Insulin Pricing Report Survey
A Note from Colorado Attorney General Phil Weiser:

The Colorado Legislature has called on us to investigate the rising price of prescription insulin drugs. We are also charged with making recommendations about how to improve affordability and accessibility of this life-saving drug.

During this public health emergency, it is as clear as ever that access to healthcare is an imperative. It is also clear that we must work together as Coloradans to identify problems and develop life-saving solutions.

In that spirit, I’m hoping you will take a moment to complete this survey and share your experiences. Please also forward this request to your loved ones and ask that they do the same.

Your responses will provide critical insights that will inform our analysis. We want to hear from you about the most pressing challenges you have experienced with obtaining prescription insulin drugs. Your story will help shape our recommendations about how to improve accessibility to insulin for all Coloradans.

Thank you for your time and your input.

Phil Weiser
Colorado Attorney General

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General Information
This survey is anonymous, the Department of Law does not intend to receive any personal identifying information via this survey, Google Forms will not send Department of Law personal identifying information unless you include this information in your responses. The Department of Law will keep all information submitted confidential.  
Does anyone in your household (including yourself) have diabetes?
Clear selection
What type of diabetes do you or your household member have?
What is the sex of the person in your household who has diabetes?
What is the age of the person in your household with diabetes?
What is the ethnicity of the person with diabetes?
Clear selection
What county do you live in?
What is your annual household income?
Clear selection
How many people live in your home (including yourself)?
Which insulin(s) do you (or individuals in your household) use? Please select all that apply.
Do you have health insurance?
Clear selection
If you do have health insurance, does your health insurance cover prescription drugs?
Approximately how much money do you spend on insulin every month?
Approximately how much money do you spend on insulin supplies each month (glucose meter, needles, test strips, lancets)?
How often have you/do you ration your insulin due to cost?
How often have you/do you ration your insulin supplies, such as blood glucose testing supplies and syringes, due to cost?
How often have you/do you NOT use insulin due to cost?
How often have you/do you use expired insulin?
Is insulin affordable for you?
Clear selection
Has the amount you pay for insulin increased since this time last year?
Clear selection
How much does the cost of insulin affect your life?
Clear selection
Have you ever chosen to pay for necessities such as food and housing INSTEAD of paying for insulin?
Clear selection
Your Pharmacy
Does your pharmacy offer alternatives or suggestions when your insulin is not covered or is too expensive?
Clear selection
Are you aware that there might be less expensive alternatives to your prescribed insulin?
Clear selection
Do you use discount cards such as Good Rx, or manufacturer discount cards for insulin?
Clear selection
Are these discount cards easy to use?
Clear selection
How much did you save on your insulin cost because of the discount card for a single refill?
Clear selection
Have you ever obtained insulin from anywhere other than a US pharmacy? If so, where? Please select all that apply.
Your Story
This section, like the rest of the survey and questions, is optional.
Tell us how high diabetes prescription costs have affected you.
Has the novel Coronavirus affected your ability to pay for insulin?
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