Novolin 70/30 Pens - Too Expensive

[owlegrad]

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Had a newly diagnosed patient today who had a script for the Novolin 70/30 pens, first time ever getting insulin. 160 dollars or so, no insurance. Customer can't afford that. Call the doctor to switch to a cheaper alternative, not available of course. I do speak to a case manager (I don't know what this is?) whose reply is, "He can use a credit card." <click> Well thank you for that keen insight Sherlock.

I wasn't comfortable recommending an OTC insulin to a newly diagnosed diabetic who had no experience monitoring blood sugar or giving himself injections. I don't know, I would love to hear what others have done in this situation? By far my least favorite part of retail is seeing people go untreated. My pharmacist ended up calling the doctor back, with similarly fantastic results. Not sure exactly what was said, but the patient ended up leaving with nothing, but I think was going to go see his doctor again about this situation. Hopefully it works out.

 

[confettiflyer]

Had a newly diagnosed patient today who had a script for the Novolin 70/30 pens, first time ever getting insulin. 160 dollars or so, no insurance. Customer can't afford that. Call the doctor to switch to a cheaper alternative, not available of course. I do speak to a case manager (I don't know what this is?) whose reply is, "He can use a credit card." <click> Well thank you for that keen insight Sherlock.

I wasn't comfortable recommending an OTC insulin to a newly diagnosed diabetic who had no experience monitoring blood sugar or giving himself injections. I don't know, I would love to hear what others have done in this situation? By far my least favorite part of retail is seeing people go untreated. My pharmacist ended up calling the doctor back, with similarly fantastic results. Not sure exactly what was said, but the patient ended up leaving with nothing, but I think was going to go see his doctor again about this situation. Hopefully it works out.

Wonder how high his a1c was that they went straight to SC insulin (unless he was a newly dx'd type 1). Makes me wonder, given the amount of care they seem to be showing, whether this was appropriate in the first place.

But anyway, that aside, you can technically work out a regular insulin regimen for him (that seems to have worked for >50 years for lots of people), but throw in the test strips and this guy is sinking fast.

Yeah i dunno =/

 

[spacecowgirl]

Relion brand insulin at Walmart is $24 per vial. they have Humulin 70/30. Still adds up buying all of the supplies but at least the insulin is cheaper.

 

[spacecowgirl]

Wow, Relion has all supplies too and they are pretty cheap compared to what I remember for the cash price of other brands.

It pains me somewhat to recommend sending someone to Walmart but patient care comes first.

 

[bananaface]

I'm not a big fan of referring people to other pharmacies, especially ones that use pharmacy as a loss leader and undermine the value of pharmacy services with $4 generics. However, if it is that or have the patient go without meds, I would rather have them taken care of.

If they are able to manipulate vials, Wal-Mart has always sold Humulin N, R, and 70/30 for cheap. http://relion.com/diabetes/insulin As of 2010, $24.88/vial. That would let your patient keep their prescribed 70/30 regimen and be much more affordable.

Alternately, you could look into patient assistance programs. http://www.rxassist.org/pap-info/company_detail.cfm?CmpId=16

It's hard to toss back an insulin regimen to the physician, because they are all just friggin expensive.

 

[owlegrad]

Wonder how high his a1c was that they went straight to SC insulin (unless he was a newly dx'd type 1). Makes me wonder, given the amount of care they seem to be showing, whether this was appropriate in the first place.

But anyway, that aside, you can technically work out a regular insulin regimen for him (that seems to have worked for >50 years for lots of people), but throw in the test strips and this guy is sinking fast.

Yeah i dunno =/

Thanks for the post. I am not sure about type I or II for him. There was a bit of a language barrier and frankly he was clearly overwhelmed by it all. I helped him pick out a meter and went over some basics with him, but it was pretty obvious that he was in over his head. Anyway, he was slim, which combined with the insulin as first treatment made me think type I - how often is this only discovered later in life? The guy was at least in his twenties. I don't know what his numbers were, a1c or blood glucose levels.

The response from the "case manager" startled me to be honest. I mean I understand some doctors don't want to be bothered with PA's for Ambien and such, but not caring about a new diabetic patient who can't afford unnecessarily expensive insulin? It was a new low for me. Frankly, I was upset on behalf of the patient.

Is the trick to just not care? I mean do you just get used to it? Would love to hear more ideas from the peanut gallery. 😉

 

[owlegrad]

I'm not a big fan of referring people to other pharmacies, especially ones that use pharmacy as a loss leader and undermine the value of pharmacy services with $4 generics. However, if it is that or have the patient go without meds, I would rather have them taken care of.

If they are able to manipulate vials, Wal-Mart has always sold Humulin N, R, and 70/30 for cheap. http://relion.com/diabetes/insulin As of 2010, $24.88/vial. That would let your patient keep their prescribed 70/30 regimen and be much more affordable.

Alternately, you could look into patient assistance programs. http://www.rxassist.org/pap-info/company_detail.cfm?CmpId=16

It's hard to toss back an insulin regimen to the physician, because they are all just friggin expensive.

If the pen is specified on the prescription, can the 70/30 vial be substituted? Thanks for the post!


EDIT: Darn, which I had thought of the assistance programs! That's a great tip, thank you.

 

[spacecowgirl]

I'm not a big fan of referring people to other pharmacies, especially ones that use pharmacy as a loss leader and undermine the value of pharmacy services with $4 generics. However, if it is that or have the patient go without meds, I would rather have them taken care of.

Jinx. I do think this is a huge service for diabetics because I can't imagine why test strips need to cost so much when the meters are free. That's always baffled me.

 

[bananaface]

If the pen is specified on the prescription, can the 70/30 vial be substituted? Thanks for the post!


EDIT: Darn, which I had thought of the assistance programs! That's a great tip, thank you.

Not as a prescription without physician approval. But, you could probably get that. But 70/30 vials are OTC anyway.

 

[owlegrad]

Not as a prescription without physician approval. But, you could probably get that. But 70/30 vials are OTC anyway.

My pharmacist specifically said the 70/30 is not OTC. 😕

 

[bananaface]

Jinx. I do think this is a huge service for diabetics because I can't imagine why test strips need to cost so much when the meters are free. That's always baffled me.

Great minds think alike!

The meters are often given away free to get people to commit to buying test strips long term. That's the cash cow, per multiple drug reps who have come along dumping coupons.

There are a couple of brands that are cheaper, like TRUEtrack. It requires 1uL of blood - but so do the OneTouch meters. Wags markets it as $49 for 100 strips, but I have seen it as cheap as $30 for 100 at Kroger subsidiaries. They are also $29.80 on Amazon right now for #100. The meter is $15 at Wags and $17.75 on Amazon. My main point is, though, any store can order in TrueTrack and offer an affordable option to patients who have to pay cash or a % coinsurance.

We sold alot of TrueTrack stuff at Fred Meyer and people seemed reasonably happy with it. People may want to get a different lancing device though. I think there were people who didn't like their lancets.

 

[bananaface]

My pharmacist specifically said the 70/30 is not OTC. 😕

Novolog 70/30 is Rx. Novolin 70/30 and Humulin 70/30 are OTC.

http://www.empr.com/insulin-products/article/123739/

On the FDA website select "OTC" and put "insulin" in the search box: http://www.accessdata.fda.gov/scrip...om/insulin-products/article/123739/ueryai.cfm

You can also verify Rx vs OTC status with your wholesaler's ordering website.

 

[confettiflyer]

Thanks for the post. I am not sure about type I or II for him. There was a bit of a language barrier and frankly he was clearly overwhelmed by it all. I helped him pick out a meter and went over some basics with him, but it was pretty obvious that he was in over his head. Anyway, he was slim, which combined with the insulin as first treatment made me think type I - how often is this only discovered later in life? The guy was at least in his twenties. I don't know what his numbers were, a1c or blood glucose levels.

The response from the "case manager" startled me to be honest. I mean I understand some doctors don't want to be bothered with PA's for Ambien and such, but not caring about a new diabetic patient who can't afford unnecessarily expensive insulin? It was a new low for me. Frankly, I was upset on behalf of the patient.

Is the trick to just not care? I mean do you just get used to it? Would love to hear more ideas from the peanut gallery. 😉

Yup sounds like LADA (latent autoimmune disease in adulthood) to me, in that case, this is definitely appropriate starting therapy.

Sheesh, this guy needs to be referred to a CDE for new-onset counseling, sounds like that won't be happening.

Haven't worked retail in a while, but yeah the trick is to know that there are millions of others like him and that any care you give is going to help.

Definitely refer to wal-mart for this guy, $25 a vial and cheap test strips are the way to go. If you're at an independent and he has other business with you, offer to counsel him on his diabetes meds/monitoring as long as he keeps his other stuff there with you.

 

[owlegrad]

Novolog 70/30 is Rx. Novolin 70/30 and Humulin 70/30 are OTC.

http://www.empr.com/insulin-products/article/123739/

On the FDA website select "OTC" and put "insulin" in the search box: http://www.accessdata.fda.gov/scrip...om/insulin-products/article/123739/ueryai.cfm

You can also verify Rx vs OTC status with your wholesaler's ordering website.

Well I feel like a dope now, because I can't remember if it was novolin or novolog. If the pharmacist made it a point to say it was not OTC, then it must have been the novolog.

Once he got a price of course we didn't fill it, so I never actually saw it, although I did see the script. It was a long day.

 

[museabuse]

I can see how the pt is overwhelmed. I see it all the time. This happens quite frequently:

Medical assistant leaving voicemail... "we got your lab resulted back, mr. Smith. Your A1C is high. You have diabetes. I called in an rx for metformin. Please follow up in 3 months.".

If I was a pt and had no idea I was diabetic, I would freak out(especially if I didn't know anything about diabetes). That's not right but this is how it happens a lot. They are lucky if they get a script called in for test stripts. The doctor should call the pt into office and explain things to pt, instead of giving news like that. Unfortunately they are to busy seeing a pt every 5 minutes.
As a pharmacist I like taking time to educate this pt but unfortunately i don't have enough time either. Especially when I can get fired for not answering the phone in 5 secs or verifying 300 rxs past their time.
Although I feel bad for the newly diagnosed diabetic, they are pretty much left to educate and motivate themselves in today's health care model.

 

[rxlea]

I can see how the pt is overwhelmed. I see it all the time. This happens quite frequently:

Medical assistant leaving voicemail... "we got your lab resulted back, mr. Smith. Your A1C is high. You have diabetes. I called in an rx for metformin. Please follow up in 3 months.".

If I was a pt and had no idea I was diabetic, I would freak out(especially if I didn't know anything about diabetes). That's not right but this is how it happens a lot. They are lucky if they get a script called in for test stripts. The doctor should call the pt into office and explain things to pt, instead of giving news like that. Unfortunately they are to busy seeing a pt every 5 minutes.
As a pharmacist I like taking time to educate this pt but unfortunately i don't have enough time either. Especially when I can get fired for not answering the phone in 5 secs or verifying 300 rxs past their time.
Although I feel bad for the newly diagnosed diabetic, they are pretty much left to educate and motivate themselves in today's health care model.

I completely agree. And this happens TOO much. It is definitely overwhelming for any newly diagnosed patient and I feel an incredible amount of compassion for them. On top of dealing with an illness, many are of low SES or have a language barrier. Down here in Tucson we have a great community clinic for these patients. There is a clinical pharmacist there, a CDE, who is also a prescriber.. it helps a lot.

AZ just passed a law loosening the prescribing laws for pharmacists (you already know this, though) so now a pharmacist isn't restricted to clinics like the one I mentioned. I heard Walgreens is already poised to take advantage of this because the wording of the law says collaborative practice with a "provider", not "physician"... so essentially, NPs can partner with RPhs. I am not really sure how I feel about this or how it is going to play out in practice, though... I think it has the potential to get out of hand and could harm patients, especially if they decide not to regularly see a doctor and just opt to go to Take Care Clinics for their care. Your A1C, BP, BG, and cholesterol readings can only show so much. I just hope that RPhs doing these services are adequately trained or care enough to recognize when a patient needs to be seen by the doc. But, I might just be a pessimist.