Buying Insulin Over-the-Counter at Walmart Common Practice

Miriam E. Tucker

February 21, 2019

Over-the-counter (OTC) insulin is sold more often at Walmart than at other pharmacy chains, most likely because of its lower cost and patients' inability to afford co-pays for prescription insulin, new research suggests.

Findings from surveys of nearly 600 US pharmacy chains in 2018 were published online February 18 in JAMA Internal Medicine by Jennifer N. Goldstein, MD, assistant program director of Internal Medicine at Christiana Care Health System, Newark, Delaware, and colleagues.

The results showed that OTC insulin is sold more commonly at Walmart than at other pharmacy chains and that inability to afford co-pays for prescription insulin was noted as a common reason for purchase, particularly at Walmart pharmacies.

In the United States, human insulins such as NPH and Regular insulin (and 70/30 mixtures) are available OTC in every state except Indiana. Walmart's own ReliOn brand of insulin (manufactured by Novo Nordisk) is considerably less expensive than the branded human insulins sold at other pharmacy chains, at approximately $25 vs $152-$163 for 10-mL vials of Novolin (Novo Nordisk) or Humulin (Eli Lilly). In contrast, insulin analogs such as lispro (Humalog, Eli Lilly), aspart (Novolog, Novo Nordisk), and glargine (Lantus, Sanofi) require prescriptions.

In an interview, Goldstein told Medscape Medical News, "Prescription [analog] insulins are considered by many to be easier to use and more predictable than the human insulins available over-the-counter. However, insulin prices have skyrocketed over the past decade and many patients with diabetes have had to ration their prescription insulin because of cost."

She cautioned that although human synthetic OTC insulins "may be an important treatment option for patients with diabetes who are uninsured or underinsured...use of such insulins without medical supervision is never recommended and could be very dangerous."

Walmart Sells an Estimated 18,000 Vials of OTC Insulin Daily

In 2018, Goldstein and colleagues conducted telephone surveys of employees of six Walmart pharmacies in each of the 49 states that allow OTC insulin and of other pharmacy chains (CVS, Walgreen's, or Rite Aid) geographically closest to each Walmart. 

The questionnaire was completed by 561 pharmacies. Of those, 97% of the respondents from the 292 Walmart pharmacies and 80% from the 269 other pharmacy chains reported that they sold insulin OTC or without a prescription. 

Of the 284 Walmart pharmacies selling OTC insulin, 87% reported selling it daily, 10.9% weekly, 1.1% monthly, and 1.1% "a few times a year." In contrast, none of the other chains reported selling it daily, 1.4% reported weekly sales, 8.8% monthly sales, and 46.3% "a few times a year." Notably, 34.5% reported that they never sold it (P < .001 for overall comparison).  

Asked whether they were aware of patients who purchased insulin OTC because they couldn't afford the co-pay for their prescribed insulin, 70.1% of the Walmart responses were "yes," compared with just 19.7% from the other pharmacy chains (P < .001). 

Walmart pharmacies reported selling a median four vials of insulin over the counter daily (mean, six vials; range, 1-50). Based on a total of 4700 Walmart pharmacies in the United States, the authors estimated that the company sells about 18,800 vials of over-the-counter insulin per day.  

"More data are needed to understand the outcomes of patients who purchase and use over-the-counter insulin," Goldstein said.

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online February 18, 2019. Abstract

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