Diabetics we need your help. We’re trying to understand the insulin market better. In particular we want to know more about customer loyalty to a particular brand or type of insulin.
Here’s what we gather from reading up on the matter. We’d love for you to let us know about any holes in the theory.
From what we’ve read, it’s a pain to establish an ideal insulin regime for diabetics. It involves numerous trips to the GP/specialist and trial and error to get everything optimised. And because competing and generic products are only bio-similar rather than identical, switching brands is something of a pain. It takes recommitting to another round of trial-and-error.
Partly resulting from this, there’s significant customer loyalty. As long as the diabetes is well controlled and as long as insurers continue to support a program, not a great deal of switching goes on. The only time most diabetics will even consider switching insulin brands is when the old regime ceases to be effective and needs to be changed anyway.
Is that broadly right? Have you ever switched insulin types/brands? How many times? Why? Was cost ever a deciding factor or was it because the previous regime stopped working effectively? And what was the process involved?
Thank you in advance for anything you can do to further our understanding of the topic.
14 thoughts on “Diabetics we need your help”
I have a son with Juvenile diabetes. He has a pump and we have stuck with the same brand of pump and insulin for 5 years since being diagnosed. Its a really tricky disease and takes a while to get levels constant and under control so for us to be persuaded to change brands it would have to be a sizable saving or some type of improved health benefit. To be honest I don’t even think we have price checked other brands in those 5 years.
Have a few friends who are diabetic so will pass this on. However, my view is that this question would be best posed to people residing in the US or even medical professianals there.
I have had conversations with my Australian friends and they just use what their doctor prescribes them.
At one stage I was interested in Novo Nordisk but the price was always a bit too rich. However, I might take another look as its dropped and see if I can dig out my notes. Long term, huge tail winds I think. The average size for a women in the US is now 16-18, as per recent wsj article.
From one of my friends:
“I took whatever the endocrinologist prescribed initially, and the GP has
continued to prescribe the same stuff. I never thought of it a something
I could choose like I can with what model car I buy”
My doctor has prescribed the same brand/delivery method since I became insulin dependent. I haven’t felt the need to ask about other brands, as I don’t think what I pay is sufficiently expensive for me to bother enquiring.
Novo Nordisk does look cheap indeed…..
And yes, all people I talked to confirmed that as a diabetic you would never volunteer to change your insulin once it is calibrated.
Your assumptions are correct. Insulin is not about “loyalty”, it is dictated by health. The only times I have changed insulins is when dictated by my endocrinologist. Once it was unsuccessful in terms of control so I changed back of my own accord. The endocrinologist agreed with the decision. Cost did not come in to the decision.
My wife was diagnosed a T1 diabetic six years ago and she used the products that her endocrinologist prescribed. Lantus by Sanofi for long-lasting insulin and Novorapid by Novo Nordisk for the quick acting insulin with each meal.
Really she had little say in the matter. Her endocrinologist is fantastic but we aren’t sure if he prescribed her two insulin because of his loyalty (or deals) to those brands or because it was the best available to her circumstance. No back and forth ensued afterwards, it was more fit the diet and lifestyle to the insulin than the other way around. Also as insulin is on the PBS and relatively cheap here (compared to other parts of the world) there is no cost conscious decision to sway loyalties from one brand to another.
Not sure if you’re more interested in T1 or T2 as they’re very different? Both seem to be growing though. My son has had T1 for three years now and uses Novorapid, which is a short acting insulin. I’d assume T2 diabetics use long acting ‘basal’ insulin like Lantus or Levemir.
As my son’s a juvenile diabetic the government subsidises everything for us so it’s hard to answer your questions. That said, no matter what the cost we would not be changing the type of insulin unless there was a medical benefit.
My son was recently fitted for a pump so instead of using Novorapid together with Levemir he only uses Novorapid now (micro doses for the basal and boluses for meals). We have asked our specialists in the past when he was on pens if a different insulin profile like Actrapid was better but they were adamant that we should stick with Novorapid.
His life depends on it so I would call it dependence rather than loyalty. Even if we had to pay full price and generics were much cheaper we wouldn’t consider changing unless there was a clear benefit and it was a very reputable company. Not only is the specific drug and its effectiveness/profile important, the storage/turnover/reliability is paramount. For example, the other day we started a new script and all of a sudden our sugars were ~10% out. Maybe our previous insulin was old or there was a hot day that reduced its potency, we’re not sure, but storage matters.
It also takes a long time to get used to a drug. We used to use Lantus but our endo recommended we change to Levemir. It took a long time to get used to the different profiles. We’re now a few months into changing to a pump and are still working out our doses through trial and error. It’s something that you constantly monitor but I wouldn’t want to change brands and start again for something as trivial as cost.
Hope this helps.
I was diagnosed with Type 2 Diabetes about 34 years ago. In the early stages I was able to keep sugar levels under control with tablets and diet. About 20 years ago the sugar levels started to rise and my doctor put me on insulin. Cost was never an issue as the insulin was subsidised by the government. In more recent times I have been issued with a Commonwealth Seniors Health Care Card and the price was further reduced. Since being put on insulin I have used Novo Rapid (22 units before each meal) and Lantus Solostar (120 units before bed). This regime is giving me good control. I consult my renal specialist 3 times a year and sometimes we fiddle with the dosage but generally all is well. I am happy to supply the name of my renal specialist to anyone who is not happy with their current doctor. I have found no reason to change brands.
There may be different perspectives when looking at different markets. In Australia, insulins are very heavily government subsidised on the PBS through the Federal Government monoply purchasing for the entire country as do many countries that subsidise their medicines- generic insulin doesn’t have a market here (which differs from countries- notably the USA where insulin costs multiples of what it does Australians ).
I was a pharmacist, I can’t ever recall having a patient ask for alternative brands and should they have I wouldn’t have made the substitution anyway on clinical grounds considering how fickle the nature of the disease and how varied the patient response can be. Most GP’s only make very small adjustments with an insulin regimen (often the patient will have a solid handle of it over time & make customary changes as they see fit) and leave it to specialist endocrinologists to stabilise their patients. That said, oral medications are usually freely subsitutable between brands where often there are cheaper alternative brands available. Insulin is another world altogether.
Hi Gareth, there is an article in the Washington post about insulin. Sorry, can’t post the link but it’s called “Bernie Sanders wants the Feds to investigate shadow pricing by insulin makers”. A bit more food for thought.
This is very much a question for people who live in the USA. On other countries, the price of insulin is either heavily subsidized by the government ( eg Australia) or much lower and less profitable ( eg all of the third world). In Australia nobody switches insulin based on price. Switches are made based on efficacy.
Conversely, the long term risks for the insulin market are 1. A steady expansion in available types of oral hypoglycemic agents, ( which certainly eat into the type II diabetes market) and 2. A vast number of competing attempts to transplant or engineer insulin producing cells. This includes human stem cell research, genetically modified xenografts (typically pig cells genetically engineered to be less immunogenic) and various schemes for encapsulating cells such that they are not immunogenic. If any of these are ever truly successful, cost will be almost irrelevant for type I diabetics. $80,000 is an accepted (conservative) value for a Quality Adjusted Life year. So 30 extra years of life for a child and no daily anxiety about control would price at about $4,000,000.
The much touted global increase in diabetes is type II. Most type II diabetes is interrelated to obesity, and insulin tends to cause weight gain. The most promising new treatments for type II diabetes ( and the most beneficial old treatments) are those which are associated with weight loss. The prospects for increased sales of insulin, or for improved insulins to develop a market in type II diabetes is limited.
Gareth, some reading of interest
Doctor prescribed be protphane and novorapid as a 17 year old when diagnosed and using pens. Have used a pump since 2006 and use novorapid. Doctor prescribed, seemed to work for me.