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New Label Could Fix Medicaid’s Insulin Pen Misstep

Medicaid’s shortsighted policy of splitting insulin pen packs could soon end.

An updated label from the Food and Drug Administration now discourages pharmacies from dividing prepackaged cartons into individual pens before distributing.  “Dispense in this sealed carton,” the new label reads. The prescribing insert repeats the instructions and also directs pharmacists to include the carton’s instructions when filling a patient’s prescription.

While the new language seems self-evident, it aims to solve a potentially serious policy issue for Medicaid beneficiaries living with diabetes.  

In 2018, some state Medicaid programs began instructing pharmacists to dispense insulin pens individually – rather than in cartons of five, as they’re packaged.  The move was intended to cut costs for the Medicaid program. But it overlooked the complexity of diabetes management.  

Having multiple insulin pens on hand equips patients to deal with changes in blood glucose, preventing hyperglycemia.  Limiting patients to one insulin pen at a time leaves them vulnerable to unexpected blood glucose fluctuations. It also increases costs and logistical complexity for patients.  Where patients previously could take a single trip to the pharmacy, they now face five. And each trip requires a co-pay. 

The policy also introduces adherence issues.  Patients may be inclined to ration their insulin to avoid making another trip to the pharmacy.  And it makes diabetes management harder for patients with insulin resistance, who need more insulin more often.  Coupled with the logistics of everyday life, work or transportation challenges, the Medicaid policy introduced a real – and unnecessary – burden for people living with diabetes.

Diabetes clinicians and advocates see the FDA’s move as a win for patient access.  As Frank Lavernia, MD, of the Alliance for Patient Access’ Diabetes Therapy Access Working Group noted, “Living with diabetes is already difficult.  This new language will help stop a poorly conceived policy from making it even harder.”

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