Expensive Diabetes Medications: Explained

The price of diabetes medications in the United States is a prevalent topic among patients and practitioners alike. Especially for patients without sufficient insurance coverage, managing diabetes can become a source of significant financial strain.

Read on to learn why diabetes medications are so expensive and what you can do to find low-cost options.

Exorbitant Diabetes Costs in The United States

According to the CDC, $1 out of every $4 spent on healthcare in the United States is spent on diabetes care, making it the most expensive chronic disease in the country. Patients with diabetes spend an estimated $16,752 on medical care each year, and $9,601 of those expenses are diabetes-related.

The cost of blood sugar-lowering medications alone has been estimated at $57.6 billion per year in the United States, accounting for 15% to 20% of the estimated yearly cost for all prescription medications.

The Consequences of High Diabetes Costs

With these statistics in mind, there’s no question that diabetes treatment costs have reached a staggering level. Unfortunately, these expenses have far-reaching consequences, especially for uninsured patients. Lost productivity, mental health concerns, and insulin rationing are a reality for millions of American diabetes patients today.

The repercussions of high diabetes costs go far beyond the surface, eventually affecting patients’ quality of life.

Insulin Pricing: Factors and Complications

Many diabetes patients require insulin to keep their blood sugar levels within the target range. In recent years, soaring insulin prices have been featured in articles from major news outlets, including The New York Times, The Washington Post, and BBC News, just to name a few.

The average retail cost of insulin increased by 54% from 2014 to 2019. Between January 2020 and October 2021, these costs were only reduced by approximately 5%. This makes it difficult for millions of diabetic Americans to afford their medication.

As of September 2022, the average retail price per unit for mixed insulins is between $0.17 and $0.48, with most diabetics needing between 10 and 200 units of insulin per day.

Without a cure for type 1 diabetes, many patients will need insulin for the rest of their lives. For these patients, high insulin prices can become a lifelong struggle.

Why Is Insulin So Expensive?

A process known as evergreening is largely responsible for high insulin prices in the U.S.  Evergreening occurs when drug companies make cumulative improvements to their medications to keep their patents from expiring. For example, a drug company may start using insulin pens, rather than vials. Or, they may slightly change a molecule in the medication.

By prolonging the lifespan of their patents, drug companies deter generic drug creation and gain the right to price insulin as they please. Combined with supply chain issues over the past several years, evergreening has led to excessive insulin costs.

Efforts To Lower U.S. Insulin Prices

Thankfully, over the past few years, new efforts to reduce U.S. insulin prices have emerged. In 2023, the U.S. House of Representatives passed a bill to cap insulin costs at $35 per month. Unfortunately, this bill only applies to patients covered under Medicare, which leaves over 21 million Americans with diabetes behind. But, this isn’t the only initiative to make insulin more affordable.

Representatives in at least 22 states across the country have passed legislation that limits insulin co-payments to $100 or less for a 30-day supply. Additionally, the governor of California has approved a budget that allots $100 million to facilitate the state’s own production of affordable insulin – an exciting prospect for the state’s over 2.3 million diabetics.

Efforts like these may continue in the coming months and years, gradually helping to reduce the effects of evergreening on the cost of insulin.

The Cost of Popular Diabetes Medications

Ozempic

If you’ve been keeping up with the latest prescription weight loss medications, you’ve probably heard of Ozempic. It’s an injectable type 2 drug containing semaglutide, a GLP-1 (glucagon-like peptide 1) agonist. This means that it stimulates the release of insulin from the pancreas. Semaglutide also helps with diabetes by preventing excess sugar production in the liver and slowing down stomach emptying.

Unfortunately, a skyrocketing demand for Ozempic paired with international supply issues has led to shortages of the drug. This is partially due to Ozempic’s growing popularity as a weight loss medication, thanks to its recognition from celebrities and TikTok influencers.

For patients paying out of pocket, the average retail price of Ozempic is $1,021.97 for a one-month supply. Patients with insurance may get the price down to $25 for a one, two, or three-month supply of Ozempic, but this isn’t guaranteed and will vary depending on the insurance plan. If you have Medicaid or Medicare, your plan may cover Ozempic, although copays can vary depending on your deductible.

Trulicity

Like Ozempic, Trulicity is a GLP-1 agonist and works by signaling the pancreas to release more insulin. Its active ingredient is dulaglutide which, as the name suggests, is closely related to semaglutide.

Though similar, Trulicity and Ozempic have a few key differences. Ozempic has been found to reduce average blood sugar levels more than Trulicity. However, data has shown that patients may take Trulicity as prescribed more (and may be less likely to stop taking it) than Ozempic.

The list price of Trulicity is approximately $990. The drug is covered by many Medicaid, Medicare, and commercial insurance plans, with out-of-pocket costs varying significantly between plans.

Jardiance

Jardiance is the brand name for empagliflozin. It’s a once-daily pill that works for type 2 diabetes by helping the kidneys remove glucose from the bloodstream.

The out-of-pocket cost of Jardiance is around $634 for a 30-tablet supply, but this cost can differ depending on the pharmacy you go to. Some insurance plans cover Jardiance, as do most Medicaid and Medicare plans. But, keep in mind that you may still be responsible for copays, even with insurance.

Farxiga

Farxiga is a medication prescribed for type 2 diabetes, chronic kidney disease, and heart failure. It contains the drug dapagliflozin, which helps the body remove glucose through urine.

For patients paying out of pocket, the average retail price of Farxiga is $649.95. It’s covered by most Medicare prescription drug plans, as well as some Medicaid and commercial insurance plans, with the possibility of co-pays.

Invokana

Invokana is a type 2 diabetes medication containing canagliflozin. After a clinical trial that revealed its potential to increase lower limb amputations, it hasn’t been as widely prescribed as the other meds on this list.

Nonetheless, some people still take Invokana to help with blood sugar management. It blocks specific proteins in the kidneys that send glucose back into the bloodstream.

The typical cost of Invokana without insurance is $640 for a 30-tablet supply. Like the medications listed above, Invokana is covered by some commercial insurance and Medicaid plans. But, of course, patients may be responsible for copays, and Medicare generally doesn’t cover Invokana.

Take a look at this chart for a side-by-side comparison of monthly costs for these popular diabetes drugs:

Does Insurance Reduce Diabetes Costs in The U.S.?

Unfortunately, insurance doesn’t always reduce diabetes costs for U.S. patients. Several factors impact out-of-pocket costs for insured diabetic patients, including the monthly premium and deductibles.

Insurance Premiums

In 2021, 54.3% of Americans were covered by employment-based health insurance. With this form of insurance, all of a company’s employees are enrolled in the same plan. In some cases, employees have a few plan options to choose from. The plan’s premium, or monthly cost, can vary depending on a few different factors, including the employees’ collective health.

In most cases, insurance plans with high premiums also provide lower co-payments (out-of-pocket costs) for patients. So, diabetes patients who can afford a higher monthly premium may avoid high diabetes medication prices, but patients who choose a lower monthly insurance premium often must pay more for their prescriptions.

Insurance Deductibles

A deductible is the amount of covered medical expenses that you must pay before your insurance plan provides coverage. For example, if you have a $1,000 deductible, you’ll be responsible for paying the first $1,000 of covered medical expenses before your plan kicks in. But, even after the deductible has been reached, you may still be responsible for co-payments.

With this information in mind, high deductible health plans, or HDHPs, typically leave patients with the highest medical expenses. So, diabetes patients covered under an HDHP will need to consider alternative options, like online pharmacies, for more manageable medication costs.

How To Find More Affordable Diabetes Medication

If you’re struggling to afford your diabetes medication, you understand the urgency of finding low-cost options. Combined with the cost of living crisis, high drug prices can have severe and far-reaching effects on diabetes patients’ overall wellness. Thankfully, there are other solutions at your fingertips.

Online pharmacies like Pharma Giant can help diabetes patients in the United States get the medications that they need at reasonable prices. Along with affordable drug prices, online pharmacies offer direct shipping. So, you can order medications from the comfort of your home.

Although sky-high diabetes medication prices can be discouraging, nationwide efforts to lower them are promising. In the meantime, patients can seek out savings from alternatives, like online pharmacies.