I have been in practice since 1984 and the biggest change to me that has taken place is the dramatic rise in the number of new drugs available for usage. It must be very hard for medical students of today to learn all of the new classes of medications available in all of the fields of medicine, not only in the diabetes space.

In particular, the fact that there are now more than 20 different choices of medications for patients with type 2 diabetes is astounding. Even harder, is to keep up with how all of the new diabetes medications work and when to choose what medication for what patient. Unfortunately, more and more of these decisions are not being made by me, but by the patients’ insurance plan.

Most stunning, however, is that in the past year I’ve had patients with insurance who simply can’t afford to pay for their diabetes medications, including insulin. I am literally seeing patients in the intensive care unit on a daily basis, in life-threatening diabetic ketoacidosis because they can’t afford their insulin.

Even those patients with commercial insurance and Medicare, can’t afford the co-pay associated with insulin. These letters below demonstrate why my office is spending time each day justifying to insurance companies that patients often need more insulin than insurance companies allow.


Unfortunately, the limit is not just on a single brand of insulin.


Patients with Medicare as their insurance carrier annually fall into a donut hole, in which medications including insulin, are not covered no matter how many calls we make or how great the need is and that goes for both type 1 and 2 diabetes.

“My son is 14 and growing and requires more long-acting insulin than he did a year ago, and my insurance refused the amount of insulin that he needs along with more than the usage of 4 syringes per day,” says Patrice Cocco. “If he can’t get the insulin that he requires, he will die.” How can this be? A nurse, I saw today, with an A1C of above 13% told me that she was recently hospitalized and placed on insulin, but when she was discharged, her insurance company told her she must try a host of oral medications and fail treatment before they would pay for insulin.

Recently, a physician came into see me for new onset diabetes. He walked out with sample medications and prescriptions to follow. Over the past two months, he has had a marked improvement in his glucose levels, and I suspect that his A1C will tumble way down from the initial level above 10%. Ironically, as I spoke to him recently, he asked me, how soon he could get off of his medications, simply because the co-pay on one of the injectable medications was more than $300/month.

I have never seen so many patients in the Intensive Care Unit in diabetic ketoacidosis, who are there because they can’t afford their insulin. I called my local pharmacy to learn that a pack of 5 insulin pens could be as pricey as $499 and a vial of insulin as much as $311. I recently read an article about how people are thinking about how to make their own home brew of insulin—not at all advised.

I always assumed that everyone with diabetes would be able to get insulin, but that simply isn’t the case. As our healthcare system has become more and more complex, patients of all ages are having difficulty affording insulin. Even those with health insurance don’t necessarily have coverage for medications and the cost of diabetes medications is exorbitant. I recently asked a drug representative in my office if she knew the cost of her medication for those who don’t have health coverage. She didn’t, so I called the local pharmacy to find that the each pill she was selling cost $15 that is $450 per month.   Of course it was expected that patients use the co-pay card, but co-pay cards can’t be used among those with Medicare and Medicaid and don’t always work the way that they should.

We live in a new age. Having health insurance certainly doesn’t mean that you will get the medications needed for optimal health. The American Association of Clinical Endocrinologists (AACE) has begun a Task Force on the Rising Cost of Insulin, and I am a member of this Task Force and will keep you updated on how we can help with this critical issue. If you have your own issues on obtaining diabetes medications that you would like to share with AACE, you may contact David Ehrenpreis, Director of Socioeconomics & Advocacy at the American Association of Clinical Endocrinologists (dehrenpreis@aace.com).

Perle’s goal is to get people to not need any of these medications, including insulin. We are more inspired than ever to continue working on safe and effective peptide therapies that generate new beta cells from one’s own pancreatic progenitor cells, even present in patients with type 1 diabetes for more than 20 years.

Two studies have shown that type 1 patients for at least 20 years (with no baseline production of their own insulin as measured by C-peptide), can make new insulin again without beta cell transplants. Our goal is to regenerate new insulin-producing cells and protect those cells from immune attack.   Perle will be the first to show that combining regeneration and immune therapies can result in insulin independence.

PS: If you haven’t heard Needle Free, you should. It is a glimpse of what is ahead, sung by American Idol, Adam Lasher and Country Phenom, Amanda Jo.