A medical assistant administers insulin to an adolescent patient who has Type 1 diabetes. Cigna's pharmacy benefit manager, Express Scripts, says it covers 1.4 million people who take insulin.
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In Mexican border towns, big discount drugstores, as well as small pharmacies like this one in Tijuana, market their less expensive medicines to American tourists.
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Patients with Type-1 diabetes don't have enough healthy islets of Langerhans cells — hormone-secreting cells of the pancreas. Granules inside these cells release insulin and other substances into the blood.
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Carmen Smith now gets the insulin she needs via her doctor's prescription. When she lacked health insurance, buying a version of the medicine over the counter was cheaper, she says. But it was hard to get the dose right.
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A nurse in 1938 checks the amount of insulin in a needle. For many decades, the only insulin available to people with diabetes came from the pancreases of cattle or pigs. Insulin from animals is still available outside the U.S. — and cheaper than a recombinant DNA version.