Research: buying insulin out of pocket without insurance

Medicines Insulin
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There is nothing that worries me more than thinking that my son may one day (when I am dead…) be without insurance. @Sam also felt that we would not be #UNLIMITED if we did not feel able to work through lack of insurance. @Sam approached me, and we decided to work together to look into the best ways to buy analog insulin without insurance in the US. The bulk of the research was done by @Sam. My portion was largely that of fact-checker and number-cruncher.

First we investigated US prices in different locations and for different insulins. We quickly found out that using GoodRx negotiated prices was always cheaper than the listed price we got on the phone or in person. So we switched to using GoodRx for pricing info.

We also found out that one has to be very thorough and careful when investigating GoodRx pricing, because there are several dropdowns with search options for every med, and one has to check every combination of options to get to the best prices.

Note: what is GoodRx?

GoodRx is an organization that negotiates prices of (prescription) medicines with retailers and issues any internet user with coupons that will provide discounts on medicine prices. To obtain GoodRx pricing, search for the medicine you need on the GoodRx web site, print the coupon and present it to the pharmacy chain for which it applies (or simply show that coupon to the pharacy on your phone)

GoodRx web site: https://www.goodrx.com/

(To be continued)

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Long-acting (basal) analog insulin sourced in the US

We investigated long-acting (basal) analog insulin prices first. The insulin brands we researched were Lantus, Levemir, Basaglar, and Tresiba. The tabulated results follow:

BasalUSASourcing_2018-02-16b
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‘*’ Like many other chains, Walgreens has a “membership club” that allows members to get medicine at lower prices. This one is called the Walgreens Prescription Savings Club, and costs $20 per year for an individual, and $35 per year for a family membership.

We concluded that:

(a) there is no significant difference between pen and vial price for basal insulin
(b) there is value to Walgreens Prescription Savings Club
(c ) the most cost-effective basal insulin in the US is Basaglar, with a price of $0.16/Unit, obtainable with a GoodRx discount pretty much anywhere.

Do note that we did not verify if all prescription membership clubs were properly tracked by GoodRx. There may be others that actually provide better savings: please let us know if you know of any such example.

(to be continued)

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I just found link to HelpRX, for novolog, that says valid with or without insurance. I’m going to activate and try to use on my next refill at CVS. Have to check if vials are covered, or get Dr to get script for cartridges.

Will update if it helps, especially since haven’t met deductible yet.

(I did search on helpRx Novolog discount.)

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Fact-acting (bolus) analog insulin sourced in the US

We then investigated fast-acting (bolus) analog insulins. The insulin brands we researched were Apidra, FIASP, Humalog, and Novolog. The tabulated results follow:

BolusUSASourcing_2018-02-16b
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Our findings for fast-acting analog insulins were very different from what we found for basal insulin:

(a) there is a shocking difference in value between pens and vials, with a very significant advantage to vials
(b) there still is value to the Walgreens Prescription Savings Club
(c ) Humalog in vials is the best value in fast-acting insulin, being 15% cheaper than Apidral in vials and a shocking 30% cheaper than Novolog in vials (all prices with a GoodRx discount)

Once we had figured USA sourcing, we looked into legally purchasing insulin online in Canada.

(to be continued, probably tomorrow)

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Sourcing analog insulin in Canada

Can we legally purchase analog insulin in Canada?

Since the 1950s, some individuals, organizations and even state governments have been purchasing prescription medicine from Canada, where prices are much lower than in the US. WebMD has an excellent write-up on it:

In summary, it is probably legal to import up to 3 months worth of prescribed drugs that are unavailable in the US, but it is probably illegal to import insulin, since it is available in the US. However, the FDA has made public the decision not to pursue enforcement against individuals who order medicine for their own use and in moderate quantities, although they could change their mind in the future. In the meantime, probably tens or hundreds of thousands of patients in the US do so. Per US common law, this very decision of the FDA makes the practice of importing insulin closer to legal. It is possible that upcoming laws will make importing drugs from Canada 100% legal—but that is not true today. Many thousands of patients have been ordering medicine from Canada for years: we have not heard of any, ordering (a) for themselves only and (b) in reasonable quantities (typically 3 months) that has run into trouble.

So it is possible today to import Canadian insulin in 3-months quantities and expect that the FDA will not enforce any prohibition against it.

Will it arrive intact and in a timely manner?

Since the drugs still have to go through customs, the time it takes for them to arrive can vary, based on reported experiences, between a few days and a couple of weeks. Insulin is shipped from Canada in insulated packages, but may arrive at environmental temperature if enough time has passed. At the same time, we don’t know of anyone who has reported damaged insulin shipments from Canada due to temperature degradation. It does not mean this has never happened—although the many experiments made on temperature degradation by the denizens of this forum make this unlikely.

Where to order from?

In the past, several of us have evaluated or compared online Canadian insulin providers. Based on past evaluations, and on our personal experiences, we decided to use Mark’s Marine Pharmacy, a Vancouver, BC brick and mortar pharmacy, as a reference pricing source when evaluating imports of Canadian insulin.

Reference: FDA FAQ on importing drugs into the US

(to be continued)

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Sourcing long-acting (basal) analog insulin in Canada for the US

We evaluated pricing through online orders in a Canadian pharmacy (Mark’s Marine Pharmacy) for the same long-acting (basal) analog insulins we had evaluated int he US. The tabulated results follow, in US dollars, excluding shipping costs (typically less than US$25 per package):

BasalCanSourcing_2018-02-17b
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The most cost-effective basal insulin out of Canada, as in the US, is Basaglar, but the cost, excluding shipping, is half that in the US.

(to be continued)

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Sourcing fast-acting (bolus) analog insulin in Canada for the US

We evaluated Canada pricing for bolus insulin in the same manner, using Mark’s Marine Pharmacy. The tabulated results follow, in US dollars, excluding shipping costs (typically less than US$25 per package):

BolusCanSourcing_2018-02-17b
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This time, there still is a slight advantage to vials for bolus insulin, as in the US, but the cartridge or pen premium is much less. In the case of Canada sourcing, there is no difference between most insulin brands, and prices for Apidra, Humalog and Novolog are the same.

For basal insulin, US price premium was 100%: double! For basal insulin, the price premium in the US is shockingly even higher, about 350% of the Canadian price! It costs less than 1/3 the price to buy bolus insulin in Canada.

I personally find this difference outrageous: there is no doubt in my mind that it must have resulted in numerous patients’ deaths in the US, for those who cannot afford the drug.

The next step was, for us, to combine all of our results and come up with costs per month for typical CWD and PWD profiles, comparing sourcing in the US and in Canada.

(to be continued, probably tomorrow)

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A note: GoodRX pricing online is not accurate. Though they will tell you it is a negotiated price and is accurate, it depends on pharmacy and region. I use it often and find the price with GoodRx discount, at Walgreens, is usually less than they show. And in my travels, I have found the prices vary by region in the app.

That said, I will call you guys out for faulty research on two things:

  1. You have to go into a pharmacy and price it with the with the GoodRx discount, or your data is faulty. And you need to call out the region you are pricing.

2, You presented the Canadian pricing per unit for buyers on the US. You have to account for the shipping in your per unit cost for the data to be useful. If I save $50 buying insulin in Canada, but pay $75 in shipping and customs fees, it actually costs more.

Sorry guys :wink:

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@kmichel, a quick response to your thoughts:

a. GoodRx rates vs real rates at the pharmacy: when we compared GoodRx rates to the local pharmacies we talked to early on, they matched or were within a very narrow dollar range. We don’t have statistical proof that it will always be true, but I am not sure how we could ever.

b. Geographic sensitivity: I checked 5 zip codes in West Coast, East Coast and Midwest, and found no or only very slight differences. But I agree w your point: we will add zip codes used. If you know of regions where there are large differences, let me know, and I’ll do a carve-out per region. I have not found any so far but 5 zip codes are a very limited sample :slight_smile:

c. Influence of shipping cost: it is coming in the next posts, when we discuss the full impact per month. The reason is that you cannot arbitrarily add shipping cost without discussing quantity of the order (or you cannot calculate the impact).

Hope that makes sense!

[EDIT] Does anyione have any ideas about how we can address @kmichel’s point (a)?

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This is essentially impossible to do because the shipping costs per unit vary, infinitely, with how many units are ordered.

If you order 1 via of insulin and pay $25 shipping it adds 2.5c per unit to the cost.

If you order 100 vials of insulin and pay the same $25 shipping it adds 25 thousandths of a cent per unit.

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In upcoming posts, we discuss different scenarios, each with a definite insulin volume, and we include shipping in the calculations.

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Guys - I am not saying your work is for naught. It is valuable and does prove the purpose of this thread. I’m just noting some things people should be aware of - pricing may vary

I would like to see Afrezza included. I have bought it out of pocket w/o insurance.

Maybe a simple note on that would suffice. “Pricing with GoodRx may vary, but it comes out to only X% per unit on average based on geography. Also, pharmacy price could vary from the GRx quoted price by Y% per unit on average.”

Agreed. But I know there is a $15-20 cost difference on drugs like Afrezza, between MN and Cupertino, Ca. Yet Tresiba is exactly the same.

However, most of the drugs I buy are significantly less at Walgreens than the GoodRx quoted price, using the GRx discount.

Some are higher. Afrezza is lower by a good $60 bucks a box, while Phentermine is about $4 higher (not much, but it is a cheap drug - so $19.95 vs. $16 is 20% higher).

I agree it is difficult. I am glad you will be discussing this impact on another post.

Agreed. On 100 vitals it is only a few cents. But how many will buy 100 vials? Or 1?

The definite volume makes sense. Nobody is likely to buy 1 vial, nor 100.

So another thought - you guys haven’t discussed manufacturers coupons on the US pricing. Yes, some pharmacies (I don’t know if all) will treat GoodRx as commercial insurance for the discount cards. That is a secret I have never shared before, so it doesn’t get removed, but this community deserves to have the trick.

I was buying Afrezza for $86-$130 per box this way. I was getting Apidra for $10 per vial. Tresiba for $15.

So let’s not share it broadly outside the forum. It is a loophole and I hate to see it disappear :wink:

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Nice work done on this @Sam and @Michel! Excellent follow up thoughts/questions items as well! This will be such a great resource for PWD.

I’ve not used a GoodRx card. Can it be used for online orders or is it for in person only use at a brick & mortar pharmacy?

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Will do!

Will do too. I will test a few more zip codes to validate further (although it clearly won’t be statistical proof).

That is quite interesting, and unexpected too.

Btw, in the process of investigation, I discovered that Walgreens often had a price advantage, something I did not expect (I was thinking that Walmart or Costco may).

I would LOVE to investigate this too. I think it warrants a full thread of its own. its conclusions also may have to be changed frequently as programs change.

I did think of investigating them for the forum in the past, but was somewhat intimidated because the few times I tried to use one such program I failed every time. If you are familiar with them, what do you think of teaming up with me to work on one such thread?

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@Mills, so far I have only used it in person (for non-D stuff, btw). We do use a mail-order pharmacy (Caremark) for most of my son’s orders. There does not seem to be an online way to use it. Possibly if I called in before an order? Does anyone know the answer?

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So I wonder if the price that the goodrx site shows is the maximum price that they’re allowed to charge? You mention that you’ve seen cheaper in the store, have you ever seen it higher?

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Why is there so much of a cost difference between NovoRapid and Fiasp? Fiasp should be the same price as NovoRapid in Canada, not so much more expensive…?

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@Michel Insurance premiums tend to be higher in San Francisco and lower in San Diego. I’m not sure if Rx prices factor into this at all, but it might be interesting to look at these areas when you do geographic sensitivity tests.

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I have seen it higher too. I have not figured out the GoodRx prices fully. When I spoke to GoodRx, they claim they are negotiated prices with each pharmacy. My contacts at Walgreens insist they have no agreements with GoodRx and it would not be feasible for them to negotiate direct with every pharmacy for every drug.

I have noticed that the discount RxPCN is usually different for the different pharmacies. I recognize some, like Navitus, so I am assuming their agreements are with the big pharmacy benefit management companies and they are not updated as quickly.

They are “close enough” tho.

How or why did they fail?

I will consider it, but it does impact buying our of pocket with no insurance, so I would hold that the Nugget of info I shared would significantly reduce the price unit cost in these tables.

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It was shortly after my son was diagnosed, but I can’t really tell you why. In two different occasions, I tried to use the Lantus program and the Novolog program, but the pharmacy told me each time it could not be used, so I did not pursue further. I did not really understand how the programs worked and assumed that we just did not qualify, or that they were not “real” programs but marketing gimmicks.

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