High cost of insulin may be sending consumers to use over-the-counter version, researchers say

Feb. 25, 2019

As drug prices continue to rise, patients who can’t afford their medicine are taking some truly drastic steps.

Some travel across borders or order through international online pharmacies, where medications commonly retail for much less. Others try to ration or skip doses.

Researchers at Christiana Care Health System in Delaware set out to learn more about an option for people struggling to manage diabetes amid rising insulin prices: Over-the-counter insulin.

Human synthetic insulin has been available over the counter, without a prescription, since the 1950s and retails for a fraction of the price of the newer, analog insulins that are now commonly prescribed.

Still, Walmart-brand ReliOn human insulin is available without a prescription in every state except Indiana and retails for a fraction of the cost of brand-name versions, making it popular among patients who can’t afford the pricer versions their doctors prescribed, according to the researchers’ findings, published in a research letter in JAMA Internal Medicine Feb. 18.

Researchers surveyed 582 Walmart and chain pharmacies about their sales and customers.

Just over half of the 557 pharmacies that completed the survey were Walmart pharmacies. Among them, 87 percent said they sold over-the-counter insulin daily. Non-Walmart pharmacies reported infrequent over-the-counter insulin sales.

Fifty-five percent of the pharmacies surveyed said they were aware of patients who purchased over-the-counter insulin because they could not afford their prescription insulin.

A 10 milliliter vial of ReliOn costs $24.88, compared to between $152 and $163 for a vial of Novolin or Humulin, according to the report.

“Many patients with diabetes are struggling to afford their medication. The availability of insulin over the counter is potentially a solution for some patients, but doesn’t come without potential consequences, especially for patients who do not have access to a health care provider to help use that medication safely,” said lead author Jennifer N. Goldstein, a doctor and assistant program director of internal medicine at Christiana Care System.

Human synthetic insulins predate federal drug prescribing regulations established in 1951 and have continued to be available without a prescription since then.

These days, patients are more commonly prescribed a combination of newer, analog insulins that help keep blood sugar levels even throughout the day. They’re often considered easier to use and more predictable, Goldstein said.

Human insulins like ReliOn don’t last as long and must be taken more often. But they are effective in managing diabetes for many patients with careful attention to diet, meal times, and when insulin peaks.

While the pharmacy survey found that this type of insulin is popular, it’s unclear whether the type of insulin a patient chose had any effect on their health.

“It’s really unclear whether over-the-counter insulin is associated with better or worse outcomes for patients because there’s no data,” Goldstein said. “The next step is really to try to examine use and outcomes.”


McClatchy-Tribune Information Services