My Insurance Won't Cover Tresiba, What Are The Alternatives?

In our latest question and answer, the pharmacist discusses alternative insulin options to Tresiba.

Question

My doctor has given me a trial of Tresiba and I like it. If my insurance does not cover it, what is a comparable alternative?

Asked by gigi On Oct 14, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Oct 14, 2022
Last updated Oct 14, 2022

Key points

  • Tresiba (insulin degludec) is an ultra-long-acting insulin, with a duration of action of around 42 hours. Studies show it is less likely to cause hypoglycemia (especially at night) when compared to other insulins.
  • The most similar insulins to Tresiba are other long-acting ones, which include Lantus, Levemir, Basaglar, and Semglee (although none last as long as Tresiba).
  • Insurance coverage of Tresiba varies per plan. It may be a preferred drug, or it may require a trial and failure of other long-acting insulin options.

Answer

It is unfortunate that it is often so difficult to know or understand what your insurance will cover when it comes to insulin products. Not only do some insurance companies prefer specific brands (e.g., Novo Nordisk Novolog versus Eli Lilly Humalog), they often require you to try several different drugs before paying for something non-preferred.

This is often the case with Tresiba, an ultra-long acting insulin. Your best alternatives to Tresiba will be other long-acting insulins, such as:

  • Lantus
  • Levemir
  • Basaglar
  • Semglee

The above drugs are the most similar alternatives in that they are all long-lasting, and can often be dosed once daily. There are some differences however that I discuss in the next section.

Tresiba Alternatives Discussion

Insulin products are generally categorized by how long they last, such as:

  • Rapid-acting (e.g., Novolog, Humalog)
  • Fast-acting (e.g., Novolin R, Humulin R)
  • Intermediate-acting (e.g., Novolin N, Humulin N)
  • Long-acting (e.g., Lantus, Levemir)
  • Ultra-Long-Acting (e.g., Tresiba)

Although Tresiba (insulin degludec) is often grouped with the other long-acting insulins since they all are generally all dosed once daily, it really is in a class of its own since it does have a longer duration of action than they do.

While Levemir, Lantus, Basaglar, and Semglee last around 24 hours (this can vary slightly by individual) per dose, Toujeo has a duration of action of 42 hours.

In addition to being the longest lasting, the claim to fame with Tresiba is that studies show it is less likely than other insulins to cause severe or nocturnal hypoglycemia (low blood sugar). It typically is a good choice for individuals who have low blood sugar problems on other long-acting insulins in the past or have problems remembering to take their medication every day..

Now, having said the above, clinical studies have not shown that Tresiba improves blood glucose numbers overall, or reduces complications from diabetes, more than the other long-acting options. It appears to be on par with them.

In terms of your best alternative option to Tresiba, that is highly dependent on what your insurance covers. Clinically, the closest options are going to be Lantus, Basaglar, and Semglee (which all actually contain the same type of insulin, insulin glargine).

I would try to stay away from Levemir as that is the shortest acting of the group, and it's not uncommon that it needs to be dosed twice daily to achieve all-day blood sugar control.

What Are The Insurance Requirements For Tresiba?

As mentioned, this is highly dependent on the plan you have.

Some plans may cover it outright as a preferred drug, but many have it as a non-preferred drug and requires a trial and failure of at least 2 to 3 drugs before it is covered (or you have a medical reason why the preferred options cannot be used).

I would recommend calling your insurance company or referring to your formulary to learn about coverage for the drug.

For most plans, being on samples of a drug doesn't generally count towards getting approved for a continuation of therapy, and would still require trials of the preferred products.

Final Words

Thanks for your question and I hope this answer helped!

References

  • Insulin degludec, PubChem
  • Tresiba Prescribing Information, Novo
  • FDA raises concerns about ultra-long acting insulins given green light in Europe and Japan, PubMed
  • Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at Hello@HelloPharmacist.com! You can also connect with Dr. Brian Staiger on LinkedIn.

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