What would you do if you found yourself in desperate need of life-saving insulin but you were uninsured or didn’t have a prescription? It’s a scary thought and a worst-case scenario—but it could happen. If you do find yourself in this situation you should know that all hope is not lost; you can purchase certain types of insulin over the counter and without a prescription, but there are many factors you should consider carefully before doing so.

Things to know

Before you head out the door there are a few things you should know upfront:

-There are currently only two types of human insulin available over the counter and they are older versions of the medicine, which means they take longer to metabolize than the newer, prescription versions you likely are accustomed to using.

-You should NOT self-administer insulin unless you have consulted with a doctor. Incorrectly administering insulin could be fatal.

-No long-acting over-the-counter insulin is available at this time. So you have to find another solution if you require basal insulin.

-There may be a safer or cheaper options, such as a local clinic or pharmaceutical assistance program.

The versions of insulin that are available over the counter were approved for sale that way because they are based on a less concentrated, older formulation "that did not require a licensed medical practitioner's supervision for safe use," an FDA representative told NPR. The assumption is that the person buying and administering the insulin knows what to do—but this is not always the case.

Today, most prescriptions cover the most up-to-date types of insulin—basal insulins such as Lantus and Levemir, as well as rapid-acting insulins like Novolog, Humalog, and Apidra. But when you buy insulin over the counter, these brand-name insulins are not available.

In some states, you can get insulin over the counter at Wal-Mart. The retailer has partnered with Novo Nordisk to sell insulin under the brand name ReliOn for about $25 a vial.

But this only enables you to buy older generic formulations of short- and intermediate-acting insulins. They behave differently in the body than newer prescription insulins do and should be carefully discussed with your doctor before use.

Insulin has been around for nearly a century, but many people with diabetes—and doctors, too—are looking more into its availability over the counter. Why? It boils down to rising healthcare costs, particularly the cost of the drug itself. Many people simply can no longer keep up with the soaring costs of this life-saving drug.

The rising cost of insulin

Insulin is an old drug and was first put on the market back in 1923. It has undergone a variety of changes to its formula since then; it was made from cow and pig pancreases for decades and then replaced by a synthetic formulation made with recombinant DNA technology in 1997, according to Medpage Today. The price has steadily been increasing as companies have found ways to upgrade the hormone.

In the United States, there are only three pharmaceutical companies that hold patents allowing them to manufacture insulin: Eli Lilly, Sanofi, and Novo Nordisk. Put together, the “big three” made more than $12 billion in profits in 2014, with insulin accounting for a large portion. This is according to Kasia Lipska, an endocrinologist at the Yale School of Medicine who wrote a column for the New York Times, “Break Up the Insulin Racket.”

These “big three” have also simultaneously raised their prices, she notes. From 2010 to 2015, the price of Lantus (made by Sanofi) went up by 168 percent; the price of Levemir (made by Novo Nordisk) rose by 169 percent; and the price of Humulin R U-500 (made by Eli Lilly) increased by 325 percent.

Jeremy Greene, professor of medicine and history of medicine at Johns Hopkins University, recently published a paper in the New England Journal of Medicine examining the high costs of insulin. He concludes that incremental improvements in the drug and the disappearance of older, less profitable versions of insulin are likely explanations for the increase in cost—but he does not blame the drug industry.

“We do not believe that there is a conspiracy to keep insulin expensive,” Greene said in a separate NPR article.

A spokesperson for Eli Lilly said that changes in insurance have contributed to the price increase of insulin.

“The reasons some people are experiencing higher out-of-pocket costs for their medicine are complex and go beyond the medicine’s list price,” Eli Lilly spokeswoman Julie Williams told a diabetes blog published on Healthline. “One of the primary reasons is the advent of new insurance plan designs—particularly the increased use of high-deductible health plans, which shift more of the cost to the individual.”

Lipska says more competition, by means of a generic form of insulin, will make insulin more affordable—and it appears that is on the horizon.

The FDA has recently decided to allow “biosimilar” versions of insulin onto the market. Biosimilar insulin acts in a similar way to existing forms of insulin, but it is not necessarily identical. For example, Basaglar, which is biologically similar to Sanofi’s basal insulin Lantus, recently entered the market and carries a cheaper price tag.

Even small savings for insulin, like Basaglar compared with others like Lantus, may benefit those with financial barriers to insulin, particularly those who are uninsured or underinsured, notes DiaTribe.

All this means that insulin costs could be falling in the near future. Additionally, many insulin patents are set to expire or have expired, paving the way to more competition.

Other options

While the future looks promising, for now some people still face challenges when it comes to affording insulin. Most experts agree, however, that going over the counter for insulin should be a last resort. Silvio Inzucchi, professor of endocrinology and director of the Yale Diabetes Center, encourages people to explore other options first.

“Most of the insulin manufacturers have some plan in place for free or reduced-cost insulin,” he told Diabetic Connect. “The options are there.”

He also recommended seeking out free community clinics, family doctors, internists, or even diabetes center specialists as possible cheaper and safer alternatives. The problem he sees with insulin over the counter is a lack of clinical oversight.

“I have a general sense that going over the counter is not a good thing for this specific type of medication,” he said. “I worry that the patients will not have the proper guidance in terms of dosing or frequency.”

The American Diabetes Association lists several resources you can explore for assistance in affording diabetes medications and supplies, such as insulin. Eli Lilly also offers a patient assistance program.

A doctor’s concerns

George Grunberger, PhD, is the president of the American Association of Clinical Endocrinologists (AACE) and said he is concerned with the lack of education for people who buy insulin without a prescription.

“Education of the patients is essential,” Grunberger told Diabetic Connect. “They need to know what they are doing and understand the units, timing, and type of insulin. It’s amazing to me how many insulin users can’t tell which insulin is long acting or short acting.”

It comes down to safety, he said, especially when using a drug as complex as insulin.

“Insulin is always rated as the riskiest drug to be used, so it needs to be tightly regulated.” he said. “But insulin is a life saver at the same time. It comes down to this—will the patient be able to achieve glucose control safely?”

Part of using insulin safely is knowing what your blood sugars are and knowing what your target should be, he said. That means you still need to have your glucose meter, or some way to test your blood sugars.

And while the cost of insulin is rising, Grunberger said patients also need to think about managing their finances more appropriately so they don’t need to go looking for cheaper, risker options in the first place.

“I have patients who can’t afford insulin but have no problem having an iPhone,” he said. “I see this every day. Unfortunately, there is no right to free medication. You have to prioritize.”

Something else to consider is that the majority of diabetes-related emergency room visits today are a result of hypoglycemia, or low blood sugar, Grunberger noted.

In the end, you should not make a change in your insulin treatment without consulting a professional and weighing the risks carefully.

“Patients need to understand how and when to administer insulin and how to make sure they get the proper dosage,” he said. “As long as you understand it, of course it can be used.”

Did you or someone you know buy insulin over the counter? Share your experiences below.