Gabriella is allergic to the kind of insulin her insurer covers at a $25 out-of-pocket cost. She can only take Apidra, but her insurance only covers 25 percent of the price, leaving the family to pay hundreds of dollars a month they can't afford.
So her mom has turned to the black market, trading for the medication with other families with diabetes she meets online, a tactic that regulators and health experts warn is a health risk...
The class of rapid-acting insulin Gabriella depends upon comes at a price — one that's risen 1,123 percent since 1996, according to data from Truven Health Analytics, even as more competitors have entered the market.
Her parents' insurer, West Virginia Public Employees Insurance Agency (PEIA), considers Gabriella's insulin Apidra "Tier 3," which means the family has to pay 75 percent of the price. A copay-reduction card from drugmaker Sanofi would help some, but would still leave them to pay $270 for one vial, which would last them about a month...
Since they're not uninsured, the Corleys don't qualify for free insulin under Sanofi's patient assistance program...
As far as the industry is concerned, Humalog, Novolog, and Apidra are all equivalent insulins in terms of how they lower blood sugar levels. So whether or not your insurer covers it comes down to the deal they can cut.
But not every patient can use the drug their insurer has decided they can take, or afford the one they want to. Drugs' formulations vary. Some patients may have a reaction to the inactive ingredients or find that one kind works differently in their body, forcing them to relearn years of mental math performed at every mealtime.
The American healthcare system is a complete, total and utter cluster-fuck.
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