Will we be OK?

Our colleagues at Beyond Type One interviewed an insulin-supply expert at the Eli Lilly and Company about how the supply chain works, if we should we worry about insulin running out and what to do if you can’t afford your refill. We share their work as part of our joint effort to disseminate good information as quickly as possible to our T1D communities.  

• Eli Lilly and Company, headquartered in Indianapolis, is one of the top three insulin manufacturers in the world
• Lilly, along with Denmark-based Novo Nordisk and France-based Sanofi, accounted for more than 90% of the insulin production market in 2019
• We hear from Wade Neucks, director of Eli Lilly’s Patient Affordability Solutions
• “It’s critical that folks understand a little bit more [about the insulin supply chain] to really feel as confident as we do about the supply of insulin during this COVID-19 outbreak.”

So, how does the supply chain work?

“We manufacture Lilly insulins twice a week, every week. Then, we fill up trucks that go to wholesalers. Those wholesalers have really big national warehouses. They load up from those big national warehouses, and they drive trucks to the regional or more local warehouses.

Those local warehouses are the folks who keep insulin on the shelf in the pharmacy. And the process of going from a regional warehouse to a pharmacy in your neighborhood is one to two days. Typically, the whole process can be as short as five days. We have a couple of wholesalers that are really close to us. Some of the wholesalers that are a little farther away, maybe 10 days to two weeks. But that’s why they all have these regional warehouses, because you’ve got to have medicine that gets to people quickly.”

In press releases on March 3rd and March 24th, Lilly said that there should be no disruption to the insulin supply chain—how can you be sure?

“So there is a lot of uncertainty, right? And I think that a lot of people are going to say that they’re uncertain even about what different companies are promising to them during this time. But I can tell you that, personally, for myself as well as from the company, we are very, very certain. And right now we do not anticipate any disruption in our ability to make your insulin.”

Hypothetically, if everybody in the United States ordered a three-month supply of Lilly insulin all at once, would there still be enough?

“To answer your question directly, it would not cause a shortage of insulin, but it would cause some local pharmacies to be out of stock and maybe even some of those regional warehouses to need to restock from the big national warehouse.

Let’s say that everybody went in and tried to order three months instead of one month. Well, obviously the first couple of people in line are going to be able to do that. The rest are going to have to wait one to two days…as insulin gets back on the shelf in your local pharmacy.

And if you let the system work, it’s designed to work for you. I think some of the places that are running into more issues is when your healthcare professional or yourself don’t give the pharmacy a head’s up that you’re going to be picking up additional insulin. So, if that’s the case for you, have your doctor write the prescription, send it into the pharmacy and give the system a day or two to react.”

We are having people report pharmacies are out of insulin. Can you explain how this happens and how long somebody might need to wait?

“You guys have been hearing it from your community members, Lilly has heard and responded to a couple of requests specifically where pharmacies are saying that Lilly insulin is on back order or the manufacturer is out of stock. We did address this in the press release, but just to be clear and so everybody hears it out loud, there is not a single Lilly insulin that is on back order and there is not a single Lilly insulin that we are out of stock of.

Let’s pretend I’m a pharmacist in your neighborhood pharmacy, and because my system has been checking in, and it knows who fills and how often they fill, it knows that I’m going to have five people who are supposed to come in and fill their 30-day insulin supply today. So a couple of days ago, the computer ordered enough insulin for all five of the folks and whatever they needed for the month.

Customer one comes in and says, “Hey, I’m here to pick up my 30-day supply.” Go to the fridge, it’s on the shelf. Customer two comes in and says, “I normally pick up a 30-day supply, but I’m actually going to pick up 90 days today.” The pharmacist goes to the fridge, he has plenty of stock on the shelf, gives all 90 days to customer number two. Customer three comes in, “I’m here for my regular 30-day supply.” Pharmacist goes to the fridge, it’s on the shelf, not a problem. The difference is going to be what customers four and five are going to hear when they say, “I’m here to pick up my 30-day supply.” The pharmacist is going to say, “Oh, I’m temporarily out of stock of insulin. It’s going to take one to two days for me to get it in. We’ll give you a call when it’s full.”

The reason that they would say the one to two days is because they’re never going to over-promise on that. So, it could be on a truck that could be there in hours or a day, but they’re going to tell you it’s going to be one to two days.

The other thing that’s happening is that awesome game of telephone. So, somebody hears, “We’re temporarily out of stock, I’m going to order it,” then it becomes, “Well the pharmacy is out of stock” and you hear it in a couple of different places because this is happening regionally. And then it turns into, “Manufacturers are running out of stock of insulin” which is not the case at all.”

So from the time your pharmacy tells you, “We’re out of stock, we need to reorder,” it should be a maximum of one to two days—is there any reason why it might take longer?

“The only reason why it could take longer is if this were happening to a critical mass of pharmacies that are all based out of one regional warehouse. But again, remember it doesn’t take a pharmacist to actually place every single order. So, as inventory starts to go down, all of the computer systems are talking, and by the time that regional warehouse would likely be out of stock, there’s already trucks on the way to make sure that there’s more insulin there.”

What kinds of resources is Lilly going to be providing to those people who are maybe having a harder time or just recently for the first time ever having a hard time getting a hold of their insulin?

“It’s a big concern and it’s a concern that Lilly’s been focused on with insulin affordability for several years now. So, we have a lot of solutions that are currently out there in the marketplace. I know that there’s some extra concern because of the pandemic, but you don’t need the excuse of the pandemic, if you can’t afford one of your Lilly insulins, please call the Lilly Diabetes Solution Center.

(You can call the Lilly Diabetes Solution Center at (833) 808-1234, Monday through Friday, 9 a.m. to 8 p.m. Eastern time.)

We’re going to have a live (Lilly representative) walk you through which solutions are the best for you. We have solutions for commercial patients, we have solutions for uninsured, we have solutions for folks who are in Part D. We can get you connected with Lilly Cares to see if you qualify, and we can also connect you to one of the 100s of clinics we partner with across the country.

It’s not just if you qualify for getting free Lilly insulin, this also helps you get your supplies and access to social workers and also discounted rates on healthcare providers, making sure that you’re taking your insulin the right way to keep you as healthy as possible. So please call. If you’re currently on a solution and it’s for your commercial insurance and you’ve recently lost your job for whatever reason, whether it’s because of COVID-19 or seasonality of employment, things like that, it doesn’t mean that those aren’t going to work for you anymore. It just means we need to find the solution that’s most appropriate for your current situation.”

Is there anything separate that you’d recommend for our community members outside the United States or a place we can direct them to?

“Anyone can call the Lilly Answers Center (1-800-545-5979) and they can triage to the most appropriate resource. Different countries are going to have different programs set up and obviously different federal poverty levels and things like that. Anyone who’s in the United States or any of the territories (Puerto Rico, Guam, etc.), it’s the Lilly Diabetes Solution Center—give us a call.”

Is there anything else that you or Lilly Diabetes would like to say to the diabetes community at this time?

The quick bullets to it are: one—your health and safety are of utmost importance. And if what you need to do to stay healthy as directed by your doctor as to pick up additional quantities, have your doctor put that prescription in the system and let the system react and work for you. It’ll happen in as little as one to two days. The second piece is whether you pick up on a 30-day cycle or a 90-day cycle, please be confident.

We are confident that we will have Lilly insulin manufactured and available to your pharmacy at whatever schedule you decided to pick it up. We’re here, we’re confident and we’re making your insulin 24 hours a day.

Editor’s note: The video content was originally produced by Beyond Type 1, shared here as part of the JDRF – Beyond Type 1 Alliance.