Insulin

I don’t know the fair price for insulin. I don’t know what the vast majority of diabetics pay out of pocket for their insulin although in speaking with several pharmacists I’m told it’s about $50. I do know many Americans struggle to pay for many different prescriptions.

If it is true that people are dying because they can’t get insulin or that drug companies are intentionally gouging the public neither should be tolerated.

But I have my doubts about what we are hearing. Here’s why:

  1. The topic has become a political campaign issue. That creates suspicion about all the facts and circumstances.
  2. Some of the blame is put on high deductible health plans, but under such plans all medications, many required to sustain life, are subject to the deductible. Why aren’t we hearing more horror stories about heart medication, etc.? In addition, insulin has been made a drug that can be reimbursed before the deductible is met or subject to a lower deductible.
  3. Some of the horror stories don’t make sense. A 27 year old dies because he can’t buy insulin and no help comes from family or friends or anyone? Seems strange.
  4. If the problem is as wide-spread as we are being told, wouldn’t you think some group, some organization would have established services, funds to help those is trouble? That’s what we do for substance abusers. Why wouldn’t some billionaire who feels he should pay higher taxes establish a fund to help?
  5. The lack of response from drug companies is also suspicious. Given the barrage of criticism wouldn’t you think they would be doing something to protect their long-term interests, to hinge their bets as it were?

7 comments

    1. Disagree with what? I was mostly asking questions. The article is more of the same reporting and is exact why I raised the issues. An old story of a 26 year old dies one month after he lost insurance and no family member or anyone else could help with the bills. Your reference is exactly why I raise the questions.

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  1. Factual data on any topic is difficult with so many activists disguised as journalists creating fake news in our main stream media…“Choose wisely grasshopper”

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  2. I have been puzzled by this too. I have no personal experience with insulin and I am struggling to figure out what exactly the problem is. I have watched several YouTube videos from various investigative sources and have come to these conclusions:

    1) The original patent was issued in 1923 and most patents only last 20 years. The Hatch-Waxman Act (passed in 1984) extends most drug patents another 5 years because the FDA approval process takes so long. The last set of approvals for insulin by the FDA were issued in 2000.

    2) Insulin is a biologic drug vs a chemically formulated drug. This means that the insulin is grown, not made in a chemical reaction. The FDA approves chemically based generics by the chemical composition. Generic biologic drugs must prove that they are effective and safe in almost the same way as approving a brand-new drug. There are currently only 17 approved generic biologic drugs approved by the FDA compared to the thousands of chemically formulated generics. Basically, you must prove that your manufacturing process does not introduce something unexpected where a pill can be examined for exact chemical makeup.

    3) Pharmaceutical companies play various tricks known as “evergreening” to extend their patent protections. This done by changing the formulation, the process, the usages, the dosage, and outright legal ticks to keep competitors out of the market and extending their patents. In some cases, they have paid generic manufactures not to produce a generic drug. The generic drug company makes money without the costs or risks. Also, the original manufacture’s process of growing a biologic is already approved so they just prove that the change in process doesn’t change the outcome when they evergreen a drug so it shortens the re-approval process and they extend their patent rights for a “new” version of the drug.

    4) There are current only 3 manufactures of insulin and the pricing for all 3 go up at the same rate suggesting price gouging or price fixing. Pricing of insulin is cheaper by 1/10th in Canada compared to the USA suggesting something is wrong with the US market. If the drug manufacturers can make a profit in Canada at the lower price than it must be price gouging.

    5) There are no transparency requirements when it comes to pricing by the manufactures, the PBMs (pharmacy benefit managers), or insurance companies.

    6) Medicare offers drug companies a blank check since the government is not allowed to negotiate by law. If you buy a Medicare part D plan, in theory, that plan’s PBM could but this doesn’t help those not on Medicare.

    7) Doses of insulin can be more than a mortgage payment for some people. Your choice is to pay high costs for a health insurance plan with lower drug costs (possibly) or pay for a less costly high deductible plan and pay more out of pocket until you reach your high deductible limit. Either way you end up paying thousands of dollars a year, every year, unlike a onetime illness or a heart attack. Some monthly dosing of insulin costs as much as a mortgage payment per month and judging from the housing crisis, people cannot afford mortgage payments either.

    The reason I researched this topic is because I am on one drug for Crohn’s disease. The drug that I am taking list’s price by my PBM is $11k per year. I do not pay that and I am not sure if my PBM is truly paying that amount either since rebates are kept secret. The drug has been off patent for decades but there is still no generic (and it is not a biologic). There are new drugs for Crohn’s being advertised on TV that are more expensive than the one I am using. There are about 780,000 people currently being treated in the US with estimates of up to 3.1 million people in the US with Crohn’s so it is not a niche drug. I talked to my doctor this past October on why all the advertising for the new drugs and the costs and he cannot figure out what is happening either. I have no idea what my costs will be when I am forced to go to Medicare.

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    1. FYI PBMs negotiate drug prices in return for placing on a drug on their formulary. Any Medicare negotiating would provide modest additional savings, again using stricter formularies. PBMs do the same for all benefit plans to the benefit of employers and workers.

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      1. If you have a drug plan that is true. Also, the PBM only has to convince whoever is hiring their service that they negotiated a great deal on their behalf. Retail / wholesale pricing is not exactly the same for everybody so it is hard to compare apples to apples for the deal that they actually negotiated. As for the rebates that the PBMs keep, are they kickbacks to raise their drug in a more profitable drug class tier? Are they passed onto the consumer or the employer as savings? How do you prove it? How does a person without insurance get a rebate? Aren’t these the ones who should get them first since they do not have negotiating power? So many questions to a very complicated issue.

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