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Should Kentucky Lawmakers Let Pharmacists Dispense Emergency Insulin?

Last month, 22-year-old Sam Klein opened up her fridge and made a startling discovery: her last vial of insulin was shattered. Klein has Type 1 diabetes, which means without insulin she could die.

In many states, pharmacists are allowed to dispense 30-days — or the smallest unit available — of a life-saving drug in an emergency situation. But in Kentucky, that’s not an option for people like Klein. So when Klein called her mom, Sarah Ferguson, she went into panic mode.

“I was getting into that frantic mom emergency-mode of thinking — running through the list of things that I could possibly do to get her insulin for the weekend because her doctor’s office was closed and she didn’t have a refill on a prescription,” Ferguson said.

Klein was due for a doctor’s appointment and a refill the following week, but the doctor didn’t return a call to the emergency line. At that point, one of Klein’s only options was an expensive emergency room visit to get a new prescription. But Ferguson put out a call for insulin on Facebook and eventually found her daughter a vial from a neighbor.

“She just went right to her refrigerator and pulled out of vial and said we can have it — I thought I was just going to burst into tears,” Ferguson said.

Kevin's Law

One of the reasons Ferguson was so upset was that she knew someone like her daughter did die because of a similar situation. In 2015, Kevin Houdeshell’s insulin prescription expired, and his doctor didn’t return calls from a pharmacist for refills. He went without the drug, and died four days later because of diabetes-related complications.

Houdeshell’s death pushed lawmakers in Ohio to act, and the resulting legislation was named after Houdeshell.

“Rather than allowing the patient to leave the pharmacy without their medications, [pharmacists] basically use the provisions in Kevin’s Law and are able to dispense an emergency supply of medications in lieu of a doctor’s re-authorization for that prescription,” said Antonio Ciaccia, director of government and public affairs at the the Ohio Pharmacists Association.

The law doesn’t just apply to insulin, but any life-saving drug, like an inhaler. And Klein and Ferguson want Kentucky to pass a similar measure. The state already allows pharmacists to dispense three days worth of a medication in an emergency situation. But that law doesn’t cover a drug like insulin, which comes in vials or pen-form, because it’s almost impossible to dispense a three-day supply.

Chris Palutis, a pharmacist and president of the Kentucky Pharmacists Association, said he’s in favor of emergency-access legislation, and that it’s a good use of pharmacists’ skills.

“If someone has a prescription for an inhaler, and it doesn’t have any refills and they come into my pharmacy and and they’re not breathing, well, technically, I can’t give them an inhaler, because that’s more than three-days supply,” Palutis. “I think that it would minimize emergency room visits.”

Is A Law Really Needed?

But in Kentucky, there’s already some insulin that’s sold without a prescription at pharmacies. One of these versions is made by pharmaceutical company Novo Nordisk and sold over-the-counter. But it’s an older generation of the insulin that’s used today.

Todd Hobbs, chief medical officer for Novo Nordisk in North America, said this older version of the drug was the only option available for a long time. But there have been a lot of scientific advances since it was introduced.

“They’ve made it more convenient, more easy to use, more patient-friendly, more like the body would do in a normal situation,” Hobbs said. “But the older insulins are just as effective to lower glucose, it’s just sometimes it takes a little more work and planning to adjust the timing of them.”

That’s where the potential problem of using this over-the-counter version of insulin in an emergency comes in. Sathya Krishnasamy, an endocrinologist at the University of Louisville, said there are indeed numerous studies that show this older insulin technically works just as well as the newer, prescription versions. But it can be more difficult to use.

“It’s not as simple as, you go into a pharmacy, pick it up and just use it,” Krishnasamy said. “There’s suddenly a lot of preparation involved and knowing what dose to take, when to take it.”

One of those changes is that older insulin has to be mixed inside the vial. If it’s not, the insulin won’t be as effective and could cause symptoms like bad cramping.

Krishnasamy says though studies have shown both versions of insulin to be safe, those studies are in controlled situations — for example, researchers aren’t going to tell patients to take the wrong dose, or not shake up the vial to see what happens. But those are real-life scenarios that could happen when patients are using an unfamiliar version of insulin without a physician’s oversight.

“It's totally different dosing, you have to check your blood sugar with the regular [OTC] insulin, there's no guessing with that. It can be a matter of life and death,” said U of L nurse practitioner Beverly Williams Coleman.

Reviving Efforts

Sam Klein and her mom didn’t even know over-the-counter insulin was an option on the night her vial broke. The OTC insulin market in the U.S. is quite small compared to prescription insulin — about 5.7 percent of all insulin sales,  according to medical consulting firm IQVIA — and sales have been steadily declining over the past few years.

Now, there’s an effort to pass legislation similar to Kevin’s Law in Kentucky, giving people emergency access to insulin. A similar bill never made it out of committee two years ago, but Klein and Ferguson are talking with legislators about the possibility of reviving the effort.

Louisville Senator Morgan McGarvey said diabetics should have an easier way to get the treatment they need, and that the solution could be legislative.

“We need to have quick access to life-saving drugs like insulin, and to the extent we can help with that in the legislature, we’re going to do it,” he said.

“I feel like this is something Kentucky can do,” Ferguson said. “We can pass the same legislation Ohio passed. If somebody is in the situation Samantha was in for some reason, you can go to the pharmacy and say, I need my insulin. And the pharmacist would be backed by law to hand it to you.”

Lisa Gillespie is WFPL's Health and Innovation Reporter.

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