Why is insulin so expensive? The absurd cost of a diabetes medicine, explained

When inventor Frederick Banting discovered insulin in 1923, he refused to take his name on the patent. He felt that it was unethical for a doctor to take advantage of a discovery that would save lives. Banting co-inventors James Collip and Charles Best sold the insulin patent at the University of Toronto for a whopping $ 1. They wanted everyone who needed their medicine to afford it.

Today, Banting and his colleagues were turning in their graves: their drug, on which count many of the 30 million Americans with diabetes, has become the reference in the field.

The cost of the four most popular types of insulin has tripled over the past decade and the costs of patient-dependent prescriptions have now doubled. In 2016, the average price of insulin had soared to $ 450 a month – and costs were steadily increasing, to the point that nearly one in four diabetics is saving or skipping doses who save lives.

Congress members lobbied pharmaceutical companies and drug benefit managers to control insulin costs. And on Wednesday, a health care company showed that it was trying to respond to the problem.

Insurance giant Cigna and its drug group, Express Scripts, have announced a new program that will cap the cost of insulin for 30 days at $ 25. This is a 40% reduction from the $ 41.50 a month paid in 2018 by Express Scripts beneficiaries.

The program is expected to be launched later this year for insurance plans that work with Express Scripts. According to the Washington Post, all diabetic patients on Cigna's plans will be able to join next year. This could affect up to 700,000 patients who depend on Cigna or Express Scripts for insulin coverage, and this application will apply even before their deductible is reached.

But there are several catches here. In order for Cigna patients to participate, their employers will have to opt for regime change, said Stat. And Cigna is one of the many insurance companies in the world, covering less than 1% of the 23 million people with diabetes in America.

"Any measure that only helps one part of the population through opaque agreements between the actors responsible for this crisis is not a solution," Elizabeth Voxter, founder and director, told Vox of the T1International patient group. "We need long-term badurance that manufacturers will be held accountable and that prices will be affordable – not another dressing."

Most patients with diabetes will always be vulnerable to the vagaries of prices imposed by drug companies, as companies can always set prices at any level. And no medicine is better for understanding how it happened than insulin.

How companies justify their price increases

In the United States, type 1 diabetes, which affects about 5% of people with diabetes, attacks insulin-producing cells of the pancreas, leaving the body with little or no hormone . With type 2 diabetes, the pancreas still produces insulin, but the body has become resistant to its effects. In both cases, patients rely on insulin to prevent food from entering their body.

But the United States is one of the largest consumers of money spent on the drug, accounting for only 15% of the global insulin market and generating nearly half of the insulin revenues of the pharmaceutical industry. According to a recent study JAMA Internal MedicineIn the 1990s, Medicaid paid between $ 2.36 and $ 4.43 per unit of insulin; in 2014, these prices more than tripled, depending on the wording.

JAMA Internal Medicine

Physicians and researchers who study insulin say it's another example – with EpiPens and decades-old generics – to raise the price of their products because of the regulatory laxity that drives drug prices. "They do it because they can," said Jing Luo, a researcher at Brigham and Women's Hospital, in 2017, "and it's scary because it happens in all sorts of drugs and clbades of drugs. ".

In countries with single-payer health systems, governments exert far greater influence over the entire health care process.

In England, for example, the government has an agency that deals directly with pharmaceutical companies. The government sets a maximum price for a drug and, if the companies do not agree, they simply lose on the market. This puts drug manufacturers at a disadvantage and lowers the price of drugs.

The United States does not do that. Instead, America has long embraced a free market approach to pharmaceuticals.

Pharmaceutical companies are discussing drug prices separately with various private insurers across the country. Meanwhile, Medicare, the government's health program for people over 65, which is also the country's largest purchaser of medicines, is actually not allowed to negotiate drug prices.

This gives more leverage to pharmaceutical companies and leads to the kind of price spike we have seen with EpiPens, recent opioid antidotes – and insulin.

Insulin manufacturers Just like Eli Lilly, who raises prices every year since 2014, these increases are just the price tag for innovation: creating more effective insulin formulations for patients.

According to a 2017 Lancet document on insulin price increases, "The old insulins have been replaced successively by newer products, gradually improved and covered by many additional patents". The result is that more than 90 percent of patients with type 2 diabetes with private insurance are prescribed the newest and most expensive insulin versions.

But it is not clear that these new formulations represent significant improvements over the old ones. The researchers wrote: "The data do not determine whether the insulin badogues used today are safer or more effective for most patients with type 2 diabetes than human insulins widely used in treatment. . 1990s, for which the main patents have expired ".

Luo, the main author of the paper Lancet, does not find the argument of the "cost of innovation" very convincing. In his research, he has encountered many examples of the same insulins available continuously for years without improvement, but their price has risen much faster than inflation.

"The list price of these products is already out of reach for most Americans with diabetes – in some cases, more than $ 300 per bottle," he said. "It is also strange to see that Humulin still costs more than $ 150 per bottle, knowing that this product was first sold in the United States in 1982".

Drug manufacturers do it because they can

The problem of the price of insulin is therefore much more important than anything that Cigna can solve alone. But other changes in the market may be on the horizon.

The three leading insulin manufacturers – Eli Lilly, Novo Nordisk and Sanofi – will testify before the House Energy and Trade Monitoring Subcommittee next week, to focus more attention on the issue. Legislators, including President Chuck Grbadley (R-IA) and Ron Wyden (D-OR), have also investigated the problem and sent letters to pharmaceutical companies asking them to report their outrageous price increases.

But as the pressure around insulin goes up, we also see the terrible impact of rising insulin prices on patients: requiring patients to reduce their insulin consumption in order to pay their medical bills – and lead to kidney failure, blindness or even death.

A clear solution to the problem would be to market a generic version of insulin. There are currently no real generic options available – although there are several renowned insulins and biosimilars – in part because companies have made these additional enhancements to insulin-based products, which which allowed them to keep their formulations under patent and that the old insulin formulations collapsed. of fashion.

But history has shown that when cheaper generic options are introduced into the market, overall drug prices fall. "There are no generic competitors for any Eli Lilly insulin," Luo said. A century after the discovery of insulin, it was time for us to have one.