The price of insulin has more than tripled in ten years. Not everybody pays full price, but many find the cost of insulin complicates their life. This week, we’ll cover why insulin prices are so high. Next week, we’ll address what to do about it.
According to this story on CBS News, people with diabetes are “cutting back [on their insulin doses] or even going without the drug,” putting them at greater risk for complications.
Insulin costs have soared from $100–$200 per month a few years ago to $400–$500 a month now. CBS News quotes a college student saying her bill for insulin has risen from $130 to $495 per month. She has given up her insulin pump and gone back to injections because of expense.
One of her friends has cut her dose down to 80% of what’s ordered to save money. This has become common practice for many. A doctor in Montana reported that insulin prices greatly complicate people’s care. “I have patients who tell me that they have to make a decision between food and insulin, and their rent and insulin.”
Why is this happening?
When insulin was discovered the 1920s, the doctors who found it gave it away. It immediately started saving lives for people with Type 1 diabetes. Now insulin has become a $24-billion-a-year market globally and is predicted to pass $48 billion in only five more years. And people around the world who need it can’t afford it.
There are several causes for the price spikes, but many of them come down to America’s pretend “free market” approach to health care. We are seeing these problems now with the controversy over one brand of epinephrine injections, whose manufacturer increased their price by 500% and then paid their CEO a nearly $19 million salary.
Here are some ways American economics are making insulin unaffordable:
• Captive market. People with Type 1 diabetes, and maybe some with Type 2 diabetes, can’t live without insulin. How are they supposed to negotiate or use their buying power when they need the product to live? You have to pay what the seller demands.
• No competition. There are only three manufacturers of all the insulin used in the U.S., so there’s no real competition.
• No generics. Generic insulins could lower the price, but they are not allowed. Insulin is classed as a “biologic” drug. Anyone wanting to manufacture a “biosimilar” insulin has to pass extremely strict tests to be allowed to sell it. For this reason, cost savings, if someone wants to compete, are estimated at only 20%–40% lower than the brand names, not 90% as often happens with generic pills.
Even so, drug companies are resisting the introduction of biosimilars, according to this article in Diabetes Forecast. There is currently only one expected to be available soon in the U.S.
• Newer insulins. Insulins are getting better. With long-acting basal and rapid-acting insulin “analogs” for meals, patients should have fewer hypos and be able to achieve tighter control than on human insulin. But the analog insulins are seven to eight times more expensive.
The older, cheaper human insulins are now rarely prescribed in the U.S. The even more-affordable animal-derived insulins are still available in much of the world, including Canada, but not in the U.S.
Some experts, like Dr. Kasia Lipska of Yale, say the benefits of analogs aren’t so impressive. “When you compare…analog versus human insulin, there aren’t big differences in terms of [blood glucose control] or safety.”
Analogs’ advantages may not be worth the price, certainly not if they are too expensive for patients to buy. A ten-year study coauthored by the University of Michigan’s William Herman, MD, MPH, says “Although the newer, more expensive insulin analogs appear to have incremental benefits compared to older, less expensive insulin preparations, their premium price requires us to ask whether they are really necessary, and if so, for whom?”
• Medicare is forbidden by law from negotiating prices paid for drugs. So manufacturers can charge whatever they want to the government.
• Like many other drugs, insulin is far more expensive in the U.S. than in most other countries. According to the advocacy group T1International, one type of rapid-acting insulin costs roughly four times as much in the U.S. as in Canada.
• The U.S. medical system is so complex and wrapped in secrecy that nobody knows how drug prices to consumers are actually set. Pharmacies, insurers, drug companies, and health-care providers all negotiate to get the best deals. A whole industry called “pharmacy benefit managers” work for insurers to get the best price, but they keep a commission for themselves. Whatever price benefit they win from a manufacturer may not be passed on to consumers.
How these price hikes affect you depends on your insurance. With the best insurance, they may not be a problem. A spokeswoman for the Pharmaceutical Research and Manufacturers of America (PhRMA) told CBS News that list prices don’t represent what patients actually pay, because insurers and pharmacy benefit managers negotiate discounts.
“In fact, an analysis by SSR Health found that net prices for insulins actually declined in 2015,” she said. “With that said, we recognize too often patients struggle with access to their medicines at the pharmacy.”
If your drug coverage is not so good, like if you have a high-deductible plan through the Affordable Care Act, you might find the cost of insulin a serious burden. What can you do to lower the cost and maintain both your health and your budget? We’ll look at some ways next week, including assistance plans, cheaper insulins, pharmacy coupons, insulin alternatives, and diet changes, and we would benefit from hearing your experiences, as well.
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David Spero: David Spero has been a nurse for 40 years and has lived with multiple sclerosis for 30 years. He is the author of four books: The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hunter House 2002), Diabetes: Sugar-coated Crisis — Who Gets It, Who Profits, and How to Stop It (New Society 2006, Diabetes Heroes (Jim Healthy 2014), and The Inn by the Healing Path: Stories on the road to wellness (Smashwords 2015.) He writes for Diabetes Self-Management and Pain-Free Living (formerly Arthritis Self-Management) magazines. His website is www.davidsperorn.com. His blog is TheInnbytheHealingPath.com.
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