How much do we pay for insulin in Australia?
Usually in Australia insulin has been available in three formats:
- 10 mL vials
- 3 mL pen cartridges (“Penfill” is the name for the Novo cartridges, but the Sanofi and Lilly cartridges have the same capacity)
- 3 mL disposable pens
Using different formats
I started off with the vials in 1982. Initially designed for drawing up into syringes, these days they’re also used for drawing up into pump reservoirs. The Omnipod and Tandem reservoirs are filled from syringes, but the Medtronic, YpsoPump, Solo, Combo, and DANA reservoirs are often connected directly to these vials for filling.
Mind you, I usually prefer to fill my pump reservoirs from 3 mL pen cartridges. It’s always been convenient to push insulin down into the reservoir, and to push air back up into the cartridge, without having to first inject the expected volume of air into a vial. For backup injections, the cartridge can easily be dropped into a pen for an injection.
Some people use disposable pens to fill their pump reservoirs, and this can work too. However with the Novo FlexTouch pens (such as used with Fiasp) we can’t control the speed of “injection”, and this can result in a froth of “champagne bubbles” in the reservoir which we then need to consolidate and flush.
Personally if I’m using these pens to fill a pump reservoir I usually just pull the pen apart and use the 3mL cartridge just like a regular pen cartridge (they can even be put into a standard pen).
Pricing with PBS
We get a prescription from the doctor which specifies the format of the insulin, and these are almost always for the same amount (150 mL) of insulin. With U100 insulin (100 U/mL) this is 15,000 U. But depending on the format, the amount we pay can vary.
10 mL vials
With 10 mL vials we get a script with two repeats. So we can get the insulin dispensed three times. Each time we will get five vials (50 mL).
The PBS-subsidised price for each dispensing is currently $30 ($7.30 for concession) although pharmacies are allowed to discount this to $29 ($6.30). I’m going to use the discounted price in these examples. So the insulin is costing us $0.58 (or $0.13) per mL.
3 mL cartridges and pens
The dispensing rules for these are each the same. We get a script with one repeat, so we can get it dispensed twice. Each time we will get five boxes of 5x cartridges/pens (a total of 75 mL). The PBS-subsidised price is the same, so we end up paying less per mL. We pay $0.39 (or $0.08) per mL.
So for the price-conscious, the cheaper price of cartridges/pens is sometimes extra incentive for pump users to avoid the 10 mL vials.
Private scripts for PBS-supported insulins
The PBS website shows us how much they’ve negotiated to pay the supplier for the insulin (this info is sometimes printed as “full price” on the pharmacy label). So if we have a private (non-PBS) script that is the price we pay. Here’s a summary of some of them as at March 2023:
|Insulin||5x vials||25x pens / cartridges|
|Levemir (not for pumps)||n/a||$354.92
|Optisulin U100 (not for pumps)||n/a||$186.12
So if you had private prescriptions for Fiasp, not only do they get a lot more expensive than with PBS, but per mL pens are more expensive than vials.
These are obviously huge jumps from $0.08 per mL! Mind you, they are still a lot cheaper than in unregulated markets like the US.
Pump users can more-easily choose based on price than MDI (injecting) users. If you end up using vials for injections, at least the syringes are still free through NDSS even though they’re less convenient than pens.
Private scripts for non-PBS-supported insulins
With Fiasp not being price-controlled by PBS after March 2023, we don’t know how much these will cost. The prices may change over time. We do expect they will start off similar to the current price levels.
Not only do we not know how long Fiasp will be available in Australia for (Novo has so far only indicated “for some time”) we have no idea what will happen to the price.
Hopefully PBS and Novo can get their acts back into gear and have Fiasp remain on PBS. Of course, there’s also the hope that Lilly will pull their finger out and make Lyumjev available in Australia to give us some choice.