What You Need to Know About Older, Lower-Cost Insulinby Mary Shomon Patient Advocate
Insulin – used to treat type 1 diabetes and some cases of type 2 diabetes – can be very expensive. The most commonly-recommended types of insulin are pricey, and even with insurance co-pays, the cost can run hundreds of dollars per month. As a result, some patients are turning to NPH and Regular insulin. Here’s what you need to know about these older, less expensive insulin drugs.
Newer types of insulin
In the past two decades, analog insulins have become the most prescribed types of insulin. These include:
- Rapid-acting bolus insulin, such as Humalog, Novolin, and Apidra.
- Long-acting basal insulin, including Lantus, Levemir, and Toujeo.
These drugs are expensive, however, and the retail price ranges from $200 to more than $500 per vial or box of pens, according to drug pricing site GoodRx.
Older insulin drugs
Older types of insulin have been on the market for decades, and in most states, are available without a prescription. The prices range from $25 to around $150 per vial, according to GoodRx, and include:
- Regular short-acting bolus insulin such as Humulin R, Novolin R, and ReliOn R
- NPH intermediate-acting basal insulin, including Humulin N, Novolin N, and ReliOn N
- 70/30 premixed insulin that combines 70 percent NPH and 30 percent Regular. These include Humulin 70/30, Novolin 70/30, and ReliOn 70/30
Why doctors prefer long-acting insulin
Most doctors prefer to prescribe the newer – and most expensive – long-acting insulin, rather than intermediate-acting NPH insulin. Long-acting insulin is injected only once a day and provides a steady delivery of insulin for up to 24 hours, with better management of blood sugar. NPH insulin needs to be injected twice a day, and the level peaks and then drops, creating a higher risk of hypoglycemia (low blood sugar).
Why doctors prefer rapid-acting analog insulin
Doctors typically prefer rapid-acting insulin because it can be injected 15 minutes before eating, or with meals. It leaves your system in around 4 to 5 hours. In comparison, short-acting Regular insulin needs to be injected at least 30 minutes to an hour before eating. It also remains in your system for up to 10 hours, compared to 5 hours for rapid-acting, increasing the risk of low blood sugar.
Insulin costs can be prohibitive
If you don’t have medical insurance – or you have a high co-pay — the cost of rapid-acting and long-acting insulin drugs may be prohibitive. If you are in this situation, talk to your doctor about starting on or switching to less expensive Regular or NPH insulin. You could save significantly or be able to afford your insulin drugs.
Are costlier analog insulin drugs necessary?
Some experts don’t believe that costlier insulins drugs are necessary. In fact, board-certified endocrinologist Marvin M. Lipman, MD, the chief medical adviser at Consumer Reports, said that long-acting insulin is “more expensive, but that doesn’t necessarily mean it works better.” According to Dr. Lipman, the only advantage is that long-acting insulin is injected once a day, while intermediate-acting NPH insulin requires two injections per day.
Older insulins are an option for type 2 diabetics
If you have type 2 diabetes, need insulin treatment, and drug prices are an impediment, talk to your doctor about whether you can start or change to lower-cost NPH or Regular insulin. A study published in Diabetes Care in 2009 found that these lower-cost insulin options can be just as effective as the newer analog insulins in managing blood sugar in patients with type 2 diabetes.
If you have type 1 diabetes
If you have type 1 diabetes, the newer, more expensive drugs are always preferable. If you can’t afford them, however, one thing is clear: cheap insulin is always better than no insulin and can even save your life.
If you switch to Regular and/or NPH insulin, you will, however, need to carefully plan and adhere to specific timing of your insulin injections and meals, and be more vigilant about controlling your carbohydrate intake at meals and snacks to successfully manage your blood sugar.
ReliOn insulin from Walmart and Sam’s Club
The lowest-cost option for the older insulin drugs is from Walmart and Sam’s Club. Walmart private labels and sells the three types of insulin – Regular, NPH, and 70/30 — under the name ReliOn. The ReliOn-branded insulin drugs are available only from Walmart and Sam's Club. Health insurance does not cover the standard cost of around $25 per vial for ReliOn insulin. ReliOn insulin is only available in vials and is not available to purchase online.
The risk of hypoglycemia
Regular, NPH and 70/30 insulin come with a higher risk of hypoglycemia (low blood sugar), compared to the newer drugs. The symptoms of hypoglycemia include shakiness, sweating, dizziness, anxiety, headache, hunger, fatigue, irritability, blurry vision, confusion, weakness, and in severe cases, loss of consciousness.
You should always have immediate access to a source of fast-acting carbohydrates – i.e., glucose tablets, glucose gel, hard candy, juice, or soda – to counteract low blood sugar.
Test more frequently
If you switch to an older insulin drug, be prepared to test your blood sugar far more frequently, especially as you adjust to the different effects and timing of the drugs. A continuous glucose monitor (CGM) can be especially helpful during the transition, to help you optimize your blood sugar management. (If the popular Dexcom and Medtronic CGMs are out of your price range, the Freestyle Libre is a far more affordable CGM option.)
Other ReliOn products
Talk to your doctor
Finally, it’s crucial that you communicate with your doctor about your ability to afford your insulin and diabetic supplies. Your doctor may not be aware of what you are paying for your medications, your health coverage, or your financial situation. Working with your doctor, you can determine the best approach for your treatment.