We’re hearing a lot about Mylan’s CEO Heather Bresch upping the price of the life-saving emergency drug/injector EpiPen to the tune of 600%. We’ve also heard about Martin Shkreli “Pharma Bro” hiking up the price of a live-saving AIDS medication. But another story not as well known, is the price-gouging of the life-saving drug insulin. Jordan Weissman with Slate reports:
The cost of insulin, which diabetics rely on to stabilize their blood sugar, has been going through the roof. A study published by the Journal of the American Medical Association in April found that between 2002 and 2013, insulin's cost had leapt by more than 200 percent, from $231 to $736 per patient annually.
“Insulin is a life-saving medication,” William Herman, one of the study's authors and a professor of medicine and epidemiology at the University of Michigan School of Public Health, told Stat at the time. “There are people with type 1 diabetes who will die without insulin. And while there have been incremental benefits in insulin products, prices have been rising. So there are people who can’t afford them. It’s a real problem.”
More disturbing is reportedly the average insulin users are seniors likely to have a tough time affording it due to what’s called the “doughnut hole” in their Medicare insurance plans, leading them to pay thousands out of pocket.
Faced with high costs, many patients seem to be skipping or rationing shots of a hormone they are required to take multiple times a day in order to stay alive, keep from going blind, or lose a foot to amputation. At least, that's what seems to be happening if you believe the front-line reports from doctors in clinical practice.
The Missourian reports Dr. Claresa Levetan, chief of endocrinology at Chestnut Hill Hospital, is saying close to 100% of insulin users are having problems affording the higher cost of insulin. Many end up in the ICU with a life-threatening condition called diabetic ketoacidosis which can put them into a coma and ultimately die. She says she has patients who tell her that they have to make a decision between food and insulin, and their rent and insulin.
“I mean, seriously, food, rent or insulin?’’ she said.
So what are the reasons insulin is so high? Weismann writes:
There seem to be a few major reasons, all of which speak to the fundamental dysfunctions in the pharmaceutical market. Rather than compete against one another, the three major drug companies that produce insulin in the U.S.—Sanofi, Eli Lilly, and Novo Nordisk—seem to have raised their prices in tandem. As Bloomberg explains, this follow-the-leader approach is called “shadow pricing,” and it’s fairly common in pharma. At the same time, there is no generic insulin on the U.S. market, in part because the branded makers have found ways to extend their patents by making small improvements to the product. There may be more competition on the horizon, as Eli Lilly is expected to start selling a biosimilar version of Sanofi's Lantus. But experts only expect that to shave 20 or 30 percent off the cost. Pharmacy benefit managers, which handle prescriptions and negotiate with drugmakers on behalf of insurers, are another likely culprit. These companies often receive commissionlike “rebates” from drug producers that may be encouraging them to buy more expensive products for their clients, as Kasia Lipska noted in the New York Times in February.
America is desperately behind other countries in regulating pharmaceutical companies. Democratic presidential nominee Hilary Clinton is addressing the issue and has created a plan. Sadly, for some who have died due to greedy pharmaceutical price hikes, it’s a little too late for lawmakers to react — but it’s a start. Social media exposure and activism will create important and positive changes if we stay on this. And we can expect a big pushback from the big pharmas.
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