Why Is Insulin So Expensive
While public outrage over the price of insulin rises, so does the cost. Between 2002 and 2013, Americans saw the cost of insulin almost triple. It has risen 55% since the first quarter of 2014.
Thus, if you were a diabetic in 2014, you paid about $450 per month for your insulin alone. This does not include the cost for blood and urine test strips, syringes, alcohol wipes, pump supplies, and more.
Good Rx also reported that long-acting insulins cost rose about 6% from 2018s 4th quarter to August 2019. Inhaled, ultra-rapid-acting insulin increased 8% during this time. Total health spending is projected to rise by about 5.5% per year over the next decade.
Thus, without change, insulin costs alone will rise above the total health spending costs.
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.
Insulin: Surgeon Becomes Unlikeliest Of Heroes
For centuries, Type 1 diabetes was a death sentence, often killing children in less than a year.
Recognizing that diet played a role in diabetes, doctors experimented with potatoes, rice and even opium as possible cures. Other doctors limited patients suffering from the disease to only 400 calories a day. All of the patients died.
Enter the unlikeliest of heroes: surgeon Dr. Frederick Banting, who had been such a mediocre medical student he didnt know how to spell diabetes.
In Type 1 diabetes, the pancreas produces little or no insulin, a hormone needed to allow sugar to enter cells to produce energy. With help from two students, Banting began research on the problem at the University of Toronto in 1921. They were able to extract insulin from an animal pancreas that they gave to a diabetic animal. The blood sugar dropped dramatically.
The discovery began to save lives. In 1923, Banting and his team were awarded the Nobel Prize for their work.
The team sold the patent to the University of Toronto, which in turn worked with Eli Lilly to develop the first commercially produced insulin.
Initially, all insulin was derived from animals, but in 1982, Eli Lilly created the first synthetic insulin, which was marketed as Humulin.
Fourteen years later, the drug maker unveiled its first analog insulin, a laboratory-grown human insulin. Other companies followed suit.
Eli Lilly, and Sanofi all provide assistance programs to aid patients who cant afford insulin.
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How Accurate Are They
The Food and Drug Administration requires meters to be accurate, but not that accurate. For results at or above 75 mg/dl : 95% of meter test results must be within plus or minus 20% of the actual blood glucose level. So, if your meter reads 100, that could mean anywhere from 80 to 120.
For results below 75 mg/dl: 95% of test results must be within plus or minus 15 points of the actual blood glucose level. So a reading of 70 means 55 to 85.
That sounds like a wide range, but Donald Powers, PhD, chairman of the technical committee at the International Organization for Standardization says,
Meters are pretty much at the limits of their technology. Theyve tried to make as small and easy to use and painless as possible. There are trade-offs between performance and convenience. Unless these things are painless and convenient, people arent going to .
It seems that most or all brands of strips are close to equally accurate. According to Powers, most test strips have similar designs and are made in roughly the same way. Even so, theyre different enough that using one meters strips in another meter will likely give an inaccurate result.
Even the same brand of strip will vary from batch to batch and even within the same container. If you read reviews of almost any kind of strip, youll see some raters saying theyre excellent and consistent. Others say their numbers are all over the place.
What Diabetes Supplies Do I Need
Depending on the type of diabetes you have — type 1 diabetes or type 2 diabetes — you’ll need to purchase:
- A glucose meter
- Lancets to pierce your finger for a blood sample
- Urine test strips to measure ketone levels
- Glucose tablets
- Emergency alert bracelet
There may be other supplies you’ll want to purchase, such as control solutions or specialty items like carrying cases.
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Are You Getting What Im Saying Here
Without insurance, it is unlikely that you have thousands of dollars under a mattress for this type of intensive management. Even with insurance, many of these items can be cost-prohibitive, with deductibles to be met each year and percentages paid out each month to durable medical equipment companies and pharmacies.
This is not meant to shame medical device manufacturers and pharmaceutical companies. Ive said before that they are not charities theyre businesses and they can choose to set their prices and work with insurance companies for discounting.
Who loses in this scenario are those who want the technology but do not have an insurance company adept at bargaining or adept at meeting customer needs. Or those who dont have insurance at all and fall into the gap of making too much to qualify for assistance programs but not enough to pay out of pocket for these items.
When someone asks a person with diabetes if its a hard disease to live with, theyre often asking about the physical aspects of the disease. Very few people outside of the community understand the financial burden many families face if they want what is the BEST technology and treatment for the person with diabetes.
I have no solutions. This is more of an academic exercise to see if what the statistics touted by the government on how much a person with diabetes pays for care was correct. Its not.
We pay much more if we want excellent care. What can be done? Beyond a cure? I dont know. Do you?
‘whole System Needs To Be Evaluated’
Some suggest that a simple across-the-board price cut might not work for all patients under the system.
The American Diabetes Association convened an Insulin Access and Affordability Working Group to study rising insulin prices and affordability of the life-sustaining medicine. The group’s study concluded that a complex supply chain from the drug factory to the pharmacy might promote higher prices.
Pharmacy benefit managers, which negotiate drug prices on behalf of health insurers, demand rebates from drug manufacturers. Their leverage: placing the drug on an insurers formulary the list of drugs that the insurance company will cover for insured consumers.
A drugmaker that offers a lower rebate might be excluded from a prescription drug plan or be placed on a less favorable tier that requires consumers to pay a larger portion on the tab.
More: Insulin costs nearly doubled from 2012 to 2016, report says
The ADA’s working group’s report found that even though drugmakers’ “list prices” for insulin have surged, their “net prices” have grown at a more modest rate. The list price is how much the drugmaker charges. The net price is money the drugmaker gets after fees, discounts and rebates to wholesalers or pharmacy benefit managers.
Consumers are not privy to these behind-the-scenes negotiations between pharmacy benefit managers and drug manufacturers. All of this is done outside the publics view.
“The whole system needs to be evaluated, Van Nuys says.
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Drug Price Rebates For Pbms: Can The System Be Fixed
In January 2019, the Department of Health and Human Services Office of Inspector General proposed a rule that would lift regulatory protection for rebates on prescription drugs paid by drug makers to PBMs, Medicare Part D plans, and Medicaid managed care organizations. The rule would do this by removing an existing provision of the Anti-Kickback Statute that protects rebates to PBMs. Advocates, including Heilaman, hope this step would eliminate kickback activity in the drug pricing and rebate system. The rule also would create two new protections: for discounts offered to patients at the pharmacy , and for fixed-fee services deals between manufacturers and PBMs.
Every day, Americans particularly our seniors pay more than they need to for their prescription drugs because of a hidden system of kickbacks to middlemen, said the Health and Human Services secretary, Alex Azar, in a . President Trump is proposing to end this era of backdoor deals in the drug industry, bring real transparency to drug markets, and deliver savings directly to patients when they walk into the pharmacy.
JDRF, a research and advocacy organization for people with type 1 diabetes, is pleased HHS has proposed ending the use of rebates in federally funded healthcare programs, said Cynthia Rice, the senior vice president of advocacy and policy, in an email statement.
Why Is Home Blood Glucose Testing Important
Home blood sugar testing is an essential part of controlling your blood sugar and self-managing diabetes. Your diabetes educator can guide you in terms of how often to check your blood glucose and how to do it properly. Make sure the diabetes educator watches you use the glucose meter several times. That way, you can be sure you’re doing it correctly. At a minimum, you’ll be checking your blood sugar every morning before you eat. It’s also advisable to check it before lunch and dinner and at bedtime. Your doctor may also ask that you test your blood one hour after eating.
Blood glucose levels checked with blood taken from the fingertips will show important changes faster than glucose levels checked with blood taken from other sites on the body. The usual way to check blood sugar levels is by:
If you take insulin, you might change the dose, depending on the reading.
Checking blood glucose frequently allows you to avoid the dangerous consequences of extremely high spikes or dangerously low drops in blood sugar. Managing these spikes and drops quickly — when treatment is most effective — can save your life.
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Are There Devices That Can Help Manage Diabetes
There are many new tools that can help people with diabetes manage this disease just as they manage other facets of their lives. For instance, increasingly sophisticated software programs are available that allow you to track and analyze trends in blood sugar levels over a period of time. These programs allow you to download and store data from a blood glucose meter directly onto a computer or cell phone and then view charts that show what percentage of time your glucose levels were within normal ranges. You will also be able to see what percentage of time they were above or below normal. These programs do more than just help you understand when glucose levels change and when they stay stable. They also let your doctor review the same data in order to make recommendations that help you stay well.
Another way you can help manage diabetes is by using a continuous glucose monitoring system . A CGMS is an FDA-approved device that records blood sugar levels throughout the day and night. This technology allows you to use the results of glucose monitoring to make informed decisions about nutrition, activity level, and medication.
Other tools include smaller, disposable glucose monitors that can be worn directly on the skin and concealed under clothing. And there are combination tools that let you monitor blood glucose and administer insulin therapy with one piece of equipment.
Save On Healthy Eating
- Plan meals ahead, only buy ingredients you need, and cook your own food. Packaged or restaurant food is much more expensive.
- Cook large batches and freezeexternal icon what you dont use right away. Almost any food can be frozen!
- Bring lunch to work instead of buying ityoull save money and eat healthier too.
- Buy food in bulk, and buy generic instead of higher-priced brands.
- Shop sales and use coupons and rewards cards.
Taking less insulin than you need is very dangerous and can even be deadly. Let your doctor know right away if youre having trouble paying for insulin. Helpexternal icon is available.
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Not So Sweet: Insulin Affordability Over Time
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With costs rising rapidly, insulin is becoming more difficult to afford for many Americans, especially those with inadequate insurance coverage.
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For adults ages 18 to 64, the most important policy factor in having affordable access to insulin is living in a state that expanded Medicaid eligibility. Medicaid protects people with diabetes from high out-of-pocket costs.
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With costs rising rapidly, insulin is becoming more difficult to afford for many Americans, especially those with inadequate insurance coverage.
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For adults ages 18 to 64, the most important policy factor in having affordable access to insulin is living in a state that expanded Medicaid eligibility. Medicaid protects people with diabetes from high out-of-pocket costs.
The Market Is Dominated By Only A Few Manufacturers
Only three pharmaceutical giants Novo Nordisk, Sanofi-Aventis, and Eli Lilly produce 90% of the global insulin supply. Basically, these big three control the market. They also tend to mirror each others prices.
Heres the thing though: insulin was invented in 1923 by Frederick Banting who immediately gave away the patent after it was clear that the drug would save millions of lives each year. Along with co-inventors James Collip and Charles Best, the patent was sold to the University of Toronto for a symbolic $1. Soon after, insulin from pigs and cattle was being produced and sold on a massive scale around the world.
Insulin does not belong to me, it belongs to the world, Banting once said.
Now, nearly 100 years later, insulin is inaccessible to thousands of Americans because of its high cost. Usually, when a drug has been on the market for decades, its patent expires, which means any manufacturer can produce a generic version that should drive the prices down by a high margin. But this expectation falls apart in the case of insulin if anything, the reverse is true.
Part of the reason for this is something called evergreening, the practice involving various techniques to extend the protection on a drug and block competition that might lead to price reductions.
In the US, there are only 17 FDA approved biosimilars for insulin. Many of these biosimilars are manufactured by one of the big three manufacturers, which doesnt help to bring the price down.
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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 The Companies Justify Their Price Increases
With Type 1 diabetes, which affects about 5 percent of people with diabetes in the US, the immune system attacks the insulin-producing cells in the pancreas, leaving the body with little or none of the hormone. In Type 2 diabetes, the pancreas still makes insulin, but the body has grown resistant to its effects. In both cases, patients rely on insulin medication to keep energy from food flowing into their bodies.
The US is a global outlier on money spent on the drug, representing only 15 percent of the global insulin market and generating almost half of the pharmaceutical industrys insulin revenue. According to a recent study in JAMA Internal Medicine, in the 1990s Medicaid paid between $2.36 and $4.43 per unit of insulin by 2014, those prices more than tripled, depending on the formulation.
The doctors and researchers who study insulin say it is yet another example along with EpiPens and of companies raising the cost of their products because of the lax regulatory environment around drug pricing. They are doing it because they can, Jing Luo, a researcher at Brigham and Womens Hospital, told Vox in 2017, and its scary because it happens in all kinds of different drugs and drug classes.
In countries with single-payer health systems, governments exert much more influence over the entire health care process.
The US doesnt do that. Instead, America has long taken a free market approach to pharmaceuticals.
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