How Much Does Sitagliptin Cost for Diabetes With or Without Insurance?
Category: Prescription Related Questions
Posted on March 24, 2021
Vanessa is a health writer and blogging expert. Her specialities are medicine, health and wellness. She is proud to call Vancouver, BC her home where she enjoys the ocean and mountains with her dog Mr. ChowChow.
One in 10 Americans has diabetes. While doctors use a range of treatments and medications to help patients control their diabetes, sitagliptin is a favorite.
But what is sitagliptin? Why is it so popular and how much does sitagliptin cost? Here are the facts.
Why Doctors Prescribe Sitagliptin for Diabetes
Sitagliptin, sold under the brand name Januvia, is a dipeptidyl peptidase-4 (DPP-4) inhibitor. DPP-4 inhibitors are a class of drugs that block the function of the DPP-4 enzyme and break down incretin. Incretin is a hormone that affects insulin production and glucose production in the liver.
As a result, sitagliptin and other gliptin medications can help diabetics control their blood sugar.
This is extremely important as uncontrolled blood sugar can lead or contribute to serious health problems including:
- Neuropathy (damage to the nerves of the hands or feet)
- Retinopathy (damage to the eyes, resulting in impaired vision or blindness)
- Kidney disease
- Heart attacks and heart failure
Sitagliptin is typically prescribed in conjunction with diet and exercise. It is appropriate for adults with Type 2 diabetes, but it not suitable for Type 1 diabetics or individuals with diabetic ketoacidosis. As around 95 percent of diabetics have Type 2 diabetes, this makes the drug appropriate for most diabetic patients.
Sitagliptin is available in 25 mg, 50 mg, and 100 mg tablets and most users take their assigned dose of sitagliptin once per day.
Is a Generic Version of Sitagliptin Available?
Currently, there is no generic alternative to sitagliptin available on the market. This is because the drug is relatively new. The U.S. Food and Drug Administration (FDA) approved Merck’s patent on Januvia in 2006.
This means that while some portions of the patent have expired, much of it will remain intact until 2026. Thus, no generic version of the drug will be available until then.
Does Insurance Cover Sitagliptin?
Insurance coverage for Januvia varies. Most Medicare plans do cover a portion of the drug.
Actual prescription costs for Medicare enrollees vary depending on:
- What other coverage they have, if any
- Which Medicare Part D plan they chose to enroll in
- Whether or not they have reached their annual deductible
- Whether or not they have reached their plan’s annual out-of-pocket spending limit
- What drug tier their plan assigned Januvia to
- The actual retail cost of the drug at the time and place of purchase
Since in many cases Januvia is a higher-tier drug, users with Medicare coverage may pay higher-than-average copays for their sitagliptin prescriptions.
Non-Medicare coverage of sitagliptin is sporadic. As with Medicare plans, when insurers do cover the drug copays are often high.
Why Some Insurers Do Not Cover Sitagliptin
Januvia is in high demand and is available only as a brand-name drug. As such, the manufacturer, Merck, can command any price it wants for the product. In fact, an increase in demand caused the cost of the drug to nearly double in the five years between 2010 and 2015.
This makes covering sitagliptin prescriptions extremely costly and undesirable for insurers.
As a result, some insurance companies choose not to cover it at all. Instead, they cover the generic versions of similar drugs in an effort to encourage doctors and patients to select or switch to those more affordable options instead.
For example, insurers are much more likely to cover other gliptin medications and sulfonylureas class drugs commonly prescribed for diabetes such as:
- Glucophage (Metformin)
- Glipizide (Glucotrol)
- Glyburide (Diabeta, Glynase PresTab)
- Glimepiride (Amaryl)
- Linagliptin (Tradjenta)
- Saxagliptin (Onglyza)
Many also cover Janumet, which is a combination of Januvia and Metformin.
Not all patients will be able to substitute one or more of these drugs for Januvia, however. Januvia is different from other, similar prescriptions in that sitagliptin side effects do not include common risks such as low blood sugar and weight gain.
For insurance companies, however, not covering Januvia leads to enormous cost savings.
How Much Does Sitagliptin Cost?
On average, sitagliptin costs between $500 and $650 for a one-month supply. Exact prices vary depending on:
- Pharmacy size, location, and association
- Whether tablets are 25 mg, 50 mg, or 100 mg in dosage
- How many days worth of medication users purchase at once
- Whether users pay with cash or using an insurance plan
- Market- and demand-based ebbs and flows in product pricing
These figures represent the cost of sitagliptin for users without insurance or where insurance does not cover the drug. It is impossible to say with any accuracy how much monthly sitagliptin cost will be for patients with insurance since coverage varies so widely and is influenced by so many different factors.
However, Januvia is almost always a top-tier drug when it is covered. Patients can expect to pay whatever the highest copay approved under their insurance plan is for each prescription. For most patients, this comes out to around $500 per month.
This makes sitagliptin treatment one of patients’ costliest options for treating their diabetes.
Alternatives to Sitagliptin
In light of Januvia’s high costs, some patients and their doctors may choose alternative forms of diabetes management. Most start with a combination of Metformin and diet and lifestyle changes. When this is insufficient to bring blood sugar levels under control, the next step is to explore the use of sulphonylurea medications such as:
Sulphonylurea medications prompt the pancreas to produce more insulin, which helps lower blood sugar levels. These drugs have been on the market since the 1950s, meaning that generic versions are readily available. This makes them ideal for cheap diabetes treatment.
Not all patients tolerate sulphonylureas well, however. Those patients and their doctors may want to explore gliptin medications, which use a different mechanism in the body to control insulin and glucose levels.
Many older gliptin medications such as Linagliptin (Tradjenta) and Saxagliptin (Onglyza) are available in inexpensive generic versions. On average, generic gliptins cost about $20 a month. Switching to any of these other drugs, alone or in combination with Metformin, may allow users to avoid the high cost of a sitagliptin prescription.
Why Alternatives Are Not Always an Option
For many patients, sulphonylureas and other gliptin medications are not a safe or viable option. Potentially dangerous or debilitating side-effects include:
- Severe drops in blood sugar levels
- Anxiety and depression
- Dizziness and nausea
- Blurred vision
- Chills and cold sweats
- Increased heart rate
- Changes to appetite
- Shakiness and slurred speech
- Weakness and fatigue, up to and including loss of consciousness
- Debilitating joint pain
- Weight gain
- Allergic-type reactions
When this is the case, patients may have no choice but to choose sitagliptin treatment over all others to help them control their diabetes.
Fortunately, it is possible to save money on your sitagliptin prescription.
Saving Money on Your Prescription: Coupons and Rebates
Some patients may qualify for coupon or rebate programs that reduce the cost of taking sitagliptin for diabetes management.
Merck runs a coupon program that allows eligible users to get sitagliptin for $5 a month for the first year that they take the drug. While not everyone will qualify for such steep discounts, in many cases the program can cut the cost of the drug in half.
To qualify, patients generally must:
- Have private insurance coverage
- Be prescribed sitagliptin by their doctors
- Meet other income and eligibility requirements
The program is not open to patients with Medicare or Medicaid. Patients enrolling in the program should also be aware that in most cases it is a limited time offer. Once the initial offer expires, they will have to pay full price for their medication.
Patients who need help affording their medications should talk to their doctors. Many physicians and medical provider organizations receive coupons or other discount codes from pharmaceutical companies to encourage them to prescribe new or brand-name medications instead of older generic drugs.
Your physician may be able to pass some of these coupons or codes on to you to reduce your costs. Coupons and codes may be hard copy or digital. Digital codes can be opened on your cell phone or other digital device and presented to your pharmacy at the time of purchase.
Saving Money on Your Prescription: Patient Assistance Program Enrollment
Patient assistance programs are similar to coupon and rebate programs with a few key differences. They are similar in that they allow patients to purchase or receive their medications at very low prices. They also tend to have very specific eligibility requirements.
Patient assistance programs are different from coupon programs in that users can often remain enrolled for as long as:
- Their doctors prescribe the medication for an approved condition
- They live in a covered geographic area
- They continue to meet eligibility requirements
- They document their continuing eligibility periodically as required
These programs exist to get medication to users who need it most but who have no hope of affording it through other means. As such, to be eligible for enrollment, you must usually be part of a very low-income household. You must also have no health insurance or carry health insurance that does not adequately cover your medication needs.
Additional terms and conditions may apply, so it is important to read all program guidelines carefully before assuming that you will qualify for coverage. Like coupon programs, however, patient assistance programs can sometimes prove invaluable by helping patients access sitagliptin long enough to:
- Stabilize their condition
- Explore alternative treatment options
- Find alternative means of covering their medication costs
Saving Money on Your Prescription: Savvy Shopping
Perhaps the best way to make sitagliptin treatment affordable is to change where you fill your prescriptions. Most patients fill their prescriptions at local pharmacies out of habit more than anything else. In some cases, patients may base their choice of pharmacy on their insurance plan and its “in-network” versus “out-of-network” options and costs.
But in situations where insurance is not covering your costs, using a pharmacy near your home is often not the best option. You can end up paying much more than necessary, particularly if you live in an area with a high cost of living.
Even if insurance will cover some of your costs, you may be able to get better pricing by switching where you fill your prescription. For many diabetic patients, specifically, buying sitagliptin online can radically cut medication costs.
Buying online allows you to source your medications from pharmacies not only outside your immediate geographic region but also from outside the United States. This is important because pharmaceuticals are more expensive in America than they are in most other countries.
Purchasing your medications through a certified pharmacy somewhere else via the web allows you to bypass hefty drug prices and enjoy the savings available to diabetics elsewhere. This can put even popular, brand-name drugs like Januvia within financial reach.
As an added benefit, ordering online also allows you to have your medication delivered to your door. This saves time and money and can serve as an extra layer of safety for immunologically high-risk patients during flu season or quarantine periods.
Saving Money on Your Prescription: Getting Creative
In addition to all of the above, your doctor may be able to assist you in finding other creative ways to keep the costs of your sitagliptin treatment down. These may include:
- Using sitagliptin in conjunction with other drugs to minimize how much you need
- Writing prescriptions for larger tablets you then cut in half for the correct dose to stretch how long a bottle lasts
- Combining sitagliptin with diet and lifestyle changes that minimize how much you need
- Using sitagliptin as a temporary treatment while exploring less expensive options long-term or to stabilize your condition so that other options can become viable
Making Sitagliptin Affordable
At first glance, sitagliptin cost can seem prohibitive. With the right sourcing strategy, however, sitagliptin treatment can become an affordable option for almost anyone. Learn more about how ordering online can help you get the medications you need when you need them without breaking the bank.