The Skyrocketing Prices of Insulin

BY NIDHI DAHIYA – When Alec Raeshawn Smith turned 26, he aged off of his mother’s health insurance plan, leaving him considering getting his own health insurance which would involve an annual deductible of $7,600 and a $450 premium or alternative option of simply going uninsured. With a yearly salary of $35,000, Smith decided it would make more sense to disregard getting his own health insurance plan, sure that he could make it work. 

Instead, Smith died less than a month after leaving his mother’s insurance plan from rationing his insulin. Without insurance, the fees of his diabetes supplies would be around $1,300 per month. He died three days before he would have been paid, three more days he would have spent without any insulin at all, as all of it had been used up at the time of his death. 

Smith died from diabetic ketoacidosis. Because of the lack of insulin, his cells were not able to take in the glucose, so the blood sugar rose to dangerous levels. Without the glucose, the metabolism in his cells threw off his body systems, leading them to function abnormally. Alec Smith died from diabetic ketoacidosis not because there was not a cure that worked for him, but that he simply could not afford it. 

Diabetes 

Diabetes is a chronic disease in which a person’s glucose levels are too high, and the body is not able to transfer the glucose into its cells, so the concentration goes up in the blood. This is a direct result of the body not being able to produce insulin, which is the hormone that causes the glucose to flow into the cells.

There are two types of diabetes called Type I and Type II. Type 1 is less common than Type II, as only 5% of diabetics being diagnosed with it. This occurs when the body’s pancreas stops making insulin, typically as a result of an autoimmune reaction. If people with type 1 diabetes do not receive insulin, they will be unable to metabolize glucose and develop diabetic ketoacidosis, like Alec. Type 2 diabetes is far more common and typically develops over a period of time, due to unhealthy lifestyle choices. With this type of diabetes, the body makes insulin but the cells in the body do not respond to the insulin properly, so the glucose is not absorbed.

Insulin can be administered to people living with diabetes in a number of different ways, including insulin pumps, injections, oral medicines, and/or syringes. 

Prices of Insulin

Insulin was initially discovered by a team of scientists in the 1920’s in Toronto. Infatuated by the possibilities of by being able to effectively aid those who believed they were sentenced to death, the scientists were wary of patenting their discovery, however they eventually did so and proceeded to sell it to the University of Toronto for $3. They were excited at the thought of affordable cures and solving a humanitarian issue. 

Now in 2019, only three companies manufacture insulin and the prices have skyrocketed. Since 1996, the price of one vial has gone up 700%, accounting for inflation. The price of one vial of insulin can range from $275 to $700, depending upon whether or not a person has insurance and what their health insurance plan entails. Incongruous with the cost, one 10mL vial of insulin only costs $5 to make. 

Despite the price of insulin increasing by 15-17% per year since 2012, the formula of insulin has not changed at all. According to David Nathan, a medical professor at Harvard Medical School, “There hasn’t been a molecule changed in them. There hasn’t been a bit of change in terms of their synthesis, their manufacturing, and yet the costs have gone up extraordinarily”. Manufacturers have been making minor changes to the formula without any significant changes to how the drug actually works or how expensive it would be to produce it. 

“Most of these drugs are being developed to preserve patent protection. The truth is they are marginally different, and the clinical benefits of them over the older drugs have been zero,” says Nathan. Sanofi, one of the three manufacturers, has filed over 74 patent applications on one insulin pen alone, Lantus. 

These manufacturers are able to increase these prices so dramatically because diabetics have nowhere else to turn to. People living with diabetes will die without insulin, and so they have to be willing to pay whatever they can in order to get some. There are no generic brands of insulin for diabetics to use either, and the cheaper options tend to have a formula that is older and far less effective, in addition to the fact that some are allergic to it. If the people do not pay exorbitant amounts of money, then they die. 

The American Government 

The United States of America is one of the only developed countries to not set price controls for its insulin, as compared with other nations such as Canada, the United Kingdom, and Germany. Despite only contributing 7% to the total world population of people who have diabetes, the United States provides 52% of all global insulin sales. While other countries have government regulations set in place to moderate the amount of money manufacturers can charge patients for insulin, America does not. In the US, private companies are able to jack up prices as high as they would like and sell it, with their consumer base not going anywhere else, because they do not have anywhere else they can go. 

The Food and Drug Administration (FDA) asserts that there needs to be more competition in the market in order to bring the prices down and that they must introduce generics into the market as well. The three manufacturers, Sanofi, Novo Nordisk, and Eli Lilly, contribute to over 90% of the insulin market. As there are not a large amount of manufacturers fighting to retain customers, the companies hold no incentive to lower prices in order to look more attractive to its consumer base. 

How Diabetics Deal

Due to the exorbitant prices of insulin, a great deal of Americans living with diabetes cannot afford it, and therefore must turn to alternate options such as insulin rationing, traveling to Canada or Mexico, and/or buying from the insulin black market. People sell extra insulin or insulin that simply is not compatible with them anymore on sites such as Facebook, Reddit, and Craigslist, listing much more reasonable and cheaper prices than the list prices provided by pharmaceutical companies. Despite not knowing where exactly this insulin is coming from and how safe it is, many must take a shot and simply use it, as they cannot afford the insulin straight from the company itself. 

Due to the United States being one of the only developed countries to not have price controls on insulin, it is remarkably cheaper in other countries. Americans who cannot afford their insulin therefore sometimes travel to bordering countries such as Canada and Mexico in order to buy their diabetes supplies at an affordable cost. Humalog, a type of insulin produced by Eli Lilly, is available in Canada for $38. The exact same product is sold in America for $140 to $329. 

Lethal rationing is yet another option people with diabetes turn to, with it being the most dangerous option. This entails diabetics using as little of their insulin as possible at a time so as to make it last as long as possible, most of the time until they can get their next paycheck, in order to pay for even more insulin. This is an approach that has previously led to death multiple times, however 1 in 4 people still admit to having rationed their insulin at least once in their life. The typical byproduct of this rationing is diabetic ketoacidosis, as occurred in Alec, and can lead a person’s body stopping functioning. 

These solutions are not acceptable since insulin can be made affordable. Moreover, people should not be put into the position to decide to ration their insulin so they can pay their bills. This is a major healthcare problem in America, and politicians must work towards changing this issue. 

Editor: Priya Radhakrishnan