If you have diabetes and use an insulin pen, odds are you don’t live in the United States.
“A new patient in Europe, depending on the country, is not even taught how to use insulin in a vial anymore,” says John Holcombe, MD, senior clinical research physician for diabetes care at Eli Lilly.
Lilly estimates that only 12 percent of insulin users in the United States use either prefilled disposable insulin pens or insulin cartridges in reusable pens.
“The advantages are that [insulin pens] are very accurate, especially with low doses of insulin,” says Holcombe. “You can consistently give accurate doses with a pen device compared to drawing that same amount of insulin up with a syringe.”
So why have insulin pens, despite these advantages and Americans’ penchant for convenience, failed to catch on in the United States?
“There are a couple of reasons,” explains Javan Collins, diabetes brand leader at Lilly. “There is a different healthcare system in Europe in which the government-or national healthcare system-pays for medications for patients, so there is not a cost element involvement. Secondly, patients in Europe have been managed a bit more intensively with their insulin therapy. The third reason is that pens have been available there much longer.”
Andrew Purcell, vice president of diabetes marketing at Novo Nordisk Pharmaceuticals, believes that the insulin pen industry has not successfully communicated the benefits of modern insulin delivery devices to healthcare providers and patients in the United States.
“[People] who use modern [insulin pen] dosers love them,” says Purcell. “We hear this qualitatively and have seen it in formal studies. Insulin doses are given more accurately with pens than with a vial and syringe, and since insulin is the most common product involved in medication errors, it would seem there is a benefit to greater accuracy.”
Collins notes that most of the growth in the U.S. insulin pen market has been in prefilled disposable pens, which insurance companies often do reimburse. The U.S. Food and Drug Administration considers prefilled insulin pens to be a drug because they are self-contained.
“Reusable pens are generally not reimbursed,” he says.
Purcell adds that Novo Nordisk-which manufactures several insulin pens and dosing systems-has only recently been able to offer pen systems to managed care providers at a cost that encourages the providers to include the products in their formularies.
Purcell is optimistic about increasing the use of pens and new dosing systems.
“We anticipate that the market will continue to grow in the future,” he predicts, “as patients and healthcare providers learn how much they can benefit from the convenience and accuracy of insulin delivery devices. Healthcare professionals are looking for products that provide clinical improvement [and are] covered by managed care. Patients want the treatment options to be convenient and require minimal lifestyle change.”