Key Facts about Basaglar: a less expensive long-acting insulin

Basaglar insulin pen

If you’ve been using a long-acting insulin like Lantus or Levemir, you might have heard about a friendly competitor called Basaglar which is a newer basal insulin option.  To get to know Basaglar better, here are some details you’ll want to be aware of.

Basaglar vs Lantus

What is the difference between Lantus and Basaglar?

The key question many people ask about these two types of insulin is whether Basaglar is the same as Lantus. Because of strict definitions that the Food and Drug Administration (FDA) uses to classify drugs as brand, generic and biosimilar, it’s not technically correct to say that Basaglar and Lantus are the same.  However, the amino acid sequence that makes up the chemical compound of both drugs is identical, and both are given the same chemical name of glargine.

To be exact, they are not the same, but to be practical, they are different brands of the same drug – glargine.

When looking at any insulin product, the key features to know are the drug’s onset, peak action, and duration of action.  In simple terms, when does it start working, when is it working at its highest level, and how long will it have an effect in my body? These characteristics of both Basaglar and Lantus are very similar – the onset is around one hour, there is no distinct peak, and the duration is 24 hours, although some patients may see the effects wear off slightly shorter than 24 hours.

Basal or long-acting insulins can be thought of as water sprinklers that deliver a small amount of insulin at a steady pace throughout a day.

Basaglar vs Lantus dosing

The dosing of Basaglar vs Lantus is identical. If a person is using Lantus as their long-acting insulin and wants to switch to Basalgar, a conversion of 1:1 or unit for unit is used.  When changing between any insulin products, it is not unusual to experience some variation in blood sugar control when a switch is made. This is normal and can be managed by more frequent glucose checks during the first few days following a switch.  Now that Basaglar has been in widespread use for more than a year, some people are reporting that higher doses of Basaglar are needed to achieve the same glucose control they had with Lantus. This doesn’t change the initial dosing conversion of 1:1, but does suggest that careful monitoring and dosing adjustments could be necessary.

Basaglar vs Lantus cost

At most pharmacies, there is a small difference between the cost of Basaglar vs Lantus. For a box of 5 pens, Basaglar will cost roughly $50 less than Lantus.  In most cases, a box of Lantus pens is around $280 while a box of Basaglar pens is about $230. For the cash paying patient, this difference may not feel significant, but insurance companies often negotiate even lower prices and then make one of the options their “preferred” drug.

Switching from Lantus to Basaglar

Basaglar is commonly substituted or interchanged for Lantus based on the lower cost and ease of dosing conversions. With the identical onset, peak and duration between the products, switching is seamless in most cases. You should definitely let your healthcare provider know if you experience a noticeable change in level of glucose control after the switch so that the variation can be addressed.

Basaglar vs Levemir

What is the difference between Levemir and Basaglar

While it might be only a small stretch to say that Basaglar and Lantus are the same, it is not correct to say that Basaglar and Levemir are the same. One difference between Basaglar and Levemir is that they are different long-acting insulins. We know that Basaglar is another name for glargine, but Levemir’s generic name is detemir.  Levemir doesn’t have the same onset, peak and duration as glargine, but they are both considered long-acting insulins. Basaglar has a duration of action of about 24 hours, but Levemir’s effects last for about 20-22 hours. Levemir also has a slight peak, whereas glargine products do not. Basaglar can be substituted or interchanged with Levemir, but careful monitoring is advised.

Basaglar vs Levemir dosing

Basaglar vs Levemir dosing usually starts out with a 1:1 or unit for unit conversion, just like Lantus. This is true when Levemir is used as a once-daily injection.  BUT, Levemir is sometimes dosed twice a day to get longer acting insulin coverage.  When it is used twice a day, the total starting dose of Basaglar may be reduced by 20% initially. This way, it can be monitored and increased as needed. For example, if someone was using 20 units once a day of Levemir, their dose would be 20 units of Basaglar. If they were using 20 units twice a day of Levemir, a Basaglar starting dose might be 32 units. Your healthcare team would make this decision based on your level of blood sugar control. 

Basaglar vs Levemir cost

The cost of Levemir is higher than Basaglar. The current cash price for a box of Levemir pens is about $450, but insurance formularies may have designated Levemir their preferred long-acting insulin. Basaglar is less expensive than Levemir, but still not affordable for most people paying cash for their medications.

Switching from Levemir to Basaglar

Most switches from Levemir to Basaglar are due to cost or mandates by insurance formularies.  Remember that if you were taking Levemir twice daily and are switching to once daily Basaglar, bigger dosing adjustments will be made, and more frequent blood sugar checks to watch your response are advised.

Bottom line

Having less expensive insulin products can only be a good thing.  Unfortunately, a 20% decrease in price is not enough to make a big difference in access to this life-saving drug, but the door opening to competitors is a step in the right direction.  The similarity of Basaglar to Lantus or Levemir in terms of safety and potency should lead to a relatively smooth transition for people making the switch.

Have you ever switched between insulin products?  If you’ve used Basaglar, tell us your experience.

 

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By |2018-09-09T00:57:14+00:00January 7th, 2017|Diabetes Medication|14 Comments

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14 Comments

  1. Jody Bidlack April 26, 2017 at 9:29 pm - Reply

    I was taking 7 units of Lantus daily. My insurance forced me to switch to Basaglar. It doesn’t work. I am up to 10 units daily of Basaglar, and my blood sugar is still not under control. The assumption that they are equal is flawed. Corporate greed is negatively affecting my health.

  2. Dr. Julie Adkison April 27, 2017 at 1:30 am - Reply

    Interesting. I have not had enough experience with switching patients in my clinical practice to know if this is common to most patients or not. With any medication change, some variation is to be expected, but I’m surprised that you’re not getting a similar level of control even when going up to 10 units. I have looked at the details of the onset, peak and duration of both types of insulin, and they look almost identical. Thanks for sharing your experience. I’ll be on the lookout for other patient reports as more people use Basaglar. The cost of insulin is outrageous!

  3. Jeff May 26, 2017 at 11:27 am - Reply

    I was on Levemir, 12 units daily, my insurance forced me to switch to Basaglar. My doctor put me on 22 units, and this stuff is messing with me badly. I just took my between meal glucose and is at 109, which is normally where my fasting blood sugar would be. Did my doctor possibly dose me too high?

    • Dr. Julie Adkison August 20, 2017 at 7:28 pm - Reply

      The usual conversion from Levemir to Basaglar is unit for unit. I would certainly inquire about that increase. Even if your doctor did want to add more basal insulin to your regimen, smaller incremental changes would be tolerated better. I would call my provider and ask for clarification.

  4. Alene Dixon September 30, 2017 at 8:00 pm - Reply

    As of 2018 my insurance will no longer cover Lantus; only options are Basaglar, Levemir or Tresiba. Going to see my dr but concerned. I take 46 units daily plus metformin.

    • Dr. Julie Adkison October 1, 2017 at 6:14 am - Reply

      Basaglar will be the closest to Lantus in terms of onset and duration of action, followed by Levemir. I’ve seen some patients in practice who need small dose adjustments after making the switch, so be sure to monitor your glucose more closely at least for the first few days after changing over. Hopefully, you won’t notice much of a change at all, except the lower cost!

  5. joel November 9, 2017 at 9:24 am - Reply

    My 14 year-old T1D switched form Lantus to Basaglar about 45 days ago (mandated by insurance). Reading about the products, I expected no problem making the switch, even less of a big deal than novalog to homolog or back. It’s really been a nightmare as her blood sugars have been much more volatile, both low and high. A neighbor gave us a lantus vial and we’re going back to that tonight, thankfully. We’ll be battling with insurance to make the change stick.

    • Dr. Julie Adkison November 12, 2017 at 5:43 am - Reply

      That much variation is not the norm, but people aren’t statistics and an individual’s response is the most important thing. I’ve heard of a few T1’s having success wtih Tresiba, but it is certainly not cheap. I’m not sure how widely insurance plans are covering it yet. Hopefully the transition back to Lantus will be smooth.

  6. Karla Little November 30, 2017 at 4:27 am - Reply

    I was on Lantis and it didnt work. I have had a prior authorization for levemir for more than 2 years. Now that this is on the market I am being forced to back step. I am not happy about this, as I felt I was just making some progress.

  7. GP Stoloff December 12, 2017 at 3:24 am - Reply

    Dr. Julie, my wife has been on 55-70 units of Toujeo for the past 14 months, with a more stable A1C of 5.3, morning BS of 80-110 and nightly BS of 150-215. She’s also prescribed 5 units of Novolog pre-dinner, when she knows she’ll be having carbs.

    Now, CVS is mandating Levemir (which she was unstable on), Basaglar, or Tresiba. Since she already had to be switched from Levemir to Toujeo, we don’t favor it. Basaglar doesn’t seem to work with an additional short-term product, and we have no experience or knowledge of Tresiba except that it is supposed to work with additional short-term products.

    If we shift to Tresiba, what starting dosage would be appropriate, given the concentration level of Toujeo?

    Your thoughts, please.

    • Dr. Julie Adkison December 12, 2017 at 6:27 am - Reply

      It wouldn’t be appropriate for me to comment on the specific dose without being involved in your wife’s care, but I can share the principles we follow when making insulin transitions. You can also find this information on the websites of the different insulin products. All of the long-acting insulins CAN BE interchanged 1:1, unit for unit. Even though Toujeo is a concentrated insulin (U-300), the dosing conversions work the same way. One thing unique about Tresiba is the longer-acting nature. It has a duration of up to 42 hours (compared to ~24 with Lantus and Basaglar and slightly less with Levemir). Some of our patients have experienced more stability in their BS with Tresiba. It comes in 2 different concentrations (U-100, and U-200), but again, the dosing conversions are similar. In our practice, we will often calculate the 1:1 conversion, then decrease the dose by 10-20% to start, to avoid hypoglycemia while we see how the individual responds.

      I also want to comment on your experience with Basaglar. I’m not sure why it wouldn’t work along with a short-acting product. That has not been my experience. One last point – it is not uncommon to need some tweaks and adjustments to the starting dose for the first few days/weeks when switching between insulins. Since they all have slightly different profiles of action, and individual responses can and do vary. I hope she finds the insulin and dose that offer the best stability and control!

  8. Lee Srephens September 24, 2018 at 6:03 am - Reply

    I was down to to 7 to 8 units of Lantus fasting blood surgar between 90 and 110 now taking 25 units of Balaslar and fasting blood slurs are 169 plus and I am having breathing problems. United Health switched to this drug and as far as I am concerned it does not work. I have also gain weight with no change in diet. I am going to stop this drug and do without until I can switch back to Lantus

  9. Mr Gregory September 24, 2018 at 2:08 pm - Reply

    I was taking 34u Lantus and also using a dexcom6, therefore I know exactly how it worked… Just switched to Basaglar and the first day I kept bottoming out and had to decrease to 32u and that’s pretty good other than in the 5th hour after injection of Basaglar which is 3am for me… I drop really low and have to drink 60-80 carbs… after that my line is very even until I wake up. I think I might slowly move my dose time so that the low comes at 6pm/ Meal time.
    Lantus didn’t do this, it was very even line all the time. Oh… also, with Basaglar, in the 22-24th hours, sugar goes high and needs correcting, I believe that the Lantus makes it a little closer to the 24th hour.

    • Dr. Julie Adkison September 25, 2018 at 1:02 am - Reply

      Interesting observations, especially with the duration of action differences. I’ll be curious to know if moving the dose time still causes the low at the 5th-hour mark. I love that CGM provides such great data and can change the way we manage diabetes.

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