Insulin Shortages and Insulin Discontinuations: what to do if your insulin is on the chopping block
A week ago, I experienced something new with my T1D. My pharmacy issued a text update regarding the refill status of my insulin. The update read something along the lines of:
¨blah blah something something your insulin is on backorder. If you do not receive an update from us, contact us after 96 hours.¨
I may or may not have immediately remembered the importance of taking slow, deep breaths after noting a marked increase in my pulse rate and that my hands started to sweat. Honestly, my first few thoughts were: how much do I have on hand for myself and my son, what if there is a backorder on other types of rapid acting insulins, where can I find insulin if it is a widespread problem, should I call my Endo office to see if they have any insight? Oh, and I had to think for a moment about how many days are in 96 hours.
What did I do?
- I opted not to call my Endo office first as it was around midnight and the office was closed.
- My son and I had insulin on hand for our immediate needs.
- I practiced my deep breathing and opted to wait until the morning so I could research more about how widespread the issue really was.
What I found online the next day was shocking! I discovered that there have been several insulin-related shortage notifications issued since January of this year.
- Fiasp® Flextouch pens will be unavailable from 4/2024 until 2025.
- Fiasp® vials are available. Except if they are on backorder like my prescription refill was.
Of interest, there is an FDA database of medication shortages where you can search for a medication name to see if it is currently listed. As of 7/7/2024, there are no insulins listed in the FDA Medication Shortages database.
- Insulin glargine vials and glargine Solostar pens
- Levemir® vials and Levemir® FlexTouch pens
- Humalog® in 3 mL vials
- Humulin R® in 3 mL vials
As of 5/24/24, Sanofi Aventis has discontinued production of insulin glargine, which is the generic of the brand name insulin, Lantus®.
There are biosimilar glargine options available, like Semglee® or Optisulin®. Lantus® (the brand name) is still available and Toujeo®, the Ultra Long Acting insulin by Sanofi Aventis, is available. Basaglar® is still available.
Levemir® will be fully phased out by NovoNordisk by the end of 2024.
What is unfortunate about Levemir being phased out for those who take and love it is that there is no generic or biosimilar option available. Anyone still taking Levemir once it is not available will need to switch to a different type of long-acting insulin.
NovoNordisk plans to continue to make their Ultra-Long Acting insulin, Tresiba.
Both Humalog® and Humulin R® will still be available in 10 mL vials and insulin pens.
> The NovoNordisk website had no information regarding the current shortage I experienced.
> The Lilly website had no information regarding the recent shortage in Humalog and Lispro that people were reporting on experiencing in the Diabetes Online Community.
To find out more about shortages, online news sources provide the most details available. This is concerning since an online news source is only as current as when the info is written. The insulin manufacturers ought to have an area of their websites, readily visible, for people who take insulin to see notices about upcoming shortages and discontinuations!
Questions are being raised about these recent shortages. Why are some of the insulins that had recent price drops from the manufacturers now in shortage or being discontinued? What should a person with diabetes do if they are nearly out of their prescribed insulin and their refill is on backorder?
How to navigate insulin shortages
For now, do what we all need to always do:
- Ensure your insulin prescriptions are written to adequately reflect your accurate insulin intake. If you use an insulin pump, be sure your prescription lists the total daily dose with the pump AND an amount used for waste from the process of filling the pump. For example, if you take 50 units a day through an insulin pump, your prescription should read: Take 50 units per day via insulin pump plus 10 units per day for waste.
- Set a calendar reminder if you do not have your insulin as an auto-refill at your pharmacy to ensure you are refilling as soon as possible every month, or every 3 months.
- Make sure you have backup insulin on hand. If you do not have an adequate “In Case of Emergency” backup of insulin, ask your Endo office if they have a sample vial available that you could have.
- If your insulin is on backorder and you need the insulin filled right away: – Contact other nearby pharmacies to see if they have it on hand. You can get your prescription transferred to a different pharmacy and pick it up where it is available.
– If nearby pharmacies do not have the insulin available, contact your preferred pharmacy and ask them what similar insulins they do have in stock. Call your insurance or look your insurance formulary info up online to see if other insulins are on the formulary.
– Call your Endo and ask for a prescription for a similar insulin that is in stock and is on the formulary.
– If the insulins available are not on your drug plan formulary, ask your insurance if there is a prior auth process that your Endo office and the pharmacy can use to get the insulin approved.
– If no other insulins are approved on your formulary plan, ask the pharmacy if there are any on the $35 cash price option for those without insurance. Ask your Endo to send a prescription for one of these insulins. - If these steps are getting you nowhere fast, visit an online resource focused on helping people get the insulin they need to live:
https://diabetes.org/tools-resources/affordable-insulin
https://www.lilly.com/resources/diabetes-solution-center
https://www.novocare.com/
https://www.teamingupfordiabetes.com/sanofidiabetes-savings-program - Contact your Endo office if you are nervous you will run out of insulin due to a shortage. Ask their office what options may be available for you.
In my experience, I was not notified by the pharmacy that my insulin was available at the 96-hour mark. However, when I called the pharmacy, they had received my insulin and I was able to pick it up 5 days after the original refill date would have been.
If there is one thing living life with T1D has taught me, it is to always be prepared for the unexpected. Make a plan, have a backup plan, and have a backup, backup plan!
References:
- https://www.accessdata.fda.gov/scripts/drugshortages/dsp_SearchResults.cfm
- https://www.usnews.com/news/health-news/articles/2024-03-25/eli-lilly-warns-that-2-insulin-products-will-be-in-short-supply
- https://www.diabetes.org.uk/about-us/news-and-views/what-fiasp-flextouch-shortages-mean-people-living-diabetes
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4 Responses
Tresiba from Express scripts is NA Got a message, “will not be shipped”! When the last administration capped insulin consumer cost at $35/month, no one wants to take the financial hit!
Any info on Tresiba Vials?
Been a week and Pharmacy still hasn’t got it after placing order.
WE recommend following up with the website resources Tavia sites in her article.
It would be great to hear more communication from drug companies explaining the shortages so that we could all plan better. I got myself switched over to the Fiasp Penfill based on information like this that i read several months ago, but now today there seems to be an even worse shortage of the penfills. I was actually able to find flexpens (and now have to get a new prescription, again) before I could find penfills. Walgreens is also now refusing to provide the same level of inventory data they were providing a few months ago, so it’s a lot harder to find pharmacies that have Fiasp and a lot of the ones they recommend you try end up having nothing.
I’m really not looking forward to November-December like this.