The natural processes of our body is something that, on a day to day basis, we hardly give a second thought to but when these processes are not normal, or don’t happen at all, we need help. Generally, we can trust our medical industry to provide that help. One such problem is when our body doesn’t make sufficient insulin or stops making insulin altogether. Insulin is a hormone, produced in our pancreas, which essentially controls the sugar level in our blood. If the level is too high or low it can cause serious health issues and even lead to a coma and death. People with type 1 or 2 diabetes suffer from a lack of natural insulin, causing high blood sugar levels and if left untreated this leads to a host of additional problems. Luckily, Dr. Frederick Banting discovered insulin almost a century ago forever changing the lives of those living with diabetes. He and his team realized the importance of insulin as a treatment and attempted to make it easily accessible to all by selling the patent for only $1. Today, however, it seems that this knowledge has been lost or is ignored and many people in the USA are struggling to afford the medication they need to stay alive. With the number of people suffering from diabetes estimated to be a whopping 34.2 million this is becoming an ever more worrisome problem.
Treating diabetes can be quite complicated
Someone with Type 2 diabetes can sometimes manage their condition with a healthy lifestyle but once they have been diagnosed their doctor might prescribe an insulin treatment. For Type 1 diabetes, where the body no longer produces insulin, it is necessary to adhere to an insulin treatment. Administering the insulin is complicated though, because the dosage can differ from person to person and an individual’s dosage requirements also changes over time. Constant monitoring is required to ensure a diabetic receives the right amount of insulin. Add to that the possibility that people can be allergic to a specific brand or that one brand might simply work better for you than another an already complex treatment becomes even more complicated. As diabetes can also cause other problems it might be necessary to treat those at the same time, meaning other medication needs to be purchased and administered.
Why is insulin so expensive?
As complicated as diabetes treatment can be, the reason for the high price of insulin in the USA is even more so. One of these reasons has to do with the insulin patent. What usually happens is that a drug is no longer covered under its original patent after a number of years. The patent served as a way for the original manufacturer of the drug to recoup the costs of investing in the research and development of said drug. As one can imagine with drug development and testing this investment can be quite pricy but once the patent has expired and the money has been recouped a door opens up for generic version of the drug and it ultimately lowers the average price. This is not the case with insulin even though it is a very old drug. Companies still have insulin under patent due to updates and modifications in the drug and delivery system. The original insulin was gathered from animals while the insulin of today is mainly brewed by genetically modified microbes. The delivery method of the drug has also changed a fair bit over the years and with each alteration companies can patent the drug ultimately retaining market dominance and control over its price.
It should also be mentioned that insulin is a complex drug to make and that there are companies that provide insulin while not retaining the rights to their product under a patent, yet the price remains high.
Anoop from Sikkim Tourism highlighted that the other major issue is that pharmaceutical manufactures can set their prices as they like due to a lack of US laws limiting them. In other countries this is not the case and there is legislation limiting drug prices. Due to this situation in the US the price of a drug can be set by the manufacturer and individual insurance companies can negotiate that price. These negotiations are usually handled by pharmacy benefit managers (PBMs) who negotiate for the insurers as a group meaning that, in theory, they have an opportunity to buy the drug in bulk and lower the price. This also does not happen as simply as that. The pharmaceutical company’s calculations that determine the list price of insulin do not need to be disclosed, nor do the negotiations between the company and the PBM. The same goes for the negotiations between the PBM and the insurer which means that the same medication can have different prices depending on the insurance policy you have and individuals are often left with having to buy a specific insulin because that is what they can get with the insurance they have regardless of whether that was the insulin your doctor prescribed or not. What’s more, many insurance policies has a high deductable that has to be reached before the insurance kicks in and the individual is left with a high out-of-pocket cost. Individuals that are not insured cannot reap the benefit of having insurance where you might pay a bit less for the insulin you need.
Is there a light at the end of this tunnel?
Efforts have been made to bring down the cost of insulin although major, nationwide results have yet to be seen. Melissa Thompson of Diabetes 365 notes “Some politicians have made waves by introducing legislation and federal bills in an attempt to lower out-of-pocket copayments and also provide lower-cost insulin. One private insurer has capped copayments for insulin to $25 a month. This, however, seems like very little progress when there is such a large systemic problem.”
Diabetics sometimes find it necessary to ration their insulin dosage or take a different insulin than the one prescribed leading to complications. The worst complication, death, is also not unheard of and sadly, there are many stories of diabetics having to forgo their medication simply because they could not afford it. Bottom line is the United States needs to do a better job of holding Pharmaceutical companies responsible, for the unreasonably high cost of insulin.