Why Is Insulin So Expensive In The Us

The Human Cost Of Insulin In America

This is the list of what Laura Marston has sacrificed to keep herself alive: Her car, her furniture, her apartment, her retirement fund, her dog.

At 36 years old, she has already sold all of her possessions twice to afford the insulin her body needs every day.

Insulin is not like other drugs. It’s a natural hormone that controls our blood sugar levels – too high causes vision loss, confusion, nausea, and eventually, organ failure; too low leads to heart irregularities, mood swings, seizures, loss of consciousness.

For most of us, our bodies produce insulin naturally. But for Type 1 diabetics like Ms Marston, insulin comes in clear glass vials, handed over the pharmacy counter each month – if they can afford it.

One vial of the insulin Ms Marston uses now costs $275 without health insurance.

In 1923, the discoverers of insulin sold its patent for $1, hoping the low price would keep the essential treatment available to everyone who needed it.

Now, retail prices in the US are around the $300 range for all insulins from the three major brands that control the market.

Even accounting for inflation, that’s a price increase of over 1,000%.

Stories of Americans rationing insulin – and dying for it – have been making national headlines.

Ms Marston knows the feeling – like most of the diabetics I spoke to, she has experienced frightening lapses in coverage through no fault of her own.

It’s the same story for Sanofi’s Apidra and Novo Nordisk’s Novolog.

Has Competition Been A Negative Factor

Greene writes that In the 95 years since insulin was developed, a number of drug companies have been making and selling it. But even with all those companies making insulin, competition hasnt resulted in lower prices its had the opposite effect. In fact, some brands of insulin have seen prices increase by more than 150 percent in the last five years alone.

He explained that these price increases can spread like wildfire with any competitors raising their prices in step with one another.

Senator Bernie Sanders along with Representative Elijah Cummings have sent a letter to the Department of Justice and the Federal Trade Commission to look into Eli Lilly, Sanofi, and Novo Nordisk for possible price collusion, where companies sync their price hikes with one another in order to raise profits.

So far the three big insulin makers;are defending themselves explaining that modern insulin is extremely expensive to create , that the pharmacy benefit managers like Express Scripts, Inc and UnitedHealth Group are raising prices in their negotiations, and that insurance companies are giving people such complicated reimbursement programs that end up causing them to pay higher amounts.

Greene points out that Blue Cross and Blue Shield of North Carolina has been spending more on insulin alongside the consumer. Each year, BCBSNC spends about $250 million on all medications, with insulin making up 13 percent of the total.

Why Are Insulin Prices Going Up Chuck Grassley Explains It

If Your Time is short

• Insulin costs have increased dramatically in recent years, and innovations alone arent enough to justify the higher prices.;
• A bipartisan Senate report;documented that the business practices of;of manufacturers, health plans and PBMs,;or;pharmacy benefit managers, are key contributors to high prices.;
• There are some discounts available to offset high prices, but;the discounts dont go to everyone with diabetes, and;they vary from vendor to vendor.

More than 7 million;Americans require insulin to treat their diabetes but some people struggle to afford the cost. On Jan. 14, 2021, Sen. Chuck Grassley, R-Iowa, tweeted, “2day Sen Wyden & I released Finance Cmte report on INSULIN costs Prices hv gone THRU THE ROOF for patients/taxpayers bc of manufacturer, health plan & PBM biz practices They make $$ as % of ballooning list price so no incentive to lower price on 100 yr old drug.”

Grassley has a history of;attempting through;proposed legislation;to;lower the cost;of the drug, and Sen. Ron Wyden, D-Oregon,;worked with him;as the ranking minority member on the Senate Finance Committee when Republicans controlled the Senate.

Is Grassley right when he tweets about why insulin costs so much? To answer that question, we look, first, at those costs.

Featured Fact-check

We rate Grassleys statement True.;

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Do You Rely On Insulin

If you or a family member has diabetes, you understand that insulin isnt a choice. Yet, diabetics across the U.S. continue to agonize over the issue of why is insulin so expensive.

Our company is working toward technical strategies that contribute solutions to this life-threatening crisis.;Our web site;focuses on providing content on complex and safety-critical products. The insider-driven articles provide opinions from experts.

We understand the benefits of innovative technologies. And, we share information about strategies for decreasing risks associated with new products. Continue reading more articles on our site.

Reasons Why Insulin Is So Outrageously Expensive

20 Jan 2019, 6:08 p.m. in #insulin4all USA by T1International

Why does insulin cost so much to patients in the USA and around the world? Why is insulin, a widely sold drug of which most forms are now off-patent, so incredibly expensive? These are simple questions, but ones with a number of complicated answers. This post will break some of those answers down and point you in the direction further reading if you want to dive deeper.

1. Only 3 Companies Control 90% of the Global Insulin Market

The big three insulin producers Eli Lilly, Novo Nordisk and Sanofi dominate more than 90% of the world insulin market by value. Often only one of these companies supplies insulin in a country, which means they more or less hold a monopoly there and can set prices as they wish. In some countries, notably China and India, there are domestic insulin companies that can help drive down the price. This means we need more companies in markets like the USA to help bring prices down. Well touch on that a bit further down the list.

2. No Generic Insulin

3.Pay-for-Delay Schemes & Lawsuits

4. Patents

5. Politics

6. Price Fixing

These;Business Insider graphs pretty much say it all.

Several lawsuits alleging some form price-fixing are currently in the works. You can read more here and here.

7. Pharma Marketing Schemes

8. Payment for Influence

What Can be Done?

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Why Insulin Is So Expensive

How Do You Take Insulin Without A Syringe

• Insulin pens look like large writing pens and can help prevent under- and overdosing. They also dont require refrigeration, are conveniently prefilled, and are more durable than syringes.
• Insulin pumps are attached to a thin tube thats implanted under your skin. Pumps are computerized or motorized, and some models also act as glucose monitors. They deliver insulin before each meal along with small amounts through the course of the day. In the US, about 60% of people with diabetes use some form of insulin pump.
• Jet injection devices are a good option if you hate needles. A jet injector holds several doses of insulin. After placing it against your skin, you press a button, and the insulin is pushed through.
• Inhalable insulin comes in a premeasured inhaler and was first approved in 2014. Its short-acting and usually not covered by insurance, which makes it more cost prohibitive than other types of insulin for most people with diabetes.

Unless you have an insulin pump that also works as a glucose monitor, insulin dosing is based on self-monitoring your blood glucose levels. You can check them by doing finger pricks or wearing a device that continuously monitors them for you.

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Why Are Insulin Prices Still So High For Us Patients

Nearly a century ago, Dr. Frederick Banting discovered lifesaving insulin, but skyrocketing prices are putting the drug out of reach for many he sought to help.

The average price of insulin nearly tripled between 2002 and 2013 in the U.S., according to an American Diabetes Association study. Yet other countries pay significantly less. In fact, Americans pay more than 10 times as much for insulin as Canadians do, according to a commentary published in a November issue of the New England Journal of Medicine.

Insulin is a flashpoint in the drug-pricing debate, and its still an ongoing issue. Its a relatively unique product that will require special solutions because so many people rely on it to ensure they can live day to day, said commentary co-author Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School.

The current costs would no doubt disappoint Canadian scientist Banting. In the 1920s he and his team members sold the patent for insulin to the University of Toronto for $1 each. They felt that insulin was such an important medication that it needed to be affordable, according to the NEJM commentary.

“Insulin does not belong to me, it belongs to the world,” Banting once said.

Insulin And Type 1 Vs Type 2 Diabetes

Since insulin was first discovered at the University of Toronto in 1921, it has become one of the planets most important medications. Normally, insulin a peptide hormone that regulates the metabolism of carbohydrates, fats, and protein is synthesized by beta cells in the pancreas. When blood glucose levels are high, insulin is released, which encourages body cells to absorb glucose, lowering its level in the blood.

This process can go awry for a variety of reasons, including an abundance of sugar-rich foods, genetics, and a general lack of movement in our lives.

There are two different types of diabetes. Type 1 diabetics have an autoimmune condition that prevents them from producing their own insulin. Thus, type 1 diabetics must inject insulin in order to survive.

Type 2 diabetics have some resistance to insulins effects. Their bodies overproduce insulin in an attempt to maintain proper blood glucose levels. Roughly 90 percent of the worlds 463 million diabetics suffer from type 2 diabetes. While they often can manage their insulin levels through healthier nutrition and exercise, many type 2 diabetics need prescription insulin as time goes on.

The greatest danger of not receiving an insulin injection is diabetic ketoacidosis , in which the bloodstream becomes extremely acidic and the diabetic is rendered dehydrated. Symptoms of DKA include vomiting, hyperventilation, coma, and death.

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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 .

Using Technology To Increase Patient/provider Communication

When a person with diabetes cant afford to buy their insulin, they start making choices.;The Journal of the American Medical Association;reported that about;30% of patients ration;their insulin. This study showed that rationing insulin is frighteningly common.

Dr. Kasia Lipska from Yale University stated, we have to advocate for change because the status quo is simply cruel and not acceptable.

Some clinicians now use internet technologies to increase communication with patients.;Mobile friendly web-based technology;now receives real-time data. This information can be accessed at any time by patients and providers.

If patients have difficulty getting their insulin, they can call their provider or access a web-based system. With this knowledge, the clinician can make referrals for assistance.

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What Severe Complications Can Occur Because Of Rationing Or Running Out Of Insulin

Diabetic ketoacidosis is an emergency condition that results if you dont have enough insulin to regulate your blood sugar. DKA causes your body to break down fat for energy in the absence of insulin. This leads to a dangerous accumulation of acids known as ketones in your blood that can cause your brain to swell and your body to go into shock.

Signs of diabetic ketoacidosis include:;

• Thirst or a very dry mouth
• Frequent urination
• High levels of ketones in your urine
• Fatigue
• Nausea, vomiting, or stomach pain
• Difficulty breathing
• A fruity or acetone odor on your breath
• Confusion or acting drunk while sober

DKA is so common and can come on so quickly that it is the first sign of Type 1 diabetes in 20% of cases, and the way many type 1 diabetics are first diagnosed with the condition. If you go into diabetic ketoacidosis, dont try to hide it or make light of it. Treat it as the emergency it is and get to a hospital as soon as possible to recover. Ive had people tell me theyre tired of taking insulin, or that theyre rationing it due to cost. In type 1 diabetes, thats all it takes to end up in a life-threatening situation, says Dr. Zilbermint.

Another complication facing diabetics who use insulin is the potential for;hyperglycemia, also known as insulin shock, which involves using too much insulin and causing your blood sugar to drop extremely low. This can cause coma, seizures, and heart attacks, says Dr. Powers.

Ways You May Be Sabotaging Your Insulin Therapy

According to the;Centers for Disease Control and Prevention, DKA hospitalization rates for people with diabetes rose 54.9 percent from 2009 to 2014, reversing a prior trend of decline, though in-hospital fatality rates continued to fall through 2014. The agency called for further study to identify the causes.

Hyperglycemic hyperosmolar nonketotic syndrome is another condition that occurs;when insulin deficiency causes blood sugars to exceed 600 mg/dl, notes;Summit Medical Group. The body responds by excreting the extra blood glucose in the urine, leading to severe dehydration and an imbalance of electrolytes. Brain swelling, seizures, organ failure, coma, and even death can occur.

Miller says he has seen his patients admitted to the ICU due to hyperglycemic crises brought on by insulin rationing. Thank God I have not had a patient die yet, and I say yet because if the crisis continues, its a matter of time.

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Expensive Testing And Trial Process Makes Insulin Expensive

The FDA has to carry out tests and trials before approving any medication.

This is done to ensure the safety of the medication to the users. However, the unfortunate thing about these tests and trials is that theres no exact statement or count on how many tests and trials a medication should pass.

So, because of this, medications will generally have to go through several tests and trials before approval.;But in the case of insulin, this test and trial process is extra demanding.;

There is an extra demanding trial process for insulin because insulin is a biologically engineered medication rather than a straight chemically engineered medication.

As such, of course, the multiple tests and trials insulin will have to go through for approval will cost manufacturers a large amount of research and development budget, invariably making the insulin expensive for the end-user.;