Ida Reighard of Butte, a registered nurse, has worked 17 years with diabetes patients and in diabetes education. The past eight years have been at St. James Healthcare, where she continues that work. She has a nursing degree from Montana State University and is married with four children. The Montana Standard asked for her perspectives on the high cost of insulin:
1. What do you see on a local level as far as the problem with insulin costs are concerned? Why do you think prices are up?
I see people daily who cannot afford their medication, particularly insulin, and their health is suffering. I feel greed is behind this huge problem. Patients contact me because the insulin their doctor ordered that works well for them has been moved to a new tier in their insurance plan and their insurance is dictating which insulin they can use. I feel pharmaceutical companies have a monopoly and we are not addressing it. My patients tell me their insurance rates are higher, deductibles are higher, and they go without their insulin or monitoring of their BG (blood glucose) levels because of this. I hear things like: “If I can find the money until August, then my insurance will kick in” or “I take it every other day because it will last the month that way so I don’t check my blood sugar. I know it is high.”
I get at least one call a week asking if I know where they can get insulin.
2. What can patients do to deal with the high insulin prices? What kind of advice would you give?
There really is no answer that I am aware of for this problem. If people qualify for assistance from the pharmaceutical company or from the sliding fee at Southwest Montana Community Health Center, I direct them there. Most of the people I work with have insurance and do not qualify for this type of assistance. Our only option is moving to an older, cheaper insulin that does not work as well. This is still an expense but not as much as the newer insulins.
3. Are there any grants or programs that might fund some of the insulin costs?
I have had no luck with this. There are programs such as the sliding fee program and there are pharmaceutical assistance programs, but these do not work for most people. Recently one of the pharmaceutical companies stopped sending the insulin to people who were on the assistance program. My phone rang off the hook because people that had no insulin, no insurance and no way to buy insulin. It was a crisis. If people do not have their insulin, it is life-threatening, especially for people with Type 1 Diabetes. They will die without it.
4. During your years with diabetes education, when did you first notice the prices began to climb? Have you ever seen anything like this (insulin prices) before in your career in healthcare?
I remember Lantus being $100 a vial in 2000 when it came out. People were switched from cheaper, less effective from NPH to Lantus, which was less insulin so it was pretty close by comparison. Currently Lantus is $300 a vial. It has been on the market for 16 years and for some reason has not gone generic. I honestly cannot think of another medication that is this old going up so high in price. Diabetes is a progressive disease. People require more insulin as the disease progresses. This means more cost. People simply cannot take care of their disease and prevent complications due to cost. Diabetes is difficult to manage, but this makes it impossible.
5. Do you know of any diabetes patients who are forgoing their insulin because they can’t afford it?
I see patients daily who cannot afford their insulin and/or diabetes supplies. Often times this has resulted in hospitalization. Insulin is very expensive and even if people have insurance, they have to pay out of pocket until they reach their deductible. Oftentimes people take smaller doses so their bottle of insulin will last longer or they do not take the insulin at all. Patients feel embarrassed and they do not want to tell their medical team they cannot afford their insulin. It is honestly one of the first questions I ask the patient. We have to address the cost otherwise they won’t get better.
We are actually switching people from the newer, better insulins to less expensive insulins that do not work as well and are harder to manage because of cost.
6. Any final comments?
I am glad there is some attention to this problem. People with diabetes have a lot to manage. At this cost, they can’t even begin to fight this battle. We have the tools. Research has led to treatments and medications that work. Unfortunately, they are not obtainable for most people with diabetes.
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