Some Patients Purchasing Over-the-Counter Insulins Due to High Prescription Costs Interview with:

Jennifer N. Goldstein, MD, MSc Assistant  program Director of Internal Medicine Christiana Care Health System Newark, Delaware

Dr. Goldstein

Jennifer N. Goldstein, MD, MSc
Assistant  program Director of Internal Medicine
Christiana Care Health System
Newark, Delaware What is the background for this study?

Response: Human synthetic insulins have been available over-the-counter for nearly a century, and at relatively low cost for around a decade under a Walmart brand name. However, little is known about  the frequency of sale of over-the-counter insulin or the reasons why patients use it.

While prescription insulins (insulin analogues) are considered by many to be easier to use and more predictable than the over-the-counter versions, the cost of these insulins has skyrocketed.

Our study examined the frequency of sale of over-the-counter insulins and whether patients potentially use over-the-counter insulin as a substitute for expensive prescription insulins. What are the main findings?

Response: We conducted a national survey of almost 600 Walmart and chain pharmacies and found that 87 percent of Walmart pharmacies sold insulin over-the-counter daily with an average of 4 vials a day amounting to approximately 18,000 vials per day nationwide.

Walmart pharmacies were more likely than chain pharmacies to report that patients purchased insulin over-the-counter because they could not afford their prescription insulin. What should readers take away from your report?

Response: Insulin prices have skyrocketed over the past decade and many patients with diabetes have had to ration their insulin because of cost. Our study demonstrates that some patients are purchasing human synthetic insulins over-the-counter when they cannot afford their prescription insulin. What recommendations do you have for future research as a result of this work? 

Response:  Human synthetic insulins are available over-the-counter at a relatively low cost and may be an important treatment option for patients with diabetes who are uninsured or underinsured.

However, use of such insulins without medical supervision is never recommended and could be very dangerous. More data are needed to understand the outcomes of patients who purchase and use over-the-counter insulin.

No disclosures


Goldstein JN, Patel RM, Bland K, Hicks LS. Frequency of Sale and Reasons for Purchase of Over-the-Counter Insulin In the United States. JAMA Intern Med. Published online February 18, 2019. doi:10.1001/jamainternmed.2018.7279


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