Updates in Glucagon Prescribing: Essential Tips for Pharmacists
- Kimmy Nguyen
- Sep 4
- 5 min read
Written by Christina Berg, PharmD; Chelsea Huppert, PharmD, BCACP; Aaron Brown, PharmD
Those who remember the tedious process of pulling outdates in their local community pharmacy as a young intern may recall their first encounter with glucagon. Back in the pharmacy, likely in a corner on the bottom shelf, there resided a red plastic kit covered in dust that was almost always expired. If you were filled with curiosity, you may have asked your pharmacist what this was used for, to which they would reply in general terms that glucagon was a life-saving rescue medication for the treatment of severe hypoglycemia. Then you might wonder: why was such an important medication always expired, covered in dust, and never dispensed?
Glucagon is formally defined as an injectable peptide that, when injected, through a series of signaling steps will “promote hepatic glycogenolysis and gluconeogenesis, causing a raise in blood glucose levels.”(1) For years it’s been known that it is important for those with a severe history of hypoglycemia to have glucagon on hand, but the recommendations of late have become clearer on the importance of increasing glucagon access through prescribing and counseling. Prior American Diabetes Association (ADA) guidelines recommended glucagon prescribing for all individuals at an increased risk of level 2 or 3 hypoglycemia.(2) In 2024, the ADA updated its language to recommend glucagon instead to “all individuals taking insulin or at high risk for hypoglycemia” - which remains the recommendation in 2025.(3,4) The recommendation is also modified from traditional thought by recommending that you can use glucagon to treat hypoglycemia in those “unable or unwilling to consume carbohydrates by mouth.”(4) This opens the door for expanded prescribing and use of glucagon in patients living with diabetes.
There are important reasons to prescribe glucagon and many benefits from implementing this recommendation that are worth highlighting. One of the most important considerations may be the relief of anxiety induced from hypoglycemia. Patients with a personal or family history of hypoglycemia are often fearful of its effects. This could not only result in a reduced quality of life for those on glucose-lowering medications with a hypoglycemia risk (i.e. insulin, sulfonylureas), but can also inhibit the clinician’s efforts to appropriately modify the patient’s diabetes regimen. Second, glucagon prescribing and counseling can reassure patients that they have the safeguards needed to appropriately manage their diabetes. Thus, glucagon can save lives in two ways: 1) rapidly correcting life-threatening hypoglycemia and 2) giving peace of mind to patients and/or caregivers. For these reasons, prescribing glucagon can aid in ensuring confident use of all diabetes medications, especially those on pharmacologic agents carrying a hypoglycemic risk.
Despite glucagon’s lifesaving potential, recent studies have consistently found glucagon is under-prescribed in populations who can benefit from it most. Even when limiting inclusion criteria to only those at highest risk for hypoglycemia, one study found ~22.4% of patients on basal/bolus insulin were prescribed glucagon within a primary care setting.(5) Further, among those prescribed glucagon, a smaller percentage are likely to fill their prescription.(6) Many factors likely contribute to these findings including provider unfamiliarity with available products or administration along with financial barriers to access. Ambulatory care pharmacists are uniquely positioned to help overcome both barriers.
Regarding product selection, the traditional, red glucagon “Emergency Kit” previously referenced remains available – however there are more options now which vary based on age of approval, administration, storage and dosing (Table 1). Worth noting, the glucagon “Emergency Kit” is the most complex option to administer due to its reconstitution requirements prior to injection. Alternatives with simpler administration include the Gvoke HypoPen (an autoinjector product) and the Gvoke prefilled syringe. Baqsimi is available as an intranasal glucagon option, having the dual benefit of avoiding injections and a simplified dosing scheme of 3 mg intranasal per dose for all approved ages. Additionally, dasiglucagon, a glucagon analog, was approved in 2021 and is sold under the brand name Zegalogue. Zegalogue is available in an autoinjector or prefilled syringe product. See below for links for full administration information for each product. Regardless of product selection, it is crucial to call emergency services immediately after administration and if the patient does not respond after 15 minutes a second dose may be given.
Glucagon Emergency Kit: https://www.glucagonemergencykit.com/instructions-for-use/
Baqsimi: https://www.baqsimi.com/safety-information/?section=ug
Gvoke HypoPen: https://www.gvokeglucagon.com/wp-content/uploads/2023/07/instructions-for-use-gvoke-hypopen.pdf
Gvoke Kit: https://www.gvokeglucagon.com/wp-content/uploads/2023/07/how-to-use-gvoke-kit.pdf
Zegalogue Autoinjector: https://www.zegalogue.com/content/dam/diabetes-patient/zegalogue/en/pdf/zegalogue-autoinjector-instruction-for-use.pdf
Zegalogue PFS: https://www.zegalogue.com/content/dam/diabetes-patient/zegalogue/en/pdf/zegalogue-PFS-instruction-for-use.pdf
Table 1: Available Products
*Available in both a one dose and two dose pack
As of this publication, the wholesale acquisition costs for all listed products are relatively similar – between $279.80 (Glucagon Emergency Kit) and $325.52 (Gvoke products). If cost is the biggest barrier to glucagon access, the first step an ambulatory care pharmacist can take is to work with your team dedicated to helping patients gain access to medications if available at your practice site (i.e. pharmacy technicians, medication access specialists, etc.). Medication access specialists or the ambulatory care pharmacist can help find manufacturer (Table 2) or practice site specific (ie. 340B pricing depending on contracts, etc.) co-pay assistance. Other co-pay assistance third-party websites (i.e. Goodrx.com) can be used as primary “insurance” coverage but patients may still have high co-pays.(8) Of note, glucagon is not available at Mark Cuban’s pharmacy, CostPlus Drug Company, which can often have medications available for cheaper prices.(9)
Table 2: Manufacturer Co-Pay Assistance
*offers are not valid with Medicaid, Medicare or Tricare prescription plans
^total cost savings is not available on the manufacturer’s website
#can be used for a maximum of 12 fills and/or savings of $1800
Ultimately, glucagon is a lifesaving medication that remains under prescribed in individuals with diabetes at risk for hypoglycemia. With many different products available - each varying in administration, storage, age approval, and access - selection must be individualized. Ambulatory care pharmacists are well positioned to identify at-risk patients, support product selection, educate both patients and providers, and help address access barriers.
1. Glucagon. In: Lexi-Drugs. UpToDate Inc; 2024. Updated April 5, 2025. Accessed April 5, 2025. http://online.lexi.com
2. Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, et al. 6. Glycemic Targets: Standards of Care in Diabetes—2023. Diabetes Care 1 January 2023; 46 (Supplement_1): S97–S110. https://doi.org/10.2337/dc23-S006
3. American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S111–S125. https://doi.org/10.2337/dc24-S006
4. American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S128–S145. https://doi.org/10.2337/dc25-S006
5. Herges JR, Haag JD, Kosloski Tarpenning KA, Mara KC, McCoy RG. Glucagon prescribing and prevention of hospitalization for hypoglycemia in a large health system. Diabetes Res Clin Pract. 2023;202:110832. doi:10.1016/j.diabres.2023.110832
6. Galindo RJ, Inselman SA, Umpierrez GE, et al. National Trends in Glucagon Prescriptions Among U.S. Adults With Diabetes and End-Stage Kidney Disease Treated by Dialysis: 2013-2017. Diabetes Care. 2023;46(7):e130-e132. doi:10.2337/dc23-0554
7. RED BOOK Online. IBM Micromedex. IBM Watson Health; 2024. Accessed June 30, 2025. http://www.micromedexsolutions.com/
8. GOODRX. Prescription Prices, Coupons & Pharmacy Information - GoodRx. www.goodrx.com. Published 2020. https://www.goodrx.com
9. Available Medications | Mark Cuban Cost Plus Drugs Company. Available Medications | Mark Cuban Cost Plus Drugs Company. Published 2025. https://www.costplusdrugs.com/medications/
10. Baqsimi. Package insert. Eli Lilly and Company; 2019.
11. Zegalogue. Package insert. Zealand Pharmaceuticals; 2021.
12. Gvoke. Package insert. Xeris Pharmaceuticals; 2021.
Christina Berg, PharmD, BCACP
Clinical Assistant Professor
Pharmacy Practice – University of Wyoming School of Pharmacy
Laramie, WY
Aaron W. Brown, PharmD
Clinical Assistant Professor
Pharmacy Practice – University of Wyoming School of Pharmacy
Laramie, WY
Chelsea Huppert, PharmD, BCACP
Clinical Assistant Professor
Pharmacy Practice & Science - UNMC College of Pharmacy
University of Nebraska Medical Center
Omaha, NE