been previously owned by Vericast, acquired RxSaver three years earlier as part of a plan to move into healthcare services. It was backed by MacAndrews & Forbes (a holding company owned by Ronald Perelman). Vericast used the money from its RetailMeNot sale in order to pay down some of its debt by buying back roughly $336 million of bonds, Bloomberg had previously reported. Several media outlets reported that Vericast had debt totaling some $2.7 billion at the time, but only about $60 million in cash, according to sources. That means that it is likely that it was forced to sell RxSaver in order to meet the firm's financial obligations.

Since the GoodRx acquisition of RxSaver, the impact on people with diabetes is that GoodRx is now offering even deeper discount coupons for Novo Nordisk Insulin Aspart (at a retail price of $52.78/vial when purchased from Walgreens, which is an additional discount of about 22% off the previously discounted price of $67/vial), which is the company's "authorized generic" (which Novo calls an "Unbranded Biologic") version of its heavily-rebated Novolog insulin analog being sold via its Novo Nordisk Pharma unit. The current coupon can be viewed below:

It is widely believed that Novo Nordisk is planning to discontinue making (or "retire") Novolog, which is no longer patent-protected, and at least three companies have announced plans to introduce Insulin Aspart biosimilars (among them: Viatris/Biocon, Lannett/HEC, and Novartis Sandoz/Gan & Lee).

Separately, Novo Nordisk told investors in its Q4 2020 investor presentation that rebates paid to pharmacy benefits managers (so-called "PBM's", who are contractually obliged to pass on all rebates to the commercial healthcare insurance companies which hire them, or own them outright) now consume 74% of Novo Nordisk's gross insulin sales in the U.S.

As an added benefit, GoodRx now offers discount coupons to purchase rival "authorized generic" insulin product from Lilly called Lilly Insulin Lispro, and the price on that is now $48.07/vial, which is even better! Users may recall that it was Lilly who originated selling a less costly "authorized generic" in response to growing public outrage over runaway prices for the now out-of-patent medicine.

As always, there are a few things patients should beware of. First, insulin pens are always more costly than a vial of insulin, and second, if they buy a larger quantity of insulin, the cost per vial does decrease slightly.

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