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Ivan Titov
Ivan Titov

Buy Insulin Over The Counter

Over-the-counter (OTC) insulin is sold more often at Walmart than at other pharmacy chains, most likely because of its lower cost and patients' inability to afford co-pays for prescription insulin, new research suggests.

buy insulin over the counter

The results showed that OTC insulin is sold more commonly at Walmart than at other pharmacy chains and that inability to afford co-pays for prescription insulin was noted as a common reason for purchase, particularly at Walmart pharmacies.

In the United States, human insulins such as NPH and Regular insulin (and 70/30 mixtures) are available OTC in every state except Indiana. Walmart's own ReliOn brand of insulin (manufactured by Novo Nordisk) is considerably less expensive than the branded human insulins sold at other pharmacy chains, at approximately $25 vs $152-$163 for 10-mL vials of Novolin (Novo Nordisk) or Humulin (Eli Lilly). In contrast, insulin analogs such as lispro (Humalog, Eli Lilly), aspart (Novolog, Novo Nordisk), and glargine (Lantus, Sanofi) require prescriptions.

In an interview, Goldstein told Medscape Medical News, "Prescription [analog] insulins are considered by many to be easier to use and more predictable than the human insulins available over-the-counter. However, insulin prices have skyrocketed over the past decade and many patients with diabetes have had to ration their prescription insulin because of cost."

She cautioned that although human synthetic OTC insulins "may be an important treatment option for patients with diabetes who are uninsured or underinsured...use of such insulins without medical supervision is never recommended and could be very dangerous."

In 2018, Goldstein and colleagues conducted telephone surveys of employees of six Walmart pharmacies in each of the 49 states that allow OTC insulin and of other pharmacy chains (CVS, Walgreen's, or Rite Aid) geographically closest to each Walmart.

The questionnaire was completed by 561 pharmacies. Of those, 97% of the respondents from the 292 Walmart pharmacies and 80% from the 269 other pharmacy chains reported that they sold insulin OTC or without a prescription.

Of the 284 Walmart pharmacies selling OTC insulin, 87% reported selling it daily, 10.9% weekly, 1.1% monthly, and 1.1% "a few times a year." In contrast, none of the other chains reported selling it daily, 1.4% reported weekly sales, 8.8% monthly sales, and 46.3% "a few times a year." Notably, 34.5% reported that they never sold it (P

Asked whether they were aware of patients who purchased insulin OTC because they couldn't afford the co-pay for their prescribed insulin, 70.1% of the Walmart responses were "yes," compared with just 19.7% from the other pharmacy chains (P

Walmart pharmacies reported selling a median four vials of insulin over the counter daily (mean, six vials; range, 1-50). Based on a total of 4700 Walmart pharmacies in the United States, the authors estimated that the company sells about 18,800 vials of over-the-counter insulin per day.

As you would expect, diabetes medications typically require a prescription; however, there is an exception for some older forms of insulin. These nonprescription insulins, which are still widely used, can be purchased without a prescription. In fact, they remain the only injectable human drugs that can be sold without a prescription under federal law.

Diabetes advocacy groups, such as the American Diabetes Association, support the availability of nonprescription insulin, which is an important treatment option for diabetes patients who lack or have inadequate insurance to help with the high cost of prescription treatment options. Although these types of insulin are not displayed in the over-the-counter (OTC) section of the store, they can legally be sold upon request to patients who do not present a prescription from an authorized prescriber. In this situation, the pharmacist is an important frontline resource for diabetics.

Insulins are complex biological products that are sensitive to temperature variations. As such, manufacturers recommend that insulin be stored in refrigerated conditions (36o-46oF). At these temperatures, insulin will retain its potency through the labeled expiration date. Once opened, insulin will continue to work for up to 28 days at room temperature (59o-86oF). Insulin can degrade and lose potency when exposed to extreme temperatures, either freezing temperatures or high heat.

To combat this nationwide problem, Georgia enacted a law that criminalizes the resale of nonprescription insulin that a patient first obtained through an OTC sale. Insulin sold in this manner is deemed adulterated under the law.

The risks with this type of corrupt distribution are very high for patients, as they are receiving and injecting potentially adulterated insulin that is very likely subpotent. The storage and handling of this diverted insulin are completely unknown to patients and should be questioned by distributors.

Maintain your awareness of these types of schemes and verify the source of insulin for retail pharmacies and drug wholesale distributors before purchasing. Pharmacies that turn a blind eye to the purchase and sale of insulin that is clearly labeled as being exclusively for sale by a specific pharmacy cannot claim ignorance of the source of the diverted insulin.

Regular coverage across Canada varies. Effective January 2018, Ontarians aged 25 and under with Type 1 diabetes would have their insulin covered by OHIP+, a bonus to the Ontario Health Insurance Plan (OHIP) which covers over 4,000 drugs listed on the Ontario Drug Benefit list.

In early February 2019, amid continued public outcry over the soaring cost of life-saving pharmaceuticals, readers shared a screen-captured image on social media of a local news station's reporting on the story of a woman who said she bought inexpensive insulin without a prescription at Walmart:

Readers asked us whether this was true. It is true, although you should note Walmart sells human insulin, an older version of the glucose-moderating hormone, whereas most insulin-dependent diabetics are currently prescribed insulin analogs that have evolved to help prevent dangerous swings in blood-glucose levels.

We confirmed with Walmart that the retail chain does indeed sell human insulin without a prescription (except in Indiana). That product is Novo Nordisk-manufactured Novolin, which Walmart has branded as ReliOn and sells for $24.88 per vial. Walmart spokeswoman Marilee McInnis confirmed to us that the company has "maintained, through negotiation, the same retail to patients since 2011." To say that the insulin is sold "over-the-counter" isn't quite accurate, however, as customers must ask a pharmacist for it.

Although this revelation might be important, life-saving information for diabetics, an important caveat is that human insulin behaves differently than the newer analog insulin currently retailing for more than $300 a vial.

Dr. Todd Hobbs, chief medical officer for Novo Nordisk, wrote that the different types of insulin have the same effect of lowering blood-glucose levels, but, "Training is required whenever someone is prescribed insulin, whether that be human insulin or the newer analog insulin products. Differences in the timing of all types of insulin must be considered for patients to effectively use them ... The difference in the types of insulin is related to how slowly or rapidly they are absorbed once injected. Scientific advances over the years have made improvements on the speed and length of time this absorption occurs."

Note, there are two types of diabetes. Type 1 diabetics' bodies cannot manufacture insulin, the hormone responsible for glucose absorption. Type 2 diabetics' bodies, on the other hand, become resistant to insulin. In most cases, Type 1 diabetes starts in childhood, whereas Type 2 is sometimes referred to as "adult-onset" diabetes.

The screen shot from the KDFW report no doubt went viral as a result of an ongoing controversy over the cost of analog insulin, which as of 7 February 2019 soared to a retail price of more than $300 per vial. Americans have been awash in medical horror stories such the death of Jesse Lutgen, a 32-year-old Type 1 diabetic who lost his job at a distribution center in Dubuque, Iowa, and with it, his health insurance. He was found dead in his home in February 2018, having run out of insulin. His last vials of the medication were given to him by a friend.

Lantus (insulin glargine) is a brand-name long-acting insulin that helps control blood sugar levels in people with Type 1 or Type 2 diabetes mellitus. Long-acting insulins are a critical part of blood glucose control. As a basal insulin, they help control blood sugar throughout the day while fast-acting or short-acting (prandial) insulins help manage blood sugar spikes after eating.

Lantus is taken as a subcutaneous injection once per day at the same time each day. Doses will vary. Lantus is an expensive insulin, but insulin glargine can be purchased as a generic. There are no long-acting insulins that can be purchased without a prescription, but FDA-approved over-the-counter intermediate-acting insulin can be purchased as a basal insulin at Walmart.

Most insurance and Medicare Part D plans cover a Lantus prescription. Many Medicare Part D recipients pay $50 or less, but those who qualify for Medicare Low Income Subsidy may pay less than $10 for a one-month supply of Lantus. The cost is even lower for those who receive Medicaid.

People without insurance coverage will usually pay the full cash price for Lantus, about $357.62 for one 10 mL vial containing 1000 units of insulin glargine. The monthly cost will depend on the dosage prescribed. A dosage of 10 units a day will cost $108 per month, but at 80 units a day, Lantus will cost about $858 per month when purchased in a vial or $853 when purchased as Solostar injection pens. For some people, daily dosages could exceed 100 units per day.

Insulin glargine, however, is available under other brand names and as a generic. Price comparisons are difficult because not all insulin products are sold in the same amount or concentration. Based on the price per 100 units, generic insulin glargine and at least one other brand-name version, Basaglar, can be purchased at a significant discount compared to Lantus. Other brand-name versions of insulin glargine, Semglee and Toujeo, are slightly more expensive. Two other long-acting insulins can be substituted for Lantus: Levemir (insulin detemir) and Tresiba (insulin degludec). Both, however, retail for a higher price than Lantus. 041b061a72


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