SAT109 Diabetic Ketoacidosis Due To Non-medical Switching

Disclosure: A.S. Can: None. Z. Zhang: None. F. Yeakley: None. Background/Objective: Non-medical switching is a change in treatment regimen for reasons other than efficacy, side effects, or adherence. Non-medical switching aims to decrease health care costs and is initiated by patient’s health insurance company. Case Report: A 20-year-old female with type 1 diabetes mellitus presented with diabetic ketoacidosis (DKA). She was having issues between her health insurance and pharmacy in filling her prescriptions. Both her standing prescription for long-acting (Basaglar, Eli Lilly and Company, Indianapolis, IN, USA) and rapid-acting (Admelog, sanofi-aventis U.S. LLC, Bridgewater, NJ, USA) insulin were no longer covered. The insulin treatment was switched as requested by her health insurance and Semglee (Mylan Pharmaceuticals Inc., a Viatris Company, Morgantown, WV, USA) as long-acting and Humalog (Eli Lilly and Company, Indianapolis, IN, USA) as rapid-acting insulin prescriptions were transmitted to the pharmacy electronically. The patient was confused on what she should be taking. This led to her thinking that her new long-acting insulin (Semglee) was her rapid-acting due to a name that she did not recognize from her past diabetes self-management education. The patient endorsed taking long-acting insulin Semglee three times daily before meals in place of rapid-acting insulin along with previously prescribed long-acting insulin Basaglar twice daily before breakfast and at bedtime. To make things worse, she could not fill her prescription for Semglee due to a Semglee shortage in the preceding three weeks before her admission. Patients with similar health plan were switched to the same insulin at the same time, causing a shortage in our service area. Even if Admelog was prescribed, she was under the impression that she was getting her rapid-acting insulin needs from Semglee. She did not fill her prescription for Admelog. After her discharge, her insurance covered her original regimen (Basaglar and Admelog) that she was on before her non-medical switching. Around the time of admission, wholesale acquisition cost of 5-pack of 3 ml (1500 Units) of Basaglar was $326.36 and unbranded Semglee $147.98 allowing a saving of $0.12 for one unit of insulin. Our patient takes 40 units of long-acting insulin daily, totaling 14600 units per year. Non-medical switching would achieve $1736 savings per year. But inpatient bill for this DKA was $17078. Discussion: In our case, non-medical switching defeated its purpose and increased health care spending. With the switches, patient became confused about her medical regimen. Non-medical switching did not only place additional financial burden but jeopardized patient safety by significantly contributing to an acute complication of diabetes. Further studies that compare health care utilization, not just drug prices are needed to find out if non-medical switching really saves money and is cost-effective. Presentation: Saturday, June 17, 2023