{"id":4976,"date":"2016-05-25T22:42:32","date_gmt":"2016-05-26T02:42:32","guid":{"rendered":"http:\/\/www.khpi.org\/blog\/?p=4976"},"modified":"2016-05-25T22:48:44","modified_gmt":"2016-05-26T02:48:44","slug":"update-on-the-rising-prices-of-insulin-between-2013-and-2016","status":"publish","type":"post","link":"http:\/\/www.khpi.org\/blog\/update-on-the-rising-prices-of-insulin-between-2013-and-2016\/","title":{"rendered":"Update On The Rising Prices of Insulin Between 2013 and 2016."},"content":{"rendered":"

Earlier this month I published a survey of the cost of insulin<\/a> to the Medicaid and Medicare programs of Kentucky and the nation. \u00a0Fully 9.1% of the total cost of Kentucky\u2019s outpatient Medicaid drug program went to pay for the several brands of Insulin still available. It was obvious that some brands cost a lot more per prescription or claim than others and that the most expensive brands were prescribed most often!\u00a0 I used this critically important drug as an example of how the market for prescription drugs in America is badly broken.\u00a0 Since then I stumbled on two additional federal databases<\/a> that provide additional insight into how much these drugs cost\u00a0at the local pharmacy counter where the rubber hits the road. These are federal surveys that determine the National Average Retail Prices paid by the consumer (NARP), and the National Average Drug Acquisition Cost (NADAC) for\u00a0the pharmacy.\u00a0 Both these programs provide data at the cost per milliliter level, and otherwise facilitate apple-to-apple comparisons of the different brands.\u00a0 In brief, the additional data confirm that in 2013, for the same size bottle, the newer insulin analogs cost 71% more than the older \u201chuman\u201d insulins. \u00a0By 2015, all prices had increased; some substantially.\u00a0 Valuable information about the retail prices of drugs is being kept from public inspection.<\/p>\n

At the time I wrote the article, I was still blundering about in the deliberate darkness that surrounds what people actually pay for their drugs. \u00a0If you are like me, you have absolutely no confidence that either the full or discounted prices printed on our receipts from the drugstore have any basis in reality. \u00a0We are led to believe that our insurer has obtained big discounts for us and that we should be grateful we do not have to pay even more than we do.\u00a0 Of course, without knowledge of what the drug maker charges its distributers, how much the pharmacy benefit managers collect and pay, the acquisition cost of the drugs to the pharmacy, the amounts of any rebates or other incentives, or even how much the insurer really shells out; it is impossible to know if anybody is making an effort to protect our interests as patients.\u00a0 Too many entities are feeding at the same trough.<\/p>\n

National Average Retail Prices.<\/strong>
\nBack in 2012, CMS, the agency that administers Medicare and Medicaid, began a program to determine just how much money was crossing the retail counter of chain and independent pharmacies. Information was collected directly from the pharmacies including payer, quantity dispensed, and price.\u00a0 This latter included the combined prices paid for drug ingredient costs, customer pay amounts, and dispensing fees. Alas, Congress killed the program before we the people could benefit from the results, but not before data for at least part of 2013 was collected and posted as a \u201cdraft\u201d on the CMS website along with information about methodology.\u00a0 [Is there any doubt about whose interests were being protected by Congress? No doubt this represented another triumph of lobbying by industry.]<\/p>\n

Below is a table of NARP for insulin products in 2013. From the complete list I abstracted all vials containing the industry standard of 10 milliliters (ML) of insulin at a concentration of 100 units per ML.\u00a0 Prices are given per ML for Fee-for-Service Medicaid<\/u>, Third Party<\/u> payers including Medicaid and Medicare managed care and other insurers, and Cash<\/u> payers that would include the indigent and uninsured. A national weighted average of these is designated as the NARP [per ML].\u00a0 The cost of the most commonly dispensed 10 ML vial can be calculated.<\/p>\n

\"narp-insulin-2013-table\"<\/a><\/p>\n

Results<\/strong>.
\nThe older brands of human insulin (Humulin and Novolin) cost $79-80 per vial in 2013. The average prices of the five insulin analog brands was $135 which was 71% higher than the older human insulins. Are the newer insulins worth the money?\u00a0 What do they do that the old standards cannot? I do not know the answers but I am confident that we could all share in some savings. \u00a0Here is an external link to the\u00a0graphic visualization<\/a> of the NARP data appearing below.<\/p>\n