I hope everyone is doing great! My mom told me about insulin for $35. She is saying it is for everyone but I keep seeing it is only for Medicare recipients. I am 35, so not on Medicare quite yet. Anyone have any experience or information? Thanks in advance
Hi @Mlp1124 , I didn’t dig too deep but, as one example, Lilly (an insulin manufacturer) has a value program you can look at by following this link. https://www.insulinaffordability.com/
Hi Joe! Nice to see you are still so active on the group Thanks so much for your help as always.
anytime Michelle! glad to help when I can.
Check Goodrx too. I looked up Lispro (genetic Humalog) and in my area you can get one vial for anywhere between roughly $8.00-$30.00. A pack of 5 pens on the other hand ranges from roughly $80.00-$185.00. Ironically the $185.00 office was at one of the “big box” stores! So depending on the type you need and packaging (vial vs. pen) you might do even better shopping around.
I think it also depends on your insurance. My insurance company does a 1 month supply for $35 or a 3 month supply for $105. I currently use Lyumjev and that was covered. I heard in 2024 it will no longer be formulary, and I have filled out the paperwork and gave it to my doctor to complete his part and then send it to insurance to get it approved and be formulary again. Some insulin companies also give coupons if you ask. Good luck!!
Hi @Mlp1124 I was wondering about this too so your question provided the motivation to look it up. “$35 Insulin” is part of the Inflation Reduction Act. The bill requires Medicare Part D plans to charge no more than $35 for a 30 day supply for each insulin product. This press release does a good job explaining what changed. FACT SHEET: President Biden’s Cap on the Cost of Insulin Could Benefit Millions of Americans in All 50 States | The White House
Some states tried to jump on the bandwagon. Here in California a bill had an insurance copay cap of $35 that would apply to all insured people in the state but it got vetoed.
The fine print of the Lilly plan says " You must have a prescription consistent with FDA-approved product labeling to pay as little as $35 for a 1-month prescription fill of your Covered Insulin." Novo Nordisk has something similar. Access & affordability And Sanofi has caps for uninsured and a few insured people. Sanofi capping its insulin to a $35 out-of-pocket costs in the U.S.
Note that none of this addresses the actual cost of insulin. While my copay for a 90 day supply of Lantus is $40 on a state employee health plan, United Healthcare is charging the plan $407.87 per box. The insurance is self-funded so I’m paying for this insanity in the form of higher monthly rates for the insurance, lower salary and again in taxes along with everyone else. Novolog is $502.10/box. Then there’s the pen needles at $70-something per box.
FWIW, you can buy pen needles on Amazon, many for less than $15 or $20 per box. No Rx required.
Check GoodRx for pricing in your area, and discounts. In my area Lantus is $35.00 for those not covered by federal or state insurance. Prices for other formulations vary.
@moderators let me know if you want me to remove the pictures.
My endo told me you can still purchase regular insulin ( not fast acting) without a prescription, for about $17.
Thanks so much! I will look into this.
Without a prescription? Interesting! Is that through any program or you can walk into a pharmacy?
Wow. Thank you for this! You are all the best, as always.
Fantastic, thank you SO much for this!!
Thank you. My mom was insistent this was the case but my dad is on Medicare which I am not.
I am also not on Medicare. I have insurance thru the company I work with.
My understanding is without a prescription, any pharmacy. I remember being able to do that many years ago. The insulin is not fast acting. $17 approx.
I didn’t notice anyone mentioning this here, but think Walmart came out with its own generic knockoff of Humalog last year, which they said would cost the $35.00/vial (another company “jumping on the band wagon”). So, you could also check that out.
@Mlp1124, Recommend learning how your insurance works for insulin as they all have different algorithms for how they charge. Dr’s prescriptions don’t take into consideration how insulin is packaged by manufacturers and sold by pharmacy. For example, my insurance charges $30 for a 30 day prescription supply but the amount in the vials at the pharmacy was enough for a 34 day supply so I was charged $60. Calling my insurance I learned that a 1-30 day supply is $30 and a 31-60 day supply is $60 per insurance calculations. Since pharmacy’s don’t remove insulin from manufacturers packaging, I had to have my Dr increase my prescription to match the manufacturers packaging amount. This way I didn’t have to pay $30 for a 30 day supply and another $30 for a 4 day supply - and then fight with insurance the following month to get another prescription filled.
All insurances do it differently. It’s a game. Learning the game can help a ton and all it took was a quick 10min call to the number on the back of my insurance card. Hope it helps!
A bottle of insulin lasts me 3 weeks, so instead of increasing my dosage my doctor wrote the Rx for 3 weeks rather than 4🤪…