What you need to know about insulin

PICKING AN INSULIN — AND SWITCHING INSULINS Lots of considerations go into choosing an insulin that’s right for you — and a big one is cost.   Among Medicare beneficiaries, average

out-of-pocket insulin costs were $54 a month in 2020, though some people paid more than $100 a month, a report from Kaiser Family Foundation shows. Without insurance, insulin can cost

upwards of $1,000 a month. How you prefer to take your insulin matters too. For example, vials tend to be less expensive than pens, which can cost up to 40 percent more, according to a

GoodRx Health analysis. “In general, the [insulin] that we use is the one that your insurance pays for,” Nathan says. NEW LAW CAPS INSULIN COPAYS A new law limits copays for insulins at $35

a month for Medicare Part D beneficiaries. However, not every plan will include every insulin product in this $35 cap. For a full list of the insulin drugs covered by each plan, check out

the Medicare Plan Finder and read more about a special enrollment period that gives beneficiaries until the end of 2023 to switch plans if they didn’t get the best deal during last year’s

enrollment. The $35 cap does not apply to people who are not on Medicare, though some states have insulin copay caps for people with other health plans. If you switch insurance plans — or

your plan switches the drugs it covers — and your insulin costs more than it used to, talk to your doctor about switching brands within the same insulin category (one rapid-acting for

another, for example). In most cases, “they are pretty much interchangeable,” Nathan says, but it’s important to consult your doctor just to be sure. (It’s possible to buy some forms of

insulin without a prescription.)  You may run into a situation where your insurance plan covers the type of insulin you need, but not the delivery method you prefer — say, only the vial and

not the pen, points out Shichun Bao, M.D., an associate professor of medicine in the division of diabetes, endocrinology and metabolism at Vanderbilt University Medical Center in Nashville.

For someone who has vision or dexterity problems and has difficulty drawing insulin from a vial, “that’s not acceptable,” Bao says. Again, she recommends talking to your doctor, who may be

able to appeal to your insurance provider for coverage or help you find something that works in the meantime. “[Patients] have to communicate with their provider when there’s an issue with a

medication coverage,” says Bao, who adds that individuals should never reduce or skip doses. Surveys show that because insulin costs so much, many people who cannot afford it report they

skip doses or don’t take the full amount their doctor prescribes. Switching insulins between different categories — say from long-acting to intermediate — isn’t as simple as changing brands

within the same category, Nathan warns, and shouldn’t be done without the guidance and supervision of a physician, especially if you’re also taking other types of insulins throughout the

day. “There's nothing automatic about changing these insulins. People really do need to discuss it with their physicians,” he says. The U.S. Food and Drug Administration (FDA) has

recommendations for diabetics who may need to switch products in an emergency, including advice for adjusting doses if only one type of slower-acting insulin is available. You can find the

guidance on the agency’s website.