This Thanksgiving tale begins with Insulin. Over the past decade its price has soared, but the boon to investors has translated into hardship for patients. An Idiots’ Guide might give insulin a chapter, showcasing the generally doomed battle of investors over patients.
This time patients may prevail.
Once upon a time, insulin was inexpensive, readily available. The “demand” is robust, since it is the lifeline for millions of Americans. Before 1923, when insulin, made from animals, was patented, people who developed the disease, often as children, died young. Their pancreases simply could not produce enough insulin. Even following stringent diets, people died young.
So patients flocked to the wonder drug that would not cure their disease, but help them live with it. In 1982 the Food and Drug Administration approved “biosynthetic” human insulin. Initially the price was modest.
Today diabetes is the most prevalent — and the most costly — chronic disease. And the cost of insulin — that lifeline — has outstripped inflation. Only three companies make most of the insulin — Eli Lilly, Novo Nordisk, and Sanofi. An economist might have predicted the prices to drop; after all, manufacturing has grown more efficient (we no longer rely on pigs, but use human analogs). But companies have extended the life of their patents by “evergreening,” with modest changes. And there were no brakes on the rise: from 2014 to 2018, one study pegged the average increase at 40%. Depending on brand, dosage, insurance, and any pharmaceutical “loyalty” program a patient could find, s/he might pay from $50 to $1000 for a vial, not counting the pens, the glucose monitors, the other supplies.
Enter angry patients. Patients in Japan, in Chile, in Canada, in Mexico — indeed, around the world — pay as much as eight times less. Ten years ago patients in America paid less.
Angry patients morphed into angry constituents.
And Uncle Sam — seen by conservatives as a curmudgeon keen on grabbing Americans’ money — has tried to morph into his more avuncular avatar, to stanch the rising prices, to save Americans’ money. Ditto for state legislatures, the mini-Uncle Sams.
To date, eight states have capped the price of insulin: Utah, Washington, West Virginia, Colorado, Illinois, Maine, New Mexico.and New York. In at least five states, legislation is pending: Connecticut, Florida, Kentucky, Tennessee and Virginia. The prices range from $30 to $100 for a 30-day supply. California has even pledged $100 million to develop and manufacture its own supply of insulin for Californians.
As for Uncle Sam, original Medicare Part B does not cover insulin, unless delivered by an infusion pump, with a 20% co-pay. Part B will also cover glucose monitors, the pumps, the testing devices, again with a 20% co-pay. Americans can get coverage for insulin via a Medicare Advantage Plan, or by purchasing Medicare Part D. The cost depends on the plan, the deductibles, the co-payments. The Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, though, would cap the monthly cost at $35, for a range of types of insulin, to start in 2023.
At the same time, the market has responded. Walmart is marketing two kinds of insulin: ReliOn™ costs about $25 per vial, an older form, where patients might need to follow a strict diet, and Novolg, priced at $72.88 per vial (lower than the brand-name version). A nonprofit, Civica, backed by hospital systems and philanthropies, has pledged to manufacture low-cost versions by 2024.
This season has been dreadful: strident political rhetoric, domestic violence, rising inflation, and the European war that feels like a remake of the last European wars. We need a good-news story. We need to know that both government and the private market can work. With these caps, Big Pharma will still make mega-profits, but no longer so egregiously from the millions of Americans with diabetes. For this, we can be thankful as we feast on whatever we feast on.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, December 1, 2022
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