Did you know that in North Carolina, you no longer need a prescription to get Glucagon from the pharmacy? In April the North Carolina Legislator passed a standing order for emergency use Glucagon, no longer requiring a prescription. It is encouraged that you have a conversation with your Pharmacist to make sure they are aware of the Standing Order and see if they will be a participating pharmacy.
We sat down with members of the JDRF Advocacy team to help answer questions regarding the Standing Order. We also hosted a Q&A call, to which you can find the recording on our JDRF North Carolina YouTube Channel HERE!
- What is the cost if I have insurance through employer or private individual policy?
The out-of-pocket cost of glucagon will likely vary based on the nature of each person’s health insurance. Health insurance usually covers a prescription of glucagon. When glucagon is purchased from a pharmacy without a prescription, it may be possible to utilize funds from a Flexible Spending, Health Reimbursement, and Health Savings Accounts. In light of the recent law, it is recommended you discuss the nature of your benefits with your employer HR department or your health plan prior to purchasing glucagon.
- What is the cost if I have Medicare Part D coverage?
Medicare Part D plans generally cover a prescription of glucagon. However, some plans do not. If the Part D plan covers glucagon, the Part D plan likely will not cover or reimburse the cost of glucagon purchased without a prescription. It is important to check the Part D coverage of glucagon prior to purchase of glucagon without a prescription.
- What is the cost if I have Medicaid Coverage?
North Carolina Medicaid covers glucagon on its statewide formulary. Coverage assumes a written prescription for glucagon. Medicaid has very low out-of-pocket maximums any enrollee can be charged for a prescription. One should double check with the state Medicaid agency and Medicaid health plan directly prior to purchase of glucagon without a prescription.
- What is the cost if I don’t have insurance or Glucagon is not covered by my insurance plan?
The cash price for glucagon varies based on the product but generally costs more than $300. For those without insurance or for those who’s insurance does not cover glucagon, we encourage to consider manufacturer assistance programs as well as coupon programs like GoodRx.
- Lilly assistance program: https://www.lillyglucagon.com/
- Gvoke assistance program: https://gvokeglucagon.com/savings-and-support
- Fresenius Kabi assistance program: https://kabicare.us/patient/program/hypoglycemia-low-blood-sugar/
- Are there any protections in place surrounding coverage of glucagon in NC?
There are no state specific mandates that insurance plans cover glucagon.
- Can I just go up to the pharmacist and ask for glucagon?
In a sense, yes. However, the now legal allowance for a pharmacist to dispense glucagon does not mean every pharmacy will carry glucagon or choose to dispense.
- Does this only apply if someone is having a severe hypoglycemic episode
The indication for glucagon is to treat a severe hypoglycemic episode. You do not need to be in a state of severe hypoglycemia in order to access glucagon as having supplies on hand in the event of such an event is essential.
Special thanks to Xeris and Lilly