The landscape of diabetes management is constantly evolving, and with it, the costs associated with treatment. Recent announcements and existing patient assistance programs aim to alleviate some of the financial burden, particularly concerning insulin costs. This article delves into the details of these programs, drawing insights from a recent announcement by Novo Nordisk and expanding the discussion to address the broader question of affordability, especially concerning Continuous Glucose Monitors (CGMs) and programs like the Lilly Cares Program.
On March 14, 2023, Novo Nordisk made a significant announcement regarding the reduction of wholesale list prices for several of their insulin products, effective January 1, 2024. This move is a welcome step towards making insulin more accessible and affordable for individuals managing diabetes. The price reductions include:
- A substantial 75% decrease in the list price of NovoLog® and NovoLog® Mix 70/30.
- A significant 65% reduction in the list price of Novolin® and Levemir®.
- Price matching for unbranded insulins (pre-filled pens and vials, and pre-mix insulins) to align with the lowered prices of their branded counterparts.
Image showing text excerpt about NovoLog and Novolin insulin price reductions by Novo Nordisk.
While these price reductions are impactful, the American Diabetes Association (ADA) is actively seeking further information to understand the practical implications for consumers starting in 2024. As details emerge, the ADA aims to provide comprehensive guidance to patients.
Beyond these broad price adjustments, Novo Nordisk offers a suite of patient assistance programs designed to provide more immediate and targeted financial relief. These programs are crucial for individuals facing immediate needs or those who meet specific eligibility criteria.
One key program is the Patient Assistance Program (PAP), significantly enhanced to offer free insulin for 90 days to qualifying individuals. Since April 1, 2020, Medicare patients are no longer required to meet a $1,000 out-of-pocket threshold before becoming eligible for the Novo Nordisk PAP. Eligibility for this program hinges on several factors:
- U.S. citizenship or legal residency.
- Household income at or below 400% of the federal poverty level (FPL). For context, a family of four with an annual income up to $104,800, or an individual with an income up to $51,040, might qualify. Up-to-date FPL guidelines can be found on NeedyMeds.
- Lack of insurance or enrollment in Medicare.
- Not being enrolled in or eligible for other federal, state, or government programs like Medicaid, Low Income Subsidy, or VA Benefits (with exceptions for Medicaid applicants who have been denied).
Image displaying eligibility criteria for Novo Nordisk’s Patient Assistance Program, including income limits and residency requirements.
For those needing a more immediate, short-term solution, Novo Nordisk provides an Immediate Supply program. This program offers a free, one-time supply of up to three vials or two packs of pens of Novo Nordisk insulin (with a prescription) for individuals at risk of rationing insulin while they explore longer-term affordability options.
The My$99Insulin program offers another avenue for savings, allowing individuals to obtain up to three vials or two packs of FlexPen®/FlexTouch®/PenFill® pens of any combination of Novo Nordisk insulins for a flat price of $99 with a prescription.
Follow-on brand insulins, also known as authorized generics, provide a cost-effective alternative. Novo Nordisk Pharma, Inc. (NNPI) offers follow-on versions of NovoLog® and NovoLog® Mix at a 50% discount compared to the current list prices of the branded medications. These can be ordered at local pharmacies.
For individuals with commercial insurance, Copay Savings Cards can significantly reduce out-of-pocket expenses. Eligible patients may pay as little as $5 per 30-day supply of Tresiba® (with maximum savings of $150 per 30-day supply) and/or $25 per 30-day supply of Novolog® (with maximum savings up to $100 per 30-day supply) for up to 24 months.
Walmart offers Novo Nordisk human insulin under the brand name ReliOn™ for approximately $25 per vial and $44 per box of FlexPen®. Similar affordable options are available at CVS and other national pharmacies.
Image showcasing various Novo Nordisk insulin affordability programs, including patient assistance, savings cards, and immediate supply.
Will these programs, or programs like the Lilly Cares Program, cover CGMs? While the Novo Nordisk programs detailed here primarily focus on insulin affordability, the broader question of coverage for Continuous Glucose Monitors (CGMs) under patient assistance programs is crucial. The original announcement and these Novo Nordisk programs do not explicitly mention CGMs. Information regarding the Lilly Cares Program and its coverage for CGMs would need to be sourced directly from Lilly or program-specific materials. Patient assistance programs often have specific formularies and coverage criteria that vary.
To explore Novo Nordisk’s affordability programs further and to understand the specifics of insulin coverage, you can visit MyNovoInsulin.com. For information about the Lilly Cares Program and CGM coverage, directly consulting Lilly or their program resources is recommended. Navigating the complexities of diabetes care costs requires proactive research and utilizing available resources to ensure affordable access to essential medications and technologies.
