Study: Changing prescribing practices could slash insulin costs

Sometimes simple methods for bending the healthcare cost curve have a way of hiding in plain sight.

study published on Tuesday in the Journal of the American Medical Association adds to a growing body of evidence suggesting that human-derived formulations of insulin are as clinically effective at treating Type 2 diabetes as pricier “designer” analogues that get used more commonly.

That could offer patients relief from rising drug costs.

Jing Luo, M.D., M.P.H.
Brigham and Women's Hospital/
Harvard Medical School

Given how the cost of insulin has risen rapidly across the board lately, that could be welcome news for a large and growing patient population. Of the several million Americans using insulin today, the vast majority find themselves on newer, higher-cost analogue formulations of the drug, according to the study’s lead author, Jing Luo, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School.

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The newer insulins have been modified for attributes such as more-rapid onset or longer duration, and they’ve been marketed aggressively enough to make them blockbuster medications for pharmaceutical manufacturers. Despite some indication that they may perform better with respect to some safety events, however, very little information existed to suggest they were clinically superior.

“We were wondering whether patients with Type 2 diabetes might do as well on older formulations that don’t have as ideal a profile of action, but are clinically comparable and come from the same manufacturers—so we think the quality is good—and they’re less expensive,” Luo said.

In terms of potential savings, the study notes that the cheapest human-derived insulins can cost as little as a tenth as much as analogue therapies. Other potential benefits to patients could include greater convenience, since specialized insulin formulations can require more than twice-a-day dosing.

An op-ed piece accompanying the study points out that the least-expensive human-derived insulins typically do not come in a convenient format. But Luo said the overall cost differential between analogue and human-derived formulations would likely be more than enough to justify switching in many cases.

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The study’s conclusion isn’t particularly earth-shattering, Luo said. But despite the cost of insulin and the danger to patients for whom its growing expense might become an enticement to ration its use, neither payers nor clinicians have shown a broad inclination to change their prescribing practices yet.

This adds to the evidence that switching from analogue to human-derived insulin in a real-world setting could be safe and effective where some might not realize a viable alternative exists, Luo said.

“Unless you practice at a place like Kaiser, you’re more likely to have more clinical experience with newer analogue insulins,” he said.

Unlike situations such as dialysis, where CMS can play a role in dictating the cost of a drug, with insulin, the players are much more fragmented and decentralized. Luo said there have been entities willing to experiment, but the majority haven’t gotten there yet. And as much as he’d like these results to provide the tipping point that moves the industry toward wider use of human-derived insulin, he sees it more realistically as another data point in what’s likely to prove a longer-term journey.

At the very least, the study’s results may offer a useful path for physicians seeking ways to help patients struggling with higher insulin costs.

“For docs with patients who have issues paying for their insulin, this should make them feel more confident about switching patients to a cheaper, human-derived insulin prescription,” he says.