I've heard this before and dont understand the reasons - is it really just an oligopoly ripping us off? I rarely trust newpaper articles because it is so politicized, but this looks like it really is.
Also I understand there are newer Insulins which may have a patent, but the original is 100 years old and patent was not an issue. Why aren't there more manufacturers?
Off-patent insulin is $25/vial at Walmart. I’ll yield to any diabetics for additional nuance, but AIUI, this form of insulin is harder to correctly administer.
The newer, patent protected versions are safer and more effective. Again, AIUI, patent protection for at least one form is expiring or expired recently.
OK $25 for every 1-3 weeks isn't cheap as I'd like but looks more like I'd expect. The Rand report has a table of different kids of insulin but doesn't list which ones have a patent. Would be good to know if the middle income countries listed like Turkey/Chile have the more modern variants or the original ones.
I've known about relatively inexpensive off patent insulin for a while now. It's really strange how it almost never comes up in discussions about drug prices. I've had an open question for about as long as I've known about off patent insulin.
People often say that expensive insulin leads to "deaths". How accurate is this statement? It's hard to get a straight answer because the word "death" is so politicized and its meaning can be stretched extremely far. I'm not trying to make a statement either way about what the price of insulin should be, just trying to quantify how much "death" it causes.
My understanding is the newer long acting insulins work so well for many it is like they no longer have diabetes, they can pretty much eat whatever they want and be fine. The older insulins require more careful management of diet and blood sugar levels than the long acting types and are less convenient for that reason.
> the newer long acting insulins work so well for many it is like they no longer have diabetes, they can pretty much eat whatever they want and be fine.
I seriously doubt this. Type 1 diabetes is _a lot_ harder to manage than simply taking long acting insulin and you can go about your day regularly. Almost anything you ingest has the ability to raise your glucose levels and a single dose of insulin is not enough.
Having long lasting insulin can be potentially deadly if not administered properly as it can tank your glucose levels and make you hypoglycemic. You need to be aware of your glucose levels and eat something to increase it if it starts going down below healthy levels. For example, if you take too much of the long acting insulin late at night, it's possible your insulin levels drop during the night and you're not awake to do anything about it (this is one of the reasons people use sensors, it'll ring an alarm if your glucose levels are too low/high).
Some people also use a combination of a 1 or 2 long-lasting insulin doses as a base and use short-lived insulin for small adjustments throughout the day.
Yes, in general it's worse across the board. It takes longer to start working and continues working longer, both things you want to avoid in short-acting insulins.
Can confirm. Type 1 who switched away from Eli Lilly insulins (Humalog and Humulin N) to the Novo Nordisk (Novolin R and Novolin N) equivalents sold at Wal-Mart.
Much more planning involved, and a big adjustment compared to Humalog and Humulin. My A1Cs are also a bit higher (6.1 instead of 5.9) to give myself more safety margin.
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Why'd I switch? First I pay less out of pocket than I did compared to insurance co-pays for the name brand stuff. That is, $90/mo for short-acting, long-acting, lancets, test strips and syringes... compared to $170/mo in insurance co-pays for the Eli Lilly and Abbott equivalents, and probably around $800 MSRP.
The second is I no longer need to wait for refill authorizations which too many doctor offices drag their feet on, in addition to insurance companies enforcing only a tiny number of refills per auth (as in, requiring a physician's authorization for the insulin you'll use until you die EVERY SINGLE MONTH) which creates yet more delays and sometimes numerous phone calls to get a prescription refilled since you constantly need an authorization from the prescribing doctor. "If they keep messing up, why not switch doct--" I have. Four times, across three different HCOs, and three different insurance companies. They all screw up and fail to respond to the pharmacy on occasion, sometimes for several months (and a dozen plus phone calls) in a row.
It wasn't even about the cost anymore. The ridiculous bureaucracy with the ultimate position of, "it's the patient's fault" held by every other party forced my hand.
IME people tend to underestimate most aspects of type 1 diabetes, especially how big an ask it is to suggest someone switch insulins on short notice and out of desperation.
And the bureaucracy is ridiculous. I'm the most financially responsible person I know in my age group, yet I annually get letters threatening to send me to collections for charges I was not warned about by a weird middleman company that I get automatically charged through for medical supplies for my pump. Haven't heard from them this year, and I've called them 4 times so far trying to figure out where the charges went. It turns out they have 3 accounts registered under my name for these things and none of them are the account that my orders have been going to. At this point I'm just going to wait for the annual letter I guess.
Good job on the A1C though. I want to get there someday, but I get sudden massive drops in blood sugar out of nowhere about once every two weeks and it scares the crap out of me. I'm optimistic I'll figure it out eventually though
Wow a monthly refill authorization sounds really onerous! I can't believe they make you do that. It sounds like they try to make the process as cumbersome as possible so you go away. Which you did. I think I would do the same.
A story like that really puts into context what expensive insulin means. When it's expensive, they want to make sure you don't sell it. So even people who can get it through insurance are affected.
For contrast an experience from a rich European country: My doc writes me a yearly prescription. I forgot to renew it once, and had to pay out of my pocket to get my insulin. He sent me a backdated prescription I could use to get the cost reimbursed.
Monthly refill authorization is simultaneously the craziest thing I’ve heard and also so characteristically on theme for US health insurance I didn’t doubt it for a second.
Hey this is Blue Cross, does Bill still need insulin this month?
Yea, he has type 1 diabetes, it’s a chronic and lifelong condition he will need insulin every month.
Cool, cool, we will check back in next month to see if he needs more.
Do you expect me to come up with a cure for type 1 diabetes by next month?
No, that would be ridiculous.
Well why check every month?
In case he doesn’t need it anymore.
How would that happen?
Hmm.... good point, we can talk about it more next month when we check in to see if Bill needs more insulin.
Low profits and a giant moat. The civilized world keeps prices down because their governments do the buying, and meanwhile any new entrant needs to prove bioequivalence.
It's not that the market was totally innovation-free. Human insulin was a gigantic breakthough when Genentech brought it to market back in 1978.
Also I understand there are newer Insulins which may have a patent, but the original is 100 years old and patent was not an issue. Why aren't there more manufacturers?