What’s Up with Insulin These Days?

By Cory Bradley, Senior Pharmacy Clinical Coordinator

If you aren’t rigorously monitoring the FDA’s activity on insulin products, it is understandable if you are confused by a bunch of new insulin names on the market. In an overly simplified explanation, it’s largely a bunch of new products of the same existing insulins.

To explain further, let’s break the new insulins into three new types: 1) “Modified brands “, 2) “Alternative brands” (i.e.- generic-like), and 3) “authorized generics”. We discuss them further below, but the big emphasis is on the second and third buckets which vastly improves the affordability of insulins. Please note, due to complexity of these issues this narrative was drafted by a CareOregon author to attempt to easily summarize and communicate the options; exact opinions on the classifications may differ.

  1. Modified brands- Tweaks in the inactive formulations allow for faster absorption and onset making these ultra-rapid onset. There are marketed claims of superiority, but their clinical significance in most cases is probably minimal.
  2. Alternative brands- As the FDA now considers insulins to be biologics (due to uniqueness in manufacturing) the path to a traditional, substitutable generic remains unlikely. Alternatively, these branded products are created by competing companies, as patent protections of the original brands are now lost. Currently, they are not considered substitutable (needs a new prescription), but should be considered clinically identical. With further data, some of these could be approved for interchangeability status by the FDA.
  3. Authorized generics- In response to competition from the “alternatives to brands” as well as general public pressure regarding their brand-pricing strategies, several manufacturers have released their same products under a labeled generic name.

Key Provider Takeaways:

  1. Due to many options, insurance coverages will vary from plan to plan (including within CareOregon Medicaid vs Medicare).
  2. Be aware many of these new product names are the same types of insulins and equivalent response should be expected.
  3. For cash paying patients, the new basal insulin product Semglee offers deep discounts at roughly $100 per vial.
    For mealtime insulin, Admelog and the authorized generic Humalog/Novolog offer similar prices.

CareOregon Medicaid and Medicare Coverage for Select Insulins

 

Generic Name

Product Name

“Type”

Formulary Status

AWP Costs per 100 units

Basal Insulin

Insulin Glargine

Lantus

Original Brand

COA Only

$30.72**

Basaglar

Alternative Brand

OHP + COA

$26.11**

Semglee

Alternative Brand

OHP only

$11.84

 

 

 

Mealtime

Insulin Lispro

Humalog

Original Brand

Not Covered

$42.43

Admelog

Alternative Brand

OHP

$20.20**

Insulin Lispro

Authorized Generic

Not Covered

$21.22

Lyumjev

Modified Brand

Not Covered

$42.43

Insulin Aspart

Novolog

Original Brand

COA only

$44.71**

Insulin Aspart

Authorized Generic

Not Covered

$22.35

Fiasp

Modified Brand

COA only

$44.71**

**Pricing is listed using the public AWP. Plan specific rebates can further offset costs and assist with expanding access. Note: This is not a comprehensive list of available insulins on market. But covers the most common products in relation to the CO formularies and those with ongoing competition.