Fifty Years ago if you had Type 2 you had very few choices for treatment and they wouldn't even be prescribed unless you were "pretty far gone"

The treatments were so potentially dangerous (death from low blood sugar was real issue) that you almost had to be to the point of "they are going to die for sure if we don't do something" which made it less of a concern if they killed you trying to keep you alive

The drug companies saw an opportunity there and started working on a whole basket load of new drugs that were both safer and more effective.

The goal is to "Keep You Alive Longer with Better Function", not to cure you. And they developed a good number of new drugs that can do that

But that came at a cost and it's reflected in the price of these new Tier 2 and Tier 3 drugs

Many will recognize at least some of the names like Ozempic, Rybelsus, Trajenta, Januvia, Invokana, Jardiance and even the super new one, Mounjaro

Unlike the drugs they were designed to replace that were burdensome, caused low blood sugar 30% of the time, required you to stop what you were doing and eat at regular intervals, caused you to gain a bit of weight etc, these "new ones" were a Take It and Forget It plus lose 10 or 15 pounds as a bonus.

But the catch is, they are VERY Expensive and SOMEBODY has to pay for them. If it's either you entirely or even if you have a significant Copay that could put them out of reach

If your Doc prescribed them and you got "sticker shock" when you went to fill the prescription you can always go back to your Doc and tell them that they are unaffordable because there are other generic options

NO "NONE" of these new meds are in generic format - they are way too new - the oldest of the bunch is barely 10 years - but the drugs that existed "before them" - Yes, the burdensome/cumbersome to take drug classes that were "all we had" even 20 years back are still on the market and they are "beyond cheap" in comparison.

(next)

@A DiabetesTeam Member I am lucky as well - between my and my wife's plans I pay "zero dollars" which is a good thing.

My Wife has Parkinson's and about a dozen years back a new drug came on the market that slowed progression but it was wicked expensive - like $1400/month back then.

Fortunately our plans covered the cost, 100% between both, and it bought her about 5 extra years of independent movement.

Was that worth the $84,000 pricetag?

Sure when we weren't paying, but if we were that is a decision that would have had to been made - what is 5 years of your life worth?

Fortunately, with the Type 2 meds that is not the question that has to be answered.

The choices are pay the $1000 a month for something like Ozempic - take it and forget it and it will do everything for you, OR

Pay 15 bucks for the Glyburide and YOU have to time your meals, and count the carbs, and eat at the same time every day and do extra work to keep your weight in check - effectively YOU are doing the $985 worth of work that the expensive drug would have done for you

My Father took Glyburide for over a decade (only option save insulin) and no matter where he was or what he was doing the world "stopped" at Noon and 5 PM because he had to eat a preplanned meal (that was counted or proven adequate) or else he got a dangerous low.

Drugs like Ozempic have taken that burden from the patient, but they are (effectively) charging for doing that for them.

Perspective....

Mentioned Users

A Diabete...

The Prescription Guidelines all our Doctor's follow are four tiers (as I mentioned).

If cost is NOT a factor you would get the standard progression of meds -

Start with Metformin (Tier 1) - when that isn't enough add a Tier 2

That could be from any one of Three drug classes:

DPP-4 (Januvia, Tradjenta), GLP-1 (Ozempic, Trulicity, Byetta), SGLT-2 (Invokana, Jardiance) or even the new Super GLP-1 with GIP addition, Monjarno

The Doc would pick one of the above, with criteria guidance (some can help with heart of kidney problems that are present so could be "more beneficial for you" as YOUR Tier 2 medication.

If the Doc needs to add a Tier 3 along the line (you progress), they simply pick one of the other options to "add" to whatever Tier 2 they prescribed.

And when they run out of options (you could be on as many as 3 or 4 of these drugs), they prescribe Insulin.

So what was the "generic" Tier 2 and 3 drugs that existed before these Wallet Emptying concoctions came along?

Sulfonylurea's - all the "ides" - Glyburide, Glipizide, Glimperide and the list goes on.

These are super cheap in comparison (like under 20 bucks for a months worth totally out of pocket with no coverage) BUT they are not nice to play with

You have to take them and then eat within X minutes or you get a low. Skip a meal you get a low, don't eat at the "same time" everyday, get a low, don't eat enough carbs in the meal - get a low and you will likely gain weight

So possibly multiple "finger sticks" a day (this is why CGMs are often authorized for Sulfonylurea users) to make sure you don't go too low and your life revolves around static meal times and rigid carb counts

But they are CHEAP

A second generic class of drugs is called Thiazolidinedione's or TZD's is also available

There is only Two still on the market (the first generation was pulled about 15 years ago because they resulted in heart attacks and amputations) - the two that were re-introduced and proven safe were:

Actos and Avandia - both are now available in a low cost "generic" form, Pioglitazone and Rosiglitazone

So is this a "preferred drug", not at all, but it does the job, will keep you alive and functioning and will not drain your wallet

You have choices.

You may not prefer them, but they are there if you just can't afford your prescription - so talk to your Doc if you need to.

Here is the basic chart your doc uses - the one on the left is (somebody else is paying) on the right (you are paying) - there is a couple other (charts) for those with heart disease and those with kidney disease - just about every eventuality is covered

Cost is a major problem….period. Being on Medicare I’m susceptible to being in the “donut hole” due to excessive real time cost. Presently out of the donut hole but that may change quick IF…I decide to start/purchase a current generation long-acting drug from the list you talked about. BUT, if I do, I immediately RISK going into the donut hole…which dramatically raises my out of pocket cost.

Therefore, …………

The geniuses is this: The financial impact/burden of living with what I call, operative diabetes….WILL kill you quicker than the actual physical infirmities caused by the disease.

Court adjourned!!

Court Jester

I’m so lucky! With my partners coverage, including me, I only pay $1.22 for each of my 2 diabetes prescriptions - metformin and insulin!!