Over The Counter Insulin: A Safety Net With Sizable Risk

Though many physicians consider it a bad idea, it's possible to buy insulin over the counter (OTC), or without a prescription, in all states except Indiana.

This less expensive option exists for people caught between a diabetes diagnosis and the difficulty of having inadequate, or no health insurance.

The assumption is that individuals exercising the non-prescription option know how to administer the insulin safely. While that does not always turn out to be true, some who purchase OTC insulin consider it a matter of survival.

What’s Available

The insulins available without a prescription are not generics of up-to-date brand name insulins. They are older, less concentrated formulations:

• R, or Regular insulin which is short-acting, and
• N insulin, an intermediate-acting version that is taken twice daily.

No long-acting OTC insulin is available for people requiring basal doses.

The FDA points out that these older insulin formulas were approved for OTC sale since they “did not require a licensed medical practitioner’s supervision for safe use.” Their availability is intended to increase patient safety by making insulin obtainable “quickly in urgent situations, without delays.”

Risks

However, professionals caution that no one should self-administer any type of insulin unless they have consulted with a physician, for two reasons:

1. An incorrect administration (e.g., wrong dosing, poor timing) may lead to erratic glucose levels, and potentially fatal high or low blood sugar episodes.
2. The level of daily glucose control people obtain using OTC insulin is questionable. Though the drug quality is high, it takes longer to metabolize in the body than newer versions. This means users of R and N insulins need to maintain stability in their diet and daily activities—something they may not be aware of, or are unable to manage.

“They [patients] need to know what they are doing and understand the units, timing, and type of insulin,” says George Grunberger, PhD, president of the American Association of Clinical Endocrinologists. “It comes down to this—will the patient be able to achieve glucose control safely?”

Yet, despite the cautions associated with OTC insulin use, the medical consulting firm IMS Health reports approximately 15 percent of those who purchase insulin get it without a prescription.

Safer Savings Options

Although switching to an OTC insulin may be tempting, even Dr. Todd Hobbs, chief medical officer of Novo Nordisk in North America, admits it’s not the best option.

He states that Novo Nordisk’s non-prescription Novolin is for people without insurance coverage, and is used by patients facing rising copays and premiums because it’s what they can afford. “But we hope to try to help them to not have to do that,” said Hobbs. “We clearly think the newer versions [of insulin] are more close to what the body would do on its own.”

It’s recommended those struggling to pay for insulin first talk to their doctor, or a diabetes educator, look into resources at community clinics, check into prescription assistance programs offered by pharmaceutical companies, and those listed on the American Diabetes Association website (link below).

Future Option

Some insulin users can look forward to cutting costs with biosimilar insulins. A biosimilar called Basaglar should be available by the end of this year; savings of about 15 to 20 percent are anticipated.

Bosimilar drugs are nearly exact replicas of previously approved medications. Basaglar, for instance, is a copy of the insulin glargine, popularly known as Lantus. More cost saving biosimilar insulins will be coming down the pike as original drug patents expire.

Sources: Diabetic Connect; NPR; Diabetes Journal; American Diabetes Assoc/Prescription Assistance
Photo credit: 401(K) 2012