Saturday, November 2, 2013

How do I get Lantus Insulin Less Expensively?

November 2, 2013--

How do I get Lantus Insulin Less Expensively?

DCIN receives this question a few times a week from US caregivers of diabetic cats. I am often amazed by the question because of the “good” insulins for diabetic cats, Lantus can be the least expensive per unit. The problem often lies in knowing how to find the insulin inexpensively. (The hints I give also apply to Levemir, another human insulin often used by diabetic cats.)

Your vet gave you a prescription that probably read “U100 Glargine/Lantus 10ml vial.”
  • Lantus is the brand name for the generic insulin Glargine. Lantus is an insulin for humans and is only available from a human pharmacy (although some vets do hold some in stock). The company Sanofi makes Lantus, and no other companies currently make a generic Glargine because Sanofi still has an international patent on the insulin. That may change in 2014, and by then Sanofi may have developed a “second-generation” Lantus that is patent protected.
  • Lantus is a U100 insulin, which describes the concentration of the insulin in the liquid suspension.
  • A 10ml vial is the insulin’s containment device. It is a small glass bottle with a rubber stopper at the end that you pierce with a syringe.
At a US retail pharmacy, a 10ml vial of Lantus can cost about $180 to $200. WOWZA! That does seem cause for sticker shock. A 10ml vial of U100 insulin holds 1000 units of insulin. At $200/vial, that is a price of $.20/unit. If your cat gets 2 units of insulin twice a day, that is $.80/day for its insulin (if you could completely use a vial of Lantus insulin). It would cost less each day to give your cat its life-saving medicine that to buy a soda from a vending machine.

However, the problem with buying Lantus in a 10ml vial is that, properly handled, Lantus (once opened) is usually only effective for 2-3 months and cats on a normally low dose of insulin don’t use 1000 units of insulin in 3 months. Some people say they get up to six months effectiveness from opened Lantus. Good for them! Some people (and some vets and pharmacists) say the opened insulin only lasts 28 days. That is because of information that comes with the insulin saying that it should be discarded after 28 days. The reason for the 28-day rule is that when Sanofi applied to the US Food and Drug Administration for Lantus approval as a human insulin, it only applied for 28 days of effectiveness. Sanofi isn’t allowed under US law to tell you that if you handle the insulin properly, it will be effective much longer.

A cat on 2 units of Lantus twice/day uses less than 400 units in 3 months. That means that you would throw away more than half of each 10ml vial of insulin because it went “flat” before it could be entirely used. A solution to that is the Lantus Solostar pens. The pen is a 3ml insulin delivery device that holds only 300 units of Lantus. A cat on 2 units twice/day would completely use a pen before the end of the three-month “effectiveness” period. Most US pharmacies only sell the Lantus pens in boxes of five, which is 15ml (or 1500 units) of insulin. The cost for a box of five Lantus pens is usually about $225-$240. That makes the insulin cost about $.16/unit. Because of the smaller delivery device, you can use more of the insulin before it goes “flat.” There is less to throw away.

Some vets will tell you that you can’t use the Lantus pen because you have to use the pen needle. WRONG. This video shows you how to draw insulin with a syringe from both a vial and a pen. http://www.youtube.com/watch?v=u4KtK_skpmQ&sns=em.

Some people can’t afford an entire box of Lantus pens at one time, especially at the beginning when they have just spent hundred of dollars getting their cats diagnosed. We have heard that some pharmacies, such as those at Walmart, Target, Sam’s Club, and Costco, will split a box and sell a single pen. (You don’t need to be a member at Sam’s Club or Costco to use those pharmacies). You also can often find someone on one of the Internet message boards for diabetic cat caregivers to split a box with you.

Other Ways to Reduce Lantus Costs
  • We have been told that one can use the Lantus Savings Card when filling a script for a diabetic cat. When you sign up for the card, we have been told you need to indicate that the beneficiary (the cat) is over 18 years old. The Internet site for the savings card is at http://www.lantus.com/sign-up/offers.aspx.
  • You can buy Lantus pens or vials from a Canadian mail order pharmacy. The current price, including shipping, is about $135 (which is about $.09/unit). It can take 4-6 weeks for the insulin to get to you, so you need to plan ahead. The insulin is shipped from the manufacturing facility in Turkey, so don’t freak out when you see unfamiliar looking boxes with labeling in a foreign language. The insulin is shipped in weather-resistant containers, but it is still best (because of the long shipping time) not to order insulin when the weather in the Northern hemisphere is severely hot or cold. Some Canadian mail-order pharmacies do not list the Lantus pens on their on-line sites even though they sell them, so a phone call might be in order. (Canadian mail order pharmacies that we have seen people buy insulin from are RXCanada4Less at http://www.rxcanada4less.com/search.php and 77 Canada Pharmacy at http://www.77canadapharmacy.com/. A brick-and-mortar Canadian pharmacy we have heard that someone orders from is Marks Marine Pharmacy at www.canshipinsulin.com.)
  • Although infrequent, some brick and mortar pharmacies in the US will sell individual pens of Lantus and Levemir. We have heard of this happening at Costco, BJs, and Target. (One does not have to be a member of Costco or BJ's to use their pharmacy.) There also is an online US pharmacy that presently sells individual Lantus pens --  VetRxDirect.com at http://www.vetrxdirect.com/product/view/lantus/variation-11865. This option is not necessarily less expensive but it may be more affordable for those who cannot afford a full box of pens at one time. It also may be possible to use the Lantus Savings Card at these pharmacies.
  • You can look for Lantus on Craigslist. CL does not allow the sale of prescription drugs, but for some reason some states’ CLs allow the listing of insulin for sale. DCIN often finds insulin for sale on the CL sites in Delaware, New Jersey, Pennsylvania, and Texas. DCIN has a document about buying insulin from CL sellers at https://docs.google.com/document/d/1qTANyTw3SRZp9azAxSum2DAVyxZudMsj8dSovcRPFag/edit?usp=sharing. When DCIN buys Lantus from a CL seller, we try not to pay more than $50/box (which is about $.03/unit).
  • You may have other “free” or “cheap” Internet sites (such as FreeCycle) in your area on which people will list insulin or on which you can post for insulin. You may need to send a message to the site administrators asking them if it is OK that you seek insulin for a diabetic cat on the site. I have gotten special dispensation for making such posts because the insulin was for a cat.
  • You can seek out friends or family who use Lantus or have friends who use Lantus who may have extra pens that they may occasionally share with a diabetic cat. When my Ennis was insulin dependent, I had a friend who was on the same insulin. Because of my friend’s dosage, she would often leave 10-20 units unused in a pen. Each month, she would give me five to six “leftover” pens, and that would satisfy Ennis’s insulin needs for the month.
  • You can watch the DCIN Facebook site for offers of Lantus. Often people who have a cat no longer needing insulin (diabetic remission or death) will post trying to find a new home for the insulin.
~Venita