The High Price of Insulin Is Killing US Citizens

[Broomstick]

Note the title. Note the "US Citizens". That's very important, because it's not happening in the UK or France or Britain or Australia or really anywhere else even slightly modern/technological.

The price of insulin has skyrocketed in the last few decades, doubling between 2012 and 2016. This has resulted in people losing access to insulin, to having to choose between rent and insulin, to people suffering side effects like kidney problems, blindness, and even death because they rationed their limited supplies too much. Go to GoFundMe and type "insulin" into the search engine and you'll get more than 7000 hits of people essentially begging for help to purchase the medicine that keeps them alive. Americans near international borders cross them to purchase insulin in another country because it's cheaper to travel to a foreign country to pay cash on the counter than what they can get though the jacked up health "coverage" system in the US.

It's more than sad, it's disgusting. Of the three people who developed insulin to treat diabetes one refused any compensation and the other two sold their discovery for a mere $1 because they wanted this live-saving substance to be easily accessible to all. That was back in 1923 - insulin is NOT a new drug. Humalin has been on the market since 1982, it's not new, either.

The drug companies keep coming out with new tweaks and new formulas to justify keeping this under patent and jacking up the costs but really, basic insulin should be made and available to all who need it as a cost that can actually be met without destitution and ruin. There is no reason this can't be done other than greed and callous indifference to suffering, disability, and death.

I'm frustrated because I know people this is affecting. I know a young man who only uses insulin every other day, and even that supply is unsteady. I suspect he's selling illicit drugs to get the money to pay for his insulin as his low-level retail job isn't sufficient. By which I mean the cost of his insulin per month exceeds his GROSS income. He lives at home with his parents, who cover his food costs, he has no car, no rent, etc. His entire income is insufficient to cover the cost of the insulin necessary to keep him alive. This has been the case since he hit 26 and was no longer covered by his parents insurance. Due to untreated diabetes he is not in good physical health which makes holding down even a part time job difficult. He is slowly dying.

I'm frustrated and angry because a co-worker of mine, although in a financially better situation with a full time job and some health coverage is still stretched to the limit and terrified a day is approaching when she, too, can not afford the medicine that keeps her alive. This is a woman who works full time, has health coverage, and usually skips lunch in order to scrape together a few more pennies to buy insulin. The mental stress of only being sure she has enough to keep herself alive for a month or even as little as a week at a time is frightening to see.

A local acquaintance died from this - first she started to have kidney problems, then her vision deteriorated, then she had to have a toe amputated, then a foot... one day she was found dead in her apartment with no food in the refrigerator and no insulin. She had run out, could not get more, and simply fell into a coma and died. Her landlord found her - he'd come to ask about the rent months past due. Apparently the utilities had been shut off as well. In other words, literally every cent this woman had went to trying to buy insulin - not to shelter, not to food, not to anything but trying to get her medicine. And it wasn't enough.

That's just three of the people I know/knew.

This is happening every goddamned day in the US. And no one seems to give a fuck. Or at least, not anyone with the power to change things. The drug companies are charging what the market will bear, and then some. I dunno, maybe they assume people will pay ANYTHING to survive, which is true up to a point... but at some point best effort still isn't good enough. Of course, the poor are hardest hit and least cared about, but it's getting bad enough to affect the middle class now - and such middle class folks will soon become poor.

I'm mad as hell - but can't do a goddamned thing about it. Oh, I suppose I could kick a few bucks to the folks I know personally - although how much that's going to help with these people needing $1000+ a month (for the ones with insurance!) is debatable at best. I don't report people bending/breaking laws to stay alive. No way in hell I'd admit to wrong-doing myself in a public forum but let's just say that I put saving a life above a lot of other things I would normally adhere to. More than willing to drive people to doctor visits or hospitals even as I gnash my teeth over peoples' bodies being destroyed by something we've been able to treat for nearly a century now.

Really makes me want to scream.

If I won a really big lottery prize I'd set up a charity to cover these cost for people. I'd buy a few Congresspeople and Senators to change the laws. I'd set up a company to manufacture a generic in direct competition to the current assholes. Fuck, I don't know.

[Lord Pounder]

We lost our own Yosemite Bear partly due to fuckery over his need for a named brand of insulin his HMO said wasn’t necessary as well as complications from a spider bite.

Currently America has its sights on the NHS and thus terrifies me. In an American style system I’m dead. I use about 8 pens of Apidra and 5 Lantus a month. Plus my other medications mean I’m uninsurable.

If I could get away with it I’d scam as much insulin as I could from my doctor and give as much as I could to uninsured American diabetics.

[Lord Pounder]

We lost our own Yosemite Bear partly due to fuckery over his need for a named brand of insulin his HMO said wasn’t necessary as well as complications from a spider bite.

Currently America has its sights on the NHS and this terrifies me. In an American style system I’m dead. I use about 8 pens of Apidra and 5 Lantus a month. Plus my other medications mean I’m uninsurable.

If I could get away with it I’d scam as much insulin as I could from my doctor and give as much as I could to uninsured American diabetics.

[mr friendly guy]

I had a discussion on space battles about this. My conclusion is that modern insulin regimes like basal bolus regime is superior to older style regimes, however these are expensive.

In desperation, some people try Walmart insulin to stay alive. It's older style insulin and the dosing would be different from what your doctor has been prescribing, and there will be a risk of hypoglycemia because you won't be sure on first shot if you will get the appropriate dose. But once you do, it's cheaper than modern insulin and you will stay alive.

[InsaneTD]

From what I've heard it's getting more expensive in Australia. Sure insulin prices are kept down by the government, but the cost of other related equipment is rising. Testing strips and needles aren't free even from the charity that specialises in providing it for diabetics.

Our government seem set on going to an American style health care system too so we'll end up the same.

[mr friendly guy]

In Australia your GP may be able to help you apply for the NDSS blood glucose test strip six month approval form. I know because I had to do it for patients a few times. This should help keep costs down.

[madd0ct0r]

https://care.diabetesjournals.org/content/41/6/1299

figure 2:


figure 4:

accompanying text: long with yearly increases, the published data also suggest that when one insulin manufacturer increases the price for a given insulin formulation, the other insulin manufacturers often increase their prices by a similar amount shortly thereafter (15,16) (Fig. 4).



The article stops just short of calling it a cartel, but notes the significant lack of transparency where the profits are flowing to.

[mr friendly guy]

From the article linked above

The Increasing Use of Higher-Priced Insulins
Another important trend affecting overall costs for insulin in the last decade is the shift in insulin utilization from the less expensive human insulins to more expensive human insulin analogs (14,17–19) (Fig. 5). While the prices of both types of insulin have increased, the difference in pricing between them has substantially added to insulin costs—both to the health care system and to many patients (17,18) (human insulins are available at the pharmacy for $25 to $100 per vial compared with human insulin analogs at $174 to $300 per vial [19]). This is further discussed below in formulary decisions and patient financial burden.

This makes sense to me. Some of the newer insulin or insulin analogs like long acting insulin are being increasingly used. Note, long acting insulin by itself doesn't do much, but in combination with short acting insulins in the basal bolus regime (ie short acting insulin with meals, 1 or 2 shots of long acting insulin to provide a baseline level of insulin throughout the day) are more effective for preventing long term complications than using twice daily mixed insulin (those that have both a short acting and an intermediate insulin in the formulation).

Like I said. Older and cheaper insulin will definitely work to keep you alive. However for improved longer term outcome you need different regimens which will use some of the newer insulins. In an ideal world the doctor will prescribe which treatment has the best evidence for the patient. In the real world, patients can't afford these new treatments.

[LaCroix]

In Europe, I could order Humalog right now for ~6$/ml. This is bullshit.

[Vendetta]

In the land of communist healthcare, if you need Insulin you get it free. There is a form to fill in to get free prescriptions because it's a chronic condition so you need it forever (for non-chronic conditions prescriptions are £9).

[Zaune]

In the land of communist healthcare, if you need Insulin you get it free. There is a form to fill in to get free prescriptions because it's a chronic condition so you need it forever (for non-chronic conditions prescriptions are £9).

Unless you're unemployed, in full-time education, receiving any form of disability pension or otherwise likely to be mildly inconvencienced by a prescription charge equivalent to US$11.40, in which case it's also free.

[Bedlam]

In the land of communist healthcare, if you need Insulin you get it free. There is a form to fill in to get free prescriptions because it's a chronic condition so you need it forever (for non-chronic conditions prescriptions are £9).

Unless you're unemployed, in full-time education, receiving any form of disability pension or otherwise likely to be mildly inconvencienced by a prescription charge equivalent to US$11.40, in which case it's also free.

Or live in Scotland

[Vendetta]

On the other hand by the middle of November we're likely to be regarding diabetics as emergency protein supplies, because there's not going to be any insulin in the country anyway, we import it from Europe.

[The Romulan Republic]

Economic cleansing. And also indirect ethnic cleansing, since the the poor are disproportionately racial minorities.

[Aleister Crowley]

Economic cleansing. And also indirect ethnic cleansing, since the the poor are disproportionately racial minorities.

It's a bunch of things. Its a human rights disaster. It's a health crisis. It's that AND a war on the poor and disadvantaged. All the people making money off of INSULIN should be beyond ashamed of themselves. I feel terrible for anyone having to deal with this. The worst part is that I'm in the US and this might very well be what kills me. Not to sound alarmist, but it is a distinct possibility.

[Tribble]

Economic cleansing. And also indirect ethnic cleansing, since the the poor are disproportionately racial minorities.

It's a bunch of things. Its a human rights disaster. It's a health crisis. It's that AND a war on the poor and disadvantaged. All the people making money off of INSULIN should be beyond ashamed of themselves. I feel terrible for anyone having to deal with this. The worst part is that I'm in the US and this might very well be what kills me. Not to sound alarmist, but it is a distinct possibility.

If these people had the capability of feeling things like shame or empathy we wouldn’t be this mess in the first place.

As far as they are concerned they are allowed to charge whatever they want, and if people die because they can’t afford it who cares? From their perspective if you aren’t wealthy
enough to afford their prices you aren’t worthy of being alive anyways, apart from being a resource to be exploited.

[mr friendly guy]

Well US citizens are busing across Canada to buy insulin. I hate linking to WaPo but here it is.
https://www.washingtonpost.com/world/th ... 8ed37b80c2

[amigocabal]

Economic cleansing. And also indirect ethnic cleansing, since the the poor are disproportionately racial minorities.

It's a bunch of things. Its a human rights disaster. It's a health crisis. It's that AND a war on the poor and disadvantaged. All the people making money off of INSULIN should be beyond ashamed of themselves. I feel terrible for anyone having to deal with this. The worst part is that I'm in the US and this might very well be what kills me. Not to sound alarmist, but it is a distinct possibility.

If these people had the capability of feeling things like shame or empathy we wouldn’t be this mess in the first place.

As far as they are concerned they are allowed to charge whatever they want, and if people die because they can’t afford it who cares? From their perspective if you aren’t wealthy
enough to afford their prices you aren’t worthy of being alive anyways, apart from being a resource to be exploited.

And this is true in all fifty states of the United States?

Why is it that not even a single state is willing to enact price controls on insulin? What is wrong with California or New York or West Virginia?

There must be a serious downside to imposing price controls on insulin if no single state is willing to do that, despite the wide variances in political beliefs among the fifty states.

[Tribble]

And this is true in all fifty states of the United States?

Why is it that not even a single state is willing to enact price controls on insulin? What is wrong with California or New York or West Virginia?

There must be a serious downside to imposing price controls on insulin if no single state is willing to do that, despite the wide variances in political beliefs among the fifty states.

I’d it another way - plenty of other countries regulate the prices of drugs like insulin, and the pharmaceutical companies operating in them seem to be doing just fine. Why is it that the US appears to be the only major western country where pharmaceutical prices remains more or less completely unregulated?

The only “downside” I can see to regulating the price of critical life saving drugs like insulin (especially when they are off patent) is that the pharmaceutical companies wouldn’t make as much of an absurd profit. And It’s not like they were crying poor before the massive price hikes started. The failure of the US in enacting price controls can be easily explained as being due to extensive lobbying and obstructionism.

[Broomstick]

Why is it that not even a single state is willing to enact price controls on insulin? What is wrong with California or New York or West Virginia?

There must be a serious downside to imposing price controls on insulin if no single state is willing to do that, despite the wide variances in political beliefs among the fifty states.

There might be a legal obstacle to doing this.

The states set reimbursement rates for Medicaid - and that varies all over the places, as one would expect with more than 50 different programs. But I'm not sure a US state could legally impose a price control when it comes to private insurance coverage, much less the uninsured market.

[amigocabal]

Why is it that not even a single state is willing to enact price controls on insulin? What is wrong with California or New York or West Virginia?

There must be a serious downside to imposing price controls on insulin if no single state is willing to do that, despite the wide variances in political beliefs among the fifty states.

There might be a legal obstacle to doing this.

The states set reimbursement rates for Medicaid - and that varies all over the places, as one would expect with more than 50 different programs. But I'm not sure a US state could legally impose a price control when it comes to private insurance coverage, much less the uninsured market.

Under the Tenth Amendment, the power is reserved to the states. Congress lacks this power except with respect to D.C. , the maritime jurisdiction, and interstate sales.

Diabetics are not a powerful political constituency. More attention is focused on painting over murals of George Washington, or eliminating sex segregation of locker rooms, than making insulin affordable.

Look, all that is needed is a law capping prices at a quarter a quart, and authorizing the death penalty or lesser punishments for charging more for insulin. It is that simple.

And yet, the political establishment in California would rather waste money on a train to nowhere.

I wonder why.

[Broomstick]

Under the Tenth Amendment, the power is reserved to the states. Congress lacks this power except with respect to D.C. , the maritime jurisdiction, and interstate sales.

There's part of the problem right there - interstate sales means the Feds are involved. Unless California has its own independent insulin factory, which is possible for the older "generic" insulins, but the newer ones are under patent protection.

Oh, sure, if there was the political will a way would be found... but it's not a high priority with the people that matter. Politicians have the money to buy any insulin they or their families need. It's the poor diabetics who are crippled or dying. And American does a shitty job taking care of its poor.