Humalog Generic Insulin: A New Option, "Not a Panacea": Injections

When Erin Gilmore filled her insulin prescription at a Walgreens in the Denver area in January, she paid $ 8.50. US taxpayers paid an additional $ 280.51.

She thinks the price of insulin is too high. "It gnaws at me to know that taxpayers' money is wasted," said Gilmer, who had been diagnosed with type 1 diabetes while he was in his second year at the University of Colorado in 2002.

The diagnosis meant that for the rest of her days, she would need daily injections of insulin to stay alive. But the price of this insulin is skyrocketing.

Between 2009 and 2017, the wholesale price of a single bottle of Humalog, the insulin used by Gilmer, manufactured by Eli Lilly and Company, almost tripled from 92.70 USD to 274 , $ 70, according to data from IBM Watson Health.

Six years ago, Gilmer's qualified for Social Security Disability Insurance – and therefore for Medicare – because of many health problems. According to IBM Watson Health, the insulin it needed cost 167.70 USD per vial.

"When taxpayers' money is used to pay for drugs for someone like me, it makes it a national problem, not just a diabetes problem," Gilmer said.

Stories about the deaths of people with type 1 diabetes while they could not afford insulin made headlines. Advocates of patients like Gilmer have protested against high prices outside Lilly's headquarters in Indianapolis.

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In last October, in Minnesota, then Attorney General Lori Swanson sued insulin manufacturers, alleging exaggerated prices. On February 26, the Senate Finance Committee talked about high drug prices to leaders in the pharmaceutical industry.

That's what Lilly said Monday is launching a generic version of Humalog at half price called "insulin lispro". Catalog price: $ 137.35 per bottle.

"Patients, doctors and policy makers demand lower prices for drugs and costs for patients at the pharmacy counter," commented Eli Lilly's general manager, David Ricks, in a post published on his blog. "You may be surprised to hear that we agree: it is time for the system to change and for consumer prices to fall."

No panacea

When Lilly's Humalog, the first short-acting insulin, came on the market in 1996, the list price was about $ 21 per vial. The price did not reach $ 275 per night, but annual price increases have increased.

In February 2009, for example, the wholesale price was $ 92.70, according to IBM Watson Health. It reached $ 99.65 in December 2009, then $ 107.60 in September 2010, $ 115.70 in May 2011, etc.

"Nothing justifies why prices should continue to rise at an average rate of 10% each year," says Inmaculada Hernandez of the University of Pittsburgh School of Pharmacy, lead author of a report from January Health Affairs charge the exorbitant cost of prescription drugs to the price increase accumulated each year.

"The public generally perceives that drugs cost so much because we have to pay for research and development, and that's true," Hernandez said. "However, research and development are generally supported during the first years of a drug's life"

At $ 137.35 per vial, Lilly's generic insulin price is about the same as Humalog's price in 2012, 16 years after it was released.

"We want to acknowledge that this is not a panacea," said company spokesman Greg Kueterman. "It's an option that we hope can help the users of the current system we work with."

Humalog is a quick-acting insulin that is not worth it, but it's just one of the two types of insulin that most people with type 1 diabetes consume daily. The second type is durable. Lilly makes one that is called Basaglar. The most popular long-lasting insulin is Lantus, produced by Sanofi. Neither has a cheaper alternative.

Nevertheless, Lilly's action on Humalog could put pressure on the other two major insulin manufacturers to take action.

Novo Nordisk has described Lilly's generic insulin at a "significant development" price in a statement sent by email.

"Putting affordable insulin on the market requires ideas from all stakeholders," said Ken Inchausti of Novo Nordisk in an e-mail, which also outlines the company's actions, such as: that a program of assistance to patients. The statement did not say whether Novo Nordisk was planning to offer a cheaper version of its popular insulin Novolog, a Humalog competitor.

A statement by Sanofi, the third largest manufacturer of insulin, also failed to say whether the company would offer a cheaper version of its insulins.

"Sanofi supports any action to increase diabetic diabetic insulin access at an affordable price," spokesperson Ashleigh Koss, who also extolled the program to patients of society.

Another kind of generic

A different aspect of this story is that Lilly's new insulin is just a refurbished version of Humalog, minus the brand name. This is what is called an "authorized generic".

"Whoever came with the term," generic allowed "?" Dr. Vincent Rajkumar laughs. Rajkumar is a hematologist at the Mayo Clinic in Rochester, Minnesota.

"It's the same drug" as the brand name, he continues.

According to Rajkumar, licensed generics are typically introduced by brand-name drug companies to compete with generic versions of their drugs made by rival companies.

But in the case of Humalog and other insulins, there are no generics manufactured by competitors, for example for the drug against cholesterol Lipitor or even for other drugs antidiabetic drugs, such as metformin.

Thus, when Lilly's authorized generic drug is put on the market, the company will market Humalog insulin and the licensed generic version of this drug.

Rajkumar says that it is a public relations gesture.

"The price of insulin discussed in Congress and elsewhere is outrageous, and the company basically says," Hey, we're going to offer the same product at half the price. "On the surface, it sounds good," Rajkumar said.

"But you look at the problems and you say to yourself," OK, how is it crazy that someone is actually buying the original drug? ""

In fact, it is possible that Lilly is reaping the same profit from its authorized generic, or even more, than the brand name Humalog, according to the brand name Humalog, according to Hernandez of the University of Pittsburgh.

The profit margin would depend on discounts paid by the company to insurers and drug benefit managers. Discounts are receiving a lot of attention these days as a factor in rising drug prices. They are generally not disclosed and increase as the price of a drug increases, prompting some

"Making an authorized generic is nothing more than giving insurers two options," says Hernandez: pay the full price for a branded drug and get a higher discount, or pay the lower price for the drug. authorized generic and benefit from a discount probably lower.

"What we really need to lower insulin prices, is to introduce generics to the market, and we need more than one," he said. Hernandez said, adding that previous research had shown that prices began to fall when two or three markets.

Even in this case, Lillly's Kueterman claims that the generic insulin allowed "will hopefully help to move the system to a more sustainable model."

"I can guarantee you that our goal is to help people," said Kueterman, noting that the company's diabetes treatment center had also helped "10,000 people a month to pay a lot less for their insulin" since it opened in August 2018.

For Erin Gilmer, the news regarding a generic Lilly authorized insulin has slightly encouraged.

"It sounds really good and it will help some people, which is great," said Gilmer. "It's Eli Lilly and the pharmaceutical industry who are beginning to understand that local activism must be taken seriously and we are at a critical point."

This story is part of NPR's reporting partnership with Kaiser Health News. Independent journalist Bram Sable-Smith can be found on Twitter: @besables.