The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes

It’s the biggest diabetes news we can remember: All three major insulin manufacturers have agreed to drop prices of some of their best-selling insulins. First it was Eli Lilly, promising to slash some insulin prices right now and others in the coming months. That move appeared to provoke the two other big manufacturers, Sanofi and Novo Nordisk, into making their own announcements in the following weeks.

But if you’ve been reading the breathless coverage, you might have missed out on some critical information. Which insulins are getting cheaper, and when will the effects take place?

This article will detail everything that is currently known about the recent insulin price cuts.

Price Cuts: Fast-Acting Insulins

• Apidra: the price will drop 70 percent on January 1, 2024.
• Humalog: the price will drop by 70 percent in tardy 2023. The price reduction will cover many various forms of Humalog, including vials, cartridges, KwikPens, and the 50/50 and 75/25 pre-mixes. Additionally, the cost of insulin lispro, an unbranded version of Humalog, will drop on May 1, 2023. A vial, which previously cost , will not cost . It was unclear from Lilly’s exhort unwrap if the cost of Insulin Lispro pens will also drop.
• NovoLog: The cost will drop by 75 percent on January 1, 2024. The cost reduction will also cover NovoLog Mix 70/30. The cost of insulin aspart, an unbranded equivalent of NovoLog, will also drop.

Price Cuts: Long-Acting Insulins

• Lantus: the list cost will drop by 78 percent. The price cut doesn’t take impression until January 1, 2024. Additionally, out-of-pocket spending on Lantus ought to be capped at per month.
• Levemir: the list price will drop by 65% in January, 2024.
• Rezvoglar is not receiving a price cut, because it’s a brand-new product. But it will launch with a low list price. This new biosimilar insulin is essentially a generic version of Lantus, and should be functionally equivalent to Basalgar.

Price Cuts: Short/Intermediate Insulins

The older generation of insulins is also receiving a price cut.

Humulin R and Humulin N, manufactured by Lilly, and Novolin R and Novolin N, manufactured by NovoNordisk, will all enjoy price cuts. The price of the Humulin formulations will drop by 70 percent in late 2023, and the Novolin formulations will drop by 65 percent in January, 2024.

These old-school insulins are already quite a bit less expensive than the best insulins available today, but they are also considerably more challenging to use. Some formulations are famously available for low prices at Walmart without a prescription.

The Insulins NOT Receiving Price Cuts

Here is a list of popular American insulins that are not, to our knowledge, changing their prices.

• Admelog, a biosimilar of Humalog made by a competitor (Sanofi), is essentially a generic insulin. It was originally designed to be relatively low cost, and its cost will not change.
• Afrezza, the unique ultra-rapid inhaled insulin, is made by a different manufacturer than all of the other insulins mentioned in this article, and there’s been no indication that its price will be changed
• Basalgar, Lilly’s long-acting insulin, will not receive a price cut. However, users may find that their spending gets slashed anyway if they qualify for Lilly’s per month out-of-pocket spending cap.
• Insulin Glargine is an unbranded lower cost equivalent of Lantus that is also manufactured by Sanofi. It was released only in June 2022, and apparently its price will not change.
• Fiasp, a newer ultra-rapid insulin that works even faster than Humalog or NovoLog, will not receive a list price cut.
• Lyumjev, a newer ultra-rapid insulin that works even faster than Humalog or NovoLog, will not receive a list price cut, but users may find that their price gets slashed anyway if they qualify for Lilly’s per month out-of-pocket spending cap.
• Semglee is a biosimilar of Lantus that is manufactured by a different pharmaceutical business named Mylan. We’re not sure yet what will happen to the list price of Semglee, which was designed to be a lower-cost alternative to Lantus.
• Tresiba is a basal insulin that acts for as long as 42 hours. Its price will not change, but a lower-cost unbranded biosimilar (insulin degludec) is available.
• Toujeo is a concentrated version of Lantus, also manufactured by Sanofi, that may reduce the risk of hypoglycemia. Its price will not change.

What about Insulin Combinations?

To our knowledge, there are no price cuts on insulin combinations such as Soliqua (insulin glargine/lixisenatide) and Xultophy (insulin degludec/liraglutide).

Are Total Monthly Out-of-Pocket Really Capped at per Month?

Some users will have their out-of-pocket spending capped at per month, either immediately or in January 2024, but it all depends on which insulins you use.

• Lilly announced a monthly spending cap for its insulins, effective immediately, at “the majority of retail pharmacies.” Lilly manufactures the brand-name insulins Basalgar, Humalog, and Lyumjev.  To find out if your costs will be automatically capped, you will probably have to show up at the pharmacy and see what happens. If your price for these insulins remains above , you should see if you qualify for Lilly’s savings program.
• Sanofi also announced a cap on Lantus starting in 2024, although there is no corresponding cap on Apidra.

What If You Don’t Have Health Insurance?

Americans without health insurance can get stuck with jaw-dropping bills for insulin, prices that are dangerous and occasionally even deadly for patients without the means to pay them. Most government efforts to address the insulin affordability crisis — both failed federal legislation and successful state-level measures — have failed to address this problem at all.

If you don’t have insurance, lower list prices on these insulins should certainly assist reduce your out-of-pocket costs, though the price at the pharmacy may still be high.

In their press releases, all three insulin manufacturers were also at pains to highlight their insulin affordability programs for women and men without insurance.

• Lilly says it has streamlined access to its savings program, and that people without insurance can now immediately download a savings card that limits out-of-pocket costs.
• Sanofi’s Valyou Savings Program enables 100 percent of uninsured people “to buy one or multiple Sanofi insulins at for a 30-day supply.”
• Novo Nordisk maintains a variety of programs for patients without insurance that are in need of insulin they cannot easily afford.

If you don’t have health insurance, it would be a mistake to assume that the number on the pharmacy cash register is the price you really have to pay. You should take full advantage of these affordability programs. It might mean you have to fill out a few forms, but the savings can be massive.

What if You’re on Medicare?

The recent announcements probably do not significantly affect people with diabetes on Medicare. Medicare recipients already have their out-of-pocket costs capped at per month, thanks to the Inflation Reduction Act of 2022.

What if You’re on Medicaid?

The recent announcements probably will not significantly affect people with diabetes on Medicaid.

Medicaid users are already substantially protected from potentially high cost insulin. A 2022 US government report to Congress found that the average insulin user on Medicaid spent per year on their insulin, far less than the 6 annually spent by those with private insurance, or the 6 spend by those without insurance.

Why Prices Are Changing Now

We’re not sure exactly why insulin prices are finally changing, but it’s clear that there were a lot of factors at play. Here’s a brief review of some of the pressures that insulin manufacturers were facing:

• Years of grassroots activism has turned the insulin affordability crisis into a high-profile political issue.
• President Joe Biden, among others, continued to call for national insulin price caps.
• Medicare officially capped out-of-pocket costs for insulin, following comparable caps on insurance co-pays in many states.
• California recently announced that it would manufacture its own insulin.
• Both Civica Rx and Mark Cuban Cost Plus Drug Co. have promised to create and distribute low-cost biosimilar insulins.
• A bipartisan act in the Senate threatened to overhaul the pharmacy benefit manager rebates that have helped cause insulin costs to spiral upwards.
• Finally, a clever bit of Twitter trolling this November may have lost Eli Lilly billions of dollars overnight.

At this point, practically everyone in the country is outraged by the high price of insulin, and with many different pieces of state and federal legislation capping prices for many different patients, Big Pharma may have finally decided that the public relations hit outweighed the profits.

Diabetes Daily

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes