More Problems

The nightmare at the pharmacy.

So, I’ll try to put the problem as I understand it (I’m being generous here)… After a lot of trouble, I get the prescription for Lantus through a doctor’s visit.

The only other high end competition for Lantus is an insulin pump.  They run about $6000 for the lowest priced ones.  That does not include insulin and catheters, batteries, etc.  When pumps fail, because you are out in the wilderness, and the battery dies or the catheter site isn’t working anymore, or your pump sends out an error code, or you need a new catheter and didn’t bring one with you, people generally revert to Lantus and multiple daily injections of regular/humalog, as a backup plan.  It’s not unlike the pump, you just aren’t connected electronically all the time. So, Lantus is still a pretty good deal compared to a pump.

The alternative that existed in the US before Lantus was available (12 years ago) was NPH.  I consider NPH to be unsafe for me.  It’s activity peaks 8 hours after injection.  And it peaks hard… If you are nowhere near a meal or happen to have increased your activity level when it peaks, you are at risk.  I’m currently on multiple injections of regular because, although it peaks with the intensity of NPH, it peaks much more closely to the injection time, and so I can plan my day a little better, but it requires several injections a day, and I feel the associated lows when I try to control my blood sugar better.  Lantus, which is peakless, allows you to fast during the day if you want.  I was looking around for testimonials by diabetics, and I found this one, which I thought was pretty good, although its description is certainly incomplete.  He was almost certainly also on regular insulin, and the experiment should have included 2 injections of NPH.  It is possible that he was a rather newly diagnosed type I diabetic, in which case, his pancreas may have still been producing some insulin (honeymooning).  Most of us have become by default scientists – with keen intuition regarding the physiology of our bodies.  We wouldn’t be here 40 years later without this 6th sense.  The testimonials will be overwhelmingly in favor of Lantus among type I diabetics, and their moms.  I’m already on multiple injections with regular insulin, so the “more injections” factor doesn’t really come into consideration, but I can see that it might for a young child who is just starting to adjust to having to take shots to survive.  It would depend on what’s scarier for them: a shot or the low blood sugar.

The testimonials that I’m looking at on the internet are not consistent either with people I have known who have switched from NPH to Lantus, nor are they consistent with my experience having been on both of these insulins (not at the same time).  I don’t trust the internet information – I think it is corrupt, possibly because Lantus  is manufactured in Germany, and NPH is manufactured in both Europe and the US.  There is one study comparing NPH and Lantus, but it was done using type II diabetics.  I don’t think that these results generalize to type I diabetics who are much more insulin sensitive.  At the same time, I would hate to see money thrown down the toilet to fund another such study on type I’s.  In the end, it isn’t about statistics.  A diabetic learns to value their own experience and personal data above any statistics.  We die, otherwise. The individual experience can generally not be substituted by the group experience.  What is true for an ensemble of people, is not necessarily true for any individual within that ensemble.

Now, because Lantus is a prescription medication in the US, there is no price control on the medication from the market.  The cost is “hidden”.  There is only the negotiation that occurs between the pharmacy, the insurance company, and the drug manufacturer, none of which is hurting too badly because, after all, they control “health” and “relief from pain”, something that everyone wants.

Now, everyone knows how much money I have left, and they’ve priced the drug beyond reach for me.  $247 for a 30 day supply.  Almost $10/day.  So, after submitting my paperwork to the pharmacy, and finding out that I couldn’t afford the drug and never having used the prescription, they confiscated the prescription and would not give it back.

This drug does not require a prescription in Canada.  It is over the counter, and it surely does not cost $250 there.

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