Originally appeared on WBMA ABC 33/40 broadcast and website July 9th 2024
by Austin Pratt
Losing access to insulin is a terrifying problem for diabetics like ABC 33/40 meteorologist Riley Blackwell.
As a type 1 diabetic, he noticed an issue when looking to refill his regular prescription for his Fiasp insulin pen, immediately knowing the situation as dire.
Blackwell explained, "For type 1 diabetes your body produces little to no insulin at all so you have to take shots to live. If you don't, you will die."
He called many pharmacies but could not locate one that had the medicine he needed.
Dustin Beaty, owner of Carbon Hill Drugs says there likely isn't a shortage of the product, it's the pharmacies choosing not to supply it.
Beaty provides an example of the cost difference with a hot topic drug of the same issue, Mounjaro, saying, "It costs the pharmacy on average $1,000 per box plus whatever it costs the pharmacy to dispense it. The reimbursement on that from the insurance company typically is about $850."
It's a huge difference in the negative just on a cost standpoint for the product without even considering dispensing fees.
But where does that leave the patients? Many like Blackwell are confused, looking for their products as pharmacies are not allowed to tell you the drug is not covered well enough by insurance to be carried, they have to say it's not in stock or unavailable.
According to Beaty, Pharmacy Benefit Managers (P.B.M.s), the companies that provide money to pharmacies for insurance providers don't allow them to be informed: "it is a violation of the contract for me to tell my patient I can't fill this medication because your insurance is not paying me enough to cover my cost."
Beaty had to close two pharmacies in the last eight months because these consistent losses taken on certain prescriptions.
Alabama pharmacy association government affairs director Bobby Giles says there needs to be a change: "You absolutely without question have to pay the cost of the drug and right now that's not happening. Much less the cost of dispensing. A pharmacy cannot sell for what they buy for and stay in business. It can greatly affect you and your ability to serve patients or not."
It's estimated around 1/3 of all prescription transactions between P.B.M.s and pharmacies do not break even the cost of the good, much less any service fees. Pharmacies are also not allowed to split a bill asking patients to pay the difference.
Beaty and Giles both emphasized not supplying patient prescriptions is not what pharmacies want to be doing.
Riley Blackwell will be meeting with his doctor to see if another product will work as a substitute. But for him and other diabetics, not all insulin types work for everyone, many are allergic and it's not an easy switch.
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