Rising Prices & Doses
Insulin injections keep people with Type 1 diabetes alive, and they take multiple daily injections often starting in childhood. In adults with advanced Type 2 diabetes, doctors prescribe it to control blood sugar and stave off devastating damage throughout the body usually after diet and exercise, and other medications, have failed to reduce blood sugar levels enough.
In the time period studied, the total cost of insulin more than tripled, from $231 a year to $736 a year for each patient, in 2013 dollars. The cost per milliliter of insulin nearly tripled in that same time, from $4.34 to $12.92.
And in the same period, the average annual usage went from 171 mL to 206 mL, as prescribed doses went up. This likely happened due to increasing overweight and obesity, which increase the amount of insulin needed by a person, as well as new national recommendations that stress lower sugar levels for all people with diabetes.
Meanwhile, the per-person spending on all other blood sugar medications was $502 in 2013, down from about $600 in 2002 in constant dollars. The cost of these medications combined dropped over the first nine years, bottomed out in 2011 and rose slightly since then.
The cost of metformin, which is available as a generic drug, plummeted from $1.24 per tablet in 2002 to just 31 cents in 2013. Even the newer class of drugs known as DPP4 inhibitors only got 34 percent more expensive since they hit the market in 2006.
Drugmakers Do This Because They Can
So insulins drug pricing problem is much bigger than anything one state or drug company alone can fix. But more changes in the market may be on the horizon.
The three major insulin makers Eli Lilly, Novo Nordisk, and Sanofi testified before the House Energy and Commerces oversight subcommittee last April, focusing more attention on the issue. Lawmakers, including Sens. Chuck Grassley and Ron Wyden , have also been investigating the problem and sending letters to drug companies asking them to account for their outrageous price hikes.
But while the pressure around insulin may be mounting, were also seeing the terrible impact of rising insulin prices on patients: people being forced to taper off insulin so they can pay their medical bills, and winding up with kidney failure, blindness, or even death.
Some are forced to head to Canada, where drug prices are more heavily regulated and, according to the new NEJM editorial, where a carton of insulin costs $20 instead of the $300 patients often pay in the US. Of course, there isnt enough insulin in all of Canada to make large-scale importation feasible, the editorial authors wrote.
But not all insulins are patent-protected. For example, none of Eli Lillys insulins are, according to the drugmaker. In those cases, Luo said, potential manufacturers may be deterred by secondary patents on non-active ingredients in insulins or on associated devices .
How Much Does Insulin Cost Heres How 28 Brands And Generics Compare
GoodRx research shows that the average retail price for insulin rose 54% from 2014 to 2019.
As millions of Americans struggle to afford basic household needs during COVID-19, those prices have decreased only about 5% from January 2020 to October 2021.
While the Biden administration, manufacturers, states, and insurers have responded with efforts to curb insulin prices, FDA approvals of generics and biosimilars have largely driven the downward trend in overall cash prices.
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How Rebates Most Of The Cost Of Your Insulin Work
The math is infuriating, but heres the heavily-simplified basics of how rebates work if you made a product for $5 and wanted to sell it, you may set the price at $10, to create a $5 profit. With that $5 profit, you can invest back in your company to create better products, pay yourself whatever you want to do with your $5.
But lets say you want your product to be in more places and available to more people. You might hire a middle person to place your product in new stores across the country, and theyll charge a fee, which is reasonable.
When you begin, their fee is $1. So that you can keep your $5 profit, you raise your price to $11. Still reasonable. But over time, your middle person makes themselves indispensable and knows it. Youre making way more money because of how many products youre able to sell, so youre not about to drop your middle person.
And oh oops you also signed a contract with your middle person to ensure youll always get your product placed in these nation-wide stores, so youre locked in. And part of that contract was an understanding that you wont lower your price, since that would impact your middle-persons profit.
So now, your product costs $50. Its the same product youve never improved it. Your customers are receiving no more value than when the product cost just $10. Over time, you wanted to make more money from it, so your profit is now $10.
Its still $5 to make your product.
How Can I Reduce My Insulin Costs
If youre feeling overwhelmed by the rising cost of insulin, you are not alone.
Even with rebates, patient assistance programs, and generic insulin, the overall price of insulin and insulin products, high-deductible or high copay insurance coverage, restrictions in medicare and medicaid, and much, much more are stiff obstacles for patients to overcome.
Fortunately, there are lower-cost options available to patients who need insulin to manage their diabetes.
According to the American Diabetes Association, patients should speak to their doctors about whether the use of older human insulins, as opposed to the more expensive human insulin analogs, might be appropriate for the treatment of their diabetes, as the older medications are substantially less expensive.
Each of the major insulin makers also offers insulin savings programs or patient assistance programs to qualifying patients to help with affordability despite the rising cost of insulin, although patients must meet certain conditions such as having a particular type of health insurance or health plan.
References and Sources:
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How Much Does Insulin Cost Without Insurance In 2022
The cost of insulin has steadily increased over the past few years. This price rise is disproportionate to annual inflation. It poses a threat to people living with diabetes who cannot afford to pay for these increased prices but need insulin to survive. The retail price for insulin can be over $140 for a brand-name Humalog KwikPen however, patients can now pay about $60 for generic insulin such as lispro KwikPen.
MiraRx can help you access insulin for an affordable price. At an average of $45 per month, you can access affordable urgent care visits, low-cost lab testing, virtual care, and more. .
Reasons For The High Cost Of Insulin
|Reasons for the high cost of insulin|
|Vulnerable population who is willing to pay high costs to have access to a lifesaving drug|
|Pharmacy benefit managers and other middlemen who benefit from a high list price|
|Lobbying power of insulin manufacturers|
|Possible policy level solutions|
|Value-based reimbursement and pricing, and laws and regulations governing price increases|
|Easier path for biosimilar entry, including reciprocal approval of biosimilars|
|Governmental or nongovernmental agency to oversee pricing|
|Transparency on rebates|
|Solutions that can be implemented by physicians and institutions|
|Discussion with patients about affordability|
|Awareness about sources of information on prices|
|Practice guidelines that take cost into account|
|Preference of lower-cost biosimilars in formularies|
|1921: Discovery of insulin|
|1923: First insulin patented|
|1946: Neutral protamine Hagedorn insulin|
|1950s: Lente insulin|
|1970s: Improved purified insulins|
|1984: Recombinant human insulin|
biosimilarsgenericsN Engl J Med.
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Why Insulin Prices Are Troublingly High
Lawmakers in the House and Senate are zeroing in on legislation that would lower the price of insulin, reigniting questions over how the the cost of this essential medicine was able to skyrocket in the U.S. and remain so high.
On Thursday, House Democrats passed a bill to cap the monthly cost of insulin at $35 a month. The legislation would save Americans money, but it would do little to solve the broader problem of high drug prices.
Sen. Jeanne Shaheen this week said that she reached an agreement in principle with Sen. Susan Collins on legislation to lower insulin costs. There is no finalized legislative text yet, but Shaheen said it would target pharmacy benefit managers , middlemen that negotiate with drug companies on the behalf of insurance plans.
The diabetes drug has become emblematic of the drug pricing crisis in the U.S., with many diabetics resorting to rationing their insulin.
While drug companies often argue patients dont pay the list price for a drug, some patients do have to pay out-of-pocket for drugs until they meet their deductible. Price increases also impact people without insurance.
According to the most recent data from the Department of Health and Human Services, released in 2020, the U.S. pays dramatically higher prices for insulin compared to other countries in the Organization for Economic Co-operation and Development .
A history of anti-competitive pricing
Lack of regulations
No alternatives until recently
Inside The Senate Report On Rising Insulin Prices
Editors Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can build custom plans based on your personal circumstances through our tool, GetInsulin.org.
In January 2021, the United States Senate Finance Committee issued their findings from a two-year investigation into the price of insulin in the US. Their findings are unsurprising to anyone impacted by the cost of insulin. Too many entities manufacturers, pharmacy benefit managers , and insurance companies are driving up the cost of insulin, a life-sustaining drug that insulin-dependent people cannot go without.
The diabetes community has never gotten this level of insight before all of the contracts and deals the Senate Finance Committee were able to investigate were confidential. Below, we break down whats in the Senate Finance Committees 90-page report.
To best understand the findings, here are four definitions you need to know:
Editors Note: See Beyond Type 1s full glossary for the US Healthcare System HERE
Over almost two years, the Senate Finance Committee poured over 100,000 pages of internal documents provided by insulin manufacturers, the three major PBMs, and reports from The Centers for Medicare & Medicaid Services , trying to determine the financial and contractual relationships between the companies.
Some of the top line findings from the report include::
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Insulin Vials And Syringes
The most common way to inject insulin is with a vial and syringe .
Syringes are considered the cheapest form of insulin delivery, but theyre certainly not cheap at least not anymore. One study found that the price of insulin tripled in just 10 years.
Vials of insulin can be rapid-acting, short-acting, intermediate-acting, or long-acting. This relates to how long they are effective in the bloodstream.
Costs Of Insulin Pumps
Without insurance, a new insulin pump costs about $6,000 out of pocket, plus another $3,000 to $6,000 annually for ongoing supplies, like batteries and sensors. The cost varies depending on the features, software, brand, and size of the pump.
But youll also need to pay separately for the insulin delivered via the device, so the cost for using an insulin pump without good insurance coverage can be tremendous.
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Historic Claims Of Insulin Price
Flash forward a couple of decades to 1941, when Eli Lilly and two other insulin companies were accused of illegal anti-trust violations in overcharging for insulin to rake in profits
This Chicago Daily Tribune story from April 1, 1941, reports that a federal grand jury indicted a corporate trio insulin manufacturer Eli Lilly in Indianapolis, distributor Sharp & Dohme in Philadelphia, and drug maker and distributor E.R. Squibb & Sons in New York for conspiring to unlawfully bring about arbitrary, uniform, and non-competitive prices for insulin and to prevent normal competition in the sale of the drug. That was a federal charge of violating the Sherman Antitrust Act, the landmark legislation preventing anti-competitive business practices.
In my sleuthing I also found an Indianapolis Star story from that same day with more detail, including a statement from Mr. Eli Lilly himself, pointing to how proud he was of the companys insulin history and how 13 price decreases had supposedly been made between 1923-41.
Hes quoted as saying: Our price is now 3.5% of what it was when it was first sold in 1923, and today it costs the average diabetic just 7.5 cents per day.
All three companies eventually pleaded no contest, but never admitted any wrongdoing. In July 1941, newspapers reported that the accused companies were fined $5,000 each and their corporate officers each faced $1,500 in individual fines for the price-fixing charges.
Net Expenditures Were Flat Between 2014 And 2018
Increasing list prices have been documented by the media, policymakers and researchers. Along with this trend, decreasing net prices have also been noted. We confirm the same trends in our data.
We also analyzed net expenditures the total spent across all distribution system participants, equal to dollar inflows less outflows, summed across all participants.
The graph below shows the average list price, net price and net expenditures per 100 units of insulin for 32 insulin products over time.
We find the gap between list prices and net prices has widened substantially. But net expendituresthe total cost to the health systemhave barely changed between 2014 and 2018.
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What Is The Cost Of Insulin With Insurance
The American Diabetes Association Insulin Access and Affordability Working Group report found that nearly half of Americans have employer-sponsored health insurance. About 20% are insured through Medicaid, and 14% are insured through Medicare. Approximately 7% of Americans purchase health insurance on their own. About 9% of Americans remain uninsured.
Diabetes is considered a pre-existing condition, which is a condition you have prior to applying for health insurance. According to research, about 1.9 million people with diabetes who didn’t have insurance gained coverage after the Affordable Care Act went into effect in 2010.
Still, having insurance doesn’t mean insulin is affordable. Insured patients will often pay a copay or a percentage, rather than the list price, for their insulin. Redmond says that cost could range from $30 to $50.
In cases of high-deductible health plans, patients have to pay the list price for their insulin until their deductible is met. This could mean thousands of dollars out of pocket. Many patients just have a problem paying that much, says Redmond.
Insulin Prices: How Much Does Insulin Cost
Diabetes is no small issue in the United States. There are approximately 30.3 million people with diabetes in the U.S., according to the Diabetes Research Institute. Five percent of themor about 1.5 million peoplehave type 1 diabetes and require insulin to survive. Some people with type 2 diabetes can control blood sugar with diet and activity. Still, many need insulin, especially as the condition progresses.
And, unfortunately, insulin prices have risen dramatically over the past 10 years. Between 2012 and 2016, the price almost doubled, according to the Health Care Cost Institute. In 2012, the average cost of insulin per diabetes patient was $2,864 per year. By 2016, it had risen to $5,705. Today, one vial of insulin can cost $250, and some people need six vials per month.
In addition to that, there are other diabetes supplies, such as a glucose monitor, test strips, lancets, and a safe place to store used syringes or pens. It could easily cost someone without insurance $1,300 per month to care for the condition. Even with insurance, copayments and supplies can eat away at your monthly budget. Luckily, there are savings options.
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List Prices As A Marketing Tool
A part of drug pricing that can be jarring and confusing is the practice of including list prices effectively the cost one pays without insurance on a medications receipt. Typically 30-50% of the cost, sometimes up to 70% of the cost, is not for the medication itself, but to pay for the rebates given back to the PBMs and insurance companies, often the very company that is printing the receipt. Its not necessarily that your insurance or the pharmacy saved you that money its that by buying the medication through them, they are getting a kickback from the sheer amount of medication they were able to negotiate to go through their company.
That list price ends up being what someone who does not have insurance coverage has to pay because that person is not participating in the very system of insurance and PBMs that drove the price up in the first place.
Insulin manufacturers offer Patient Assistance Programs , cash pricing through the manufacturer, and co-pay cards to bypass the PBM system and get insulin at less than the list price, usually for no more than $100 per month and often for $0-$50 per month. In order to access these programs, a patient may have to know where to look, how to assess eligibility, and navigate what can sometimes be a challenging approval process. Beyond Type 1 launched GetInsulin.org for exactly this reason .