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Insulin Costs

Why Treating Diabetes Keeps Getting More Expensive

Why Treating Diabetes Keeps Getting More Expensive

Laura Marston is one of the 1.25 million Americans who suffer from Type 1 diabetes, an autoimmune disorder in which a person's pancreas can't make insulin. She hoards vials of the life-saving medicine in her refrigerator to protect herself from the drug's rising prices. (Jorge Ribas/The Washington Post) At first, the researchers who discovered insulin agonized about whether to patent the drug at all. It was 1921, and the team of biochemists and physicians based in Toronto was troubled by the idea of profiting from a medicine that had such widespread human value, one that could transform diabetes from a death sentence into a manageable disease. Ultimately, they decided to file for a patent — and promptly sold it to the University of Toronto for $3, or $1 for each person listed. It was the best way, they believed, to ensure that no company would have a monopoly and patients would have affordable access to a safe, effective drug. “Above all, these were discoverers who were trying to do a great humanitarian thing,” said historian Michael Bliss, “and they hoped their discovery was a kind of gift to humanity.” But the drug also has become a gift to the pharmaceutical industry. A version of insulin that carried a list price of $17 a vial in 1997 is priced at $138 today. Another that launched two decades ago with a sticker price of $21 a vial has been increased to $255. [This 90-year-old fight over insulin royalties reveals just how much has changed in medicine] Seventy-five years after the original insulin patent expired — a point at which drug prices usually decline — three companies have made incremental improvements to insulin that generate new patents and profits, creating a family of modern insulins worth billions of dollars. The history of insulin captures Continue reading >>

The Cost Of Insulin

The Cost Of Insulin

The price of insulin has more than tripled in ten years. Not everybody pays full price, but many find the cost of insulin complicates their life. This week, we’ll cover why insulin prices are so high. Next week, we’ll address what to do about it. According to this story on CBS News, people with diabetes are “cutting back [on their insulin doses] or even going without the drug,” putting them at greater risk for complications. Insulin costs have soared from $100–$200 per month a few years ago to $400–$500 a month now. CBS News quotes a college student saying her bill for insulin has risen from $130 to $495 per month. She has given up her insulin pump and gone back to injections because of expense. One of her friends has cut her dose down to 80% of what’s ordered to save money. This has become common practice for many. A doctor in Montana reported that insulin prices greatly complicate people’s care. “I have patients who tell me that they have to make a decision between food and insulin, and their rent and insulin.” Why is this happening? When insulin was discovered the 1920s, the doctors who found it gave it away. It immediately started saving lives for people with Type 1 diabetes. Now insulin has become a $24-billion-a-year market globally and is predicted to pass $48 billion in only five more years. And people around the world who need it can’t afford it. There are several causes for the price spikes, but many of them come down to America’s pretend “free market” approach to health care. We are seeing these problems now with the controversy over one brand of epinephrine injections, whose manufacturer increased their price by 500% and then paid their CEO a nearly $19 million salary. Here are some ways American economics are making insulin unaff Continue reading >>

The Prices For Life-saving Diabetes Medications Have Increased Again

The Prices For Life-saving Diabetes Medications Have Increased Again

A Type 1 diabetes patient holds up bottles of insulin. Reuters/Lucy Nicholson Insulin prices have been rising — increases that mean some people are spending as much on monthly diabetes-related expenses as their mortgage payment. It's led some people living with diabetes to turn to the black market, crowdfunding pages, and Facebook pages to get access to the life-saving drug. At the same time, the companies that make insulin have faced pressure from politicians including Senator Bernie Sanders, class-action lawsuits that accuse the companies of price-fixing, and proposed legislation in Nevada. Even in the face of this criticism, two of those drugmakers — Eli Lilly and Novo Nordisk — raised the list price of their insulins again in 2017. Diabetes is a group of conditions in which the body can't properly regulate blood sugar that affects roughly 30 million people in the US. For many people living with diabetes — including the 1.25 million people in the US who have type-1 diabetes — injecting insulin is part of the daily routine. Insulin, a hormone that healthy bodies produce, has been used to treat diabetes for almost a century, though it's gone through some modifications. As of May 2, the list price of Humalog, a short-acting insulin, is $274.70 for a 10 ml bottle, an increase of 7.8% from what the list price had been since July 2016. On May 2, Lilly also took a 7.8% list price increase to Humulin, an older form of insulin. Novo Nordisk, which also makes a short-acting insulin, increased its prices to the drug in 2017. In February, the drugmaker raised its price to $275.58 for a 10 ml bottle, up 7.9% from what the list price had been since July 2016. In December, Novo Nordisk committed to limiting all future drug list price increases from the company to single d Continue reading >>

Rising Insulin Prices Have Diabetics Crying Foul

Rising Insulin Prices Have Diabetics Crying Foul

Insulin prices are only getting more painful. Drugmakers Eli Lilly (LLY) and Novo Nordisk recently boosted their insulin list prices by almost 8 percent each, adding to concerns that treating diabetes is unaffordable for some patients. The average price of insulin almost tripled between 2002 and 2013, according to the American Diabetes Association (ADA). Even before the most recent price hike, some diabetics were cutting back or even going without the drug because of its expense. The price hikes come at a sensitive time for the drugmakers as Eli Lilly, Novo Nordisk and rival Sanofi-Aventis are facing a class-action lawsuit alleging they conspired to raise their prices in lockstep. Almost one in 10 Americans has diabetes, a group of conditions where the body fails to properly regulate blood sugar. People with Type 1 diabetes, often referred to as juvenile diabetes, need to take insulin daily to stay alive. "We were really disappointed in this announcement," said Dr. William Cefalu, the chief scientific, medical and mission officer for the ADA, who noted that his organization has partnerships for research with the drugmakers. "This is really going in the wrong direction." In early May, Eli Lilly raised its list price for Humalog by 7.8 percent, to $274.70, for a 10-milliliter bottle, while Novo Nordisk tacked on a 7.9 percent increase on its Novolog drug, to $275.58. "There's concern and anger in the diabetes community," said Allison Bailey, who has Type 1 diabetes and is a student at Iowa State University. She also volunteers with a diabetes advocacy group called T1International. She called the most recent price hike "a slap in the face." Such price hikes may be absorbed by diabetics' insurance plans, but other people may struggle if they lack insurance or have high-dedu Continue reading >>

High Cost And Rising Insulin Prices Affect The Neediest In Our Community

High Cost And Rising Insulin Prices Affect The Neediest In Our Community

High cost and rising insulin prices affect the neediest in our community by Lindsey Verano, RD, LDN, CDE and Mary Laxton, DHSc, PA-C Nearly 30 million Americans have diabetes mellitus. A small percent of diabetics have Type 1 diabetes that requires insulin to replace the non-existent native insulin produced by the pancreas. A much larger percent are Type 2 diabetics whose disease can be managed with diet, exercise, and oral prescription medications. Increasingly even Type 2 diabetics require some form of injectable insulin to treat their condition, avoid hospitalizations, slow the pace of organ damage, and maintain as healthy a lifestyle as possible given the progressive and unrelenting nature of this disease. According to the American Diabetic Association, 1 in 5 health care dollars and 1 in 3 Medicare dollars is spent caring for patients with diabetes. People with a diagnosis of diabetes have health care costs 2.3 times greater than those without diabetes. Diabetes-related complications lead to high morbidity and mortality and an increase in disability-adjusted life years, meaning a loss of years of a “healthy life.” According to the World Health Organization (2017), the accumulative effect of DALYs identifies the gap between current health status and ideal health status that allows an individual to live to an advanced age free of disease and quality-of-life-limiting disabilities. In an article in the Journal of the American Medical Society (2014) the authors noted continued increases in the incidence and prevalence of diabetes among non-Hispanic blacks, Hispanic subpopulations, and those with a high school education or less. The American Diabetes Association reported in March, 2017 that African Americans, Mexican Americans, and American Indians are more likely to Continue reading >>

Out-of-pocket Costs For Insulin Are A Problem. Litigants In Case Disagree On Who Is At Fault

Out-of-pocket Costs For Insulin Are A Problem. Litigants In Case Disagree On Who Is At Fault

Out-of-Pocket Costs for Insulin Are a Problem. Litigants in Case Disagree on Who Is at Fault A case filed more than a year ago has taken many turns, landing in a federal court in Trenton, where it has been shaped by a difference of opinion over how to address the role of pharmacy benefit managers (PBMs). After a year in court, the leading insulin manufacturers and the attorneys suing them agree: Some people with diabetes pay a lot of money out of pocket for the hormone that keeps them alive. They disagree, however, on whether laws have been broken and who should be blamed. The insulin manufacturers argue the problem of rising prices is beyond the courts ability to solve. Soon judges overseeing the 14-month-old suit will decide whether they agree. With a stay lifted in the case, the insulin companies have filed a scathing motion to dismiss the racketeering claims lodged against them. But in doing so, the drugmakers admit that consumers sticker shock is real. Its just not the manufacturers fault, they argue. And its definitely not a crime. Defendants acknowledge that pharmaceutical pricing is an important issue, especially given how recent trends in the design of insurance benefits have affected certain patients out of pocket costs, states the joint motion filed on March 9, 2018, by attorneys for Novo Nordisk, Sanofi, and Eli Lilly. If allowed to proceed, the case could finally shed light on the role of pharmacy benefit managers (PBMs), who may be the plaintiffs ultimate target. The lead attorneys have followed a strategy that will allow them to gather evidence while fighting the pharmaceutical firms and use it later in a suit against the PBMs. Not everyone agrees with this approach, however. Attorneys representing 71 patientswho have not been certified as a classargue t Continue reading >>

Insulin Prices Skyrocketing

Insulin Prices Skyrocketing

America’s getting plenty angry about the rising cost of insulin—and no wonder. Between 2002 and 2013, the average price for this life-saving, injectable drug used by nearly 10 million Americans with diabetes has tripled, according to the American Diabetes Association (ADA). “No one who relies on insulin should have to wonder if they’ll be able to afford it,” the ADA asserts in an online petition for its Stand Up for Affordable Insulin campaign.1 The ADA’s action doesn’t stand alone. In November, Vermont senator and former contender for the Democratic presidential nomination Bernie Sanders fired off a letter calling on the U.S. Justice Department and the Federal Trade Commission asking for an investigation of pharmaceutical makers Eli Lilly, Novo Nordisk and Sanofi for possibly colluding on insulin price increases.2 “Not only have these pharmaceutical companies raised insulin prices significantly—sometimes by double digits overnight—in many instances the prices have apparently increased in tandem,” noted the letter, co-signed by Rep. Elijah Cummings (D-MD). “We have…heard from our constituents that the life-saving insulin they need is increasingly unaffordable,” And in early January 2017, the New York law firm Bernstein Litowitz Berger & Grossmann sued Novo Nordisk on behalf of the Lehigh County (PA) Employees' Retirement System alleging the company “reported materially false and misleading earnings and forecasts” that were “inflated” by price fixing. That’s not all. In a rapidly-changing insulin market, the recent introduction in the U.S. of the generic “biosimilar insulin” called Basaglar, which won FDA approval in December 2015, has put a lower-priced type on the market. This development reportedly prompted two major manufactu Continue reading >>

How Insulin Became Unaffordable

How Insulin Became Unaffordable

Just before Alec Raeshawn Smith turned 24, he thought he had come down with the flu. When he went to the doctor a few days later, staff immediately tested his blood sugar levels. They were dangerously highSmiths body had stopped producing insulin, a vital hormone that allows the body to turn the glucose in food into usable energy. Like 1.25 million other Americans , Smith was diagnosed with Type 1 diabetes. Unlike Type 2, a more common condition sometimes linked to high body weight, Type 1 diabetes is an autoimmune disease caused when white blood cells attack the pancreas, killing insulin-producing cells. There is no cure for Type 1, and it cant be treated with pills or other noninvasive procedures; artificial insulin must be injected into the patient several times per day. Without insulin, people with Type 1 diabetes will die, said David Nathan, a professor at Harvard Medical School, in an interview with the HPR. And not over a long period of time, but over the course of a week. For Smith, then a server at Khans Mongolian Barbeque in Richfield, Minn., the diagnosis was life-changing. At first, he had trouble maintaining his active lifestyleSmith loved hiking, fishing, concerts, Minnesota sports, and playing with his young daughter Savannahbut in time his nutritionist and endocrinologist helped him bring his diabetes under control. For two years, Smith managed his condition relatively well. But it wasnt easy financially, even after he was promoted to manager. Doctor visits combined with the expensive life-preserving drugs added up, even with insurance. Copays usually totaled between $200 and $300 a month. Smith occasionally had to borrow money from his mother, Nicole Smith-Holt, to pay for his medication. On May 20, 2017, Smith turned 26, aging out of his parents insur Continue reading >>

Diabetes Coverage And Insulin Costs | Accu-chek

Diabetes Coverage And Insulin Costs | Accu-chek

Changes to diabetes coverage? Rising insulincosts? Make sure your voice is heard. Changes to diabetes coverage? Rising insulincosts? Make sure your voice is heard. Managing diabetes is complicated enoughwithout wondering if your insurance will cover the necessary treatment and supplies, or if you can continue to afford insulin. So, without getting political, we'd like to talk a bit about what may be on the horizon, and what you can do to protect yourself and your family. Coverage for preexisting conditions, including diabetes Diabetes is a lifelong, expensive disease. Before the Affordable Care Act (aka Obamacare) prevented insurance companies from denying people coverage due to preexisting conditions, many with diabetes went uninsured or found themselves unable to change jobs without losing coverage.1 Last month, the U.S. Senate voted to repeal the Affordable Care Act without having a replacement ready. Because there is no other plan on deck, we can't be sure whether it would also cover preexisting conditions, or what might happen in the meantime. As you've probably already noticed, the cost of insulin has been rising faster than many other necessities. Yet for many people with diabetes, it's as essential as air or food. The American Diabetes Association has already asked Congress to step up to seek a solution, but it's hard to know what to expect under a new healthcare law. Add your name to the ADA petition to support affordable insulin . It takes just a minute. Sign up with DPAC. Two of the Diabetes Patient Advocacy Coalition's key issues are insulin affordability and retaining coverage for people with preexisting conditions. They'll keep you informed and lobby elected officials to do the right thing. It's free, so join now . Call or write to your legislators. The U Continue reading >>

Why Is Insulin So Expensive In The U.s.?

Why Is Insulin So Expensive In The U.s.?

Dr. Jeremy Greene sees a lot of patients with diabetes that's out of control. In fact, he says, sometimes their blood sugar is "so high that you can't even record the number on their glucometer." Greene, a professor of medicine and history of medicine at Johns Hopkins University, started asking patients at his clinic in Baltimore why they had so much trouble keeping their blood sugar stable. He was shocked by their answer: the high cost of insulin. Greene decided to call some local pharmacies, to ask about low-cost options. He was told no such options existed. "Only then did I realize there is no such thing as generic insulin in the United States in the year 2015," he says. Greene wondered why that was the case. Why was a medicine more than 90 years old so expensive? He started looking into the history of insulin, and has published a paper about his findings in this week's issue of the New England Journal of Medicine. The story of insulin, it turns out, starts back in the late 1800s. That's when scientists discovered a link between diabetes and damaged cells in the pancreas — cells that produce insulin. In the early 1920s, researchers in Toronto extracted insulin from cattle pancreases and gave it to people who had diabetes, as part of a clinical trial. The first patient was a 14-year-old boy, who made a dramatic recovery. Most others recovered as well. Soon, insulin from pigs and cattle was being produced and sold on a massive scale around the world. But for some, the early forms of the medicine weren't ideal. Many people required multiple injections every day, and some developed minor allergic reactions. Over the next few decades, scientists figured out how to produce higher-quality insulin, Greene says. They made the drug purer, so recipients had fewer bad reaction Continue reading >>

Drug Makers Accused Of Fixing Prices On Insulin

Drug Makers Accused Of Fixing Prices On Insulin

A lawsuit filed Monday accused three makers of insulin of conspiring to drive up the prices of their lifesaving drugs, harming patients who were being asked to pay for a growing share of their drug bills. The price of insulin has skyrocketed in recent years, with the three manufacturers — Sanofi, Novo Nordisk and Eli Lilly — raising the list prices of their products in near lock step, prompting outcry from patient groups and doctors who have pointed out that the rising prices appear to have little to do with increased production costs. The lawsuit, filed in federal court in Massachusetts, accuses the companies of exploiting the country’s opaque drug-pricing system in a way that benefits themselves and the intermediaries known as pharmacy benefit managers. It cites several examples of patients with diabetes who, unable to afford their insulin treatments, which can cost up to $900 a month, have resorted to injecting themselves with expired insulin or starving themselves to control their blood sugar. Some patients, the lawsuit said, intentionally allowed themselves to slip into diabetic ketoacidosis — a blood syndrome that can be fatal — to get insulin from hospital emergency rooms. A recent study in The Journal of the American Medical Association found that the price of insulin nearly tripled from 2002 to 2013. “People who have to pay out of pocket for insulin are paying enormous prices when they shouldn’t be,” said Steve Berman, a lawyer whose firm filed the suit on behalf of patients and is seeking to have it certified as a class action. In a statement, Sanofi said, “We strongly believe these allegations have no merit, and will defend against these claims.” Lilly said it had followed all laws, adding, “We adhere to the highest ethical standards.” Continue reading >>

Why Does Insulin Cost So Much?

Why Does Insulin Cost So Much?

Everyone who has type 1 diabetes has to use insulin, and about 25 percent of the people who have type 2 diabetes rely on it to control their blood sugar. But its costs are skyrocketing and no end is in sight. At the annual convention of the American Diabetes Association in Boston this June I listened with perhaps 1,000 other diabetes professionals to one of the world’s top experts on diabetes talk about insulin costs. Irl Hirsch, MD, is the professor of medicine at the University of Washington School of Medicine, also treats patients with diabetes, and has type 1 diabetes himself. For several years, readers of my articles have written me to complain about the rising cost of insulin. Because I know how expensive that insulin has become, I made sure to hear Dr. Hirsch’s presentation. But I was surprised to see that he cited one of my articles in a slide that he presented. The Patent Problem Dr. Hirsch reviewed the cost of insulin from 1921 when Drs. Frederick Banting and Charles Bestdiscovered it. “In a generous gesture that unfortunately didn’t start a trend, they sold the patent for $1 so that cheap insulin would quickly become available. It worked like a charm: within two years Eli Lilly had sold 60 million units of its purified extract of pig and cow insulin.” But after 1977 Genentech began to produce the first genetically-engineered, synthetic human insulin. This led to the first “dramatic increase” in the price of insulin. Since 1982 Eli Lilly has marketing it as Humulin. In 1996 the development of the first insulin analog, lispro, led to another increase in the cost of insulin. Eli Lilly markets lispro as Humalog. Citing My Article Here, Dr. Hirsch cited an article that I wrote in 2001, “Is the Cost of Insulin Skyrocketing?” At the time I wrote, t Continue reading >>

Insulin Is Too Expensive For Many Of My Patients. It Doesn’t Have To Be.

Insulin Is Too Expensive For Many Of My Patients. It Doesn’t Have To Be.

At age 15, I suddenly felt an unquenchable thirst and began urinating frequently. I lost 20 pounds. I had developed Type 1 diabetes, an autoimmune disease that destroyed my body’s ability to produce insulin. Without insulin, I would have eventually developed a condition called diabetic ketoacidosis, which is lethal without (and even sometimes with) treatment. Years later, I’m a practicing endocrinologist. I could never have imagined back when I first started taking insulin that one day I would have so many patients who could not afford the medication because of skyrocketing prices. When the drug was discovered in 1921, the original patent was sold to the University of Toronto for $1 so that no one else could patent it and “secure a profitable monopoly.” Numerous improvements later, insulin is produced by a three-company oligopoly. When the first of the newer insulin “analogs,” Humalog, hit the market in 1996, it sold for $21 a vial. Today, vials of analog insulins, including Humalog, sell for about $300 . Patients with Type 1 diabetes typically require two or three vials of insulin per month, but patients who are more resistant to insulin, such as those with Type 2 diabetes, may require six or more. A recent paper in the Journal of the American Medical Association found that insulin nearly tripled in cost from 2002 to 2013. A lawsuit filed in January accuses pharmaceutical companies of price collusion for allegedly raising insulin prices repeatedly and in lockstep to match their competitors. Prices have gotten so bad that the American Diabetes Association recently launched an online petition at MakeInsulinAffordable.org, which has been signed by more than 250,000 people. Because insulin is so expensive, some people take less than their prescribed dose, causi Continue reading >>

Insulin Price Hikes Draw Blood, Criticism

Insulin Price Hikes Draw Blood, Criticism

insulin’s turn. A steady increase in the price of the life-saving diabetes treatment over the past decade has spurred anger among people living with the ailment -- with some lawmakers calling for a federal investigation of the companies that make and sell it. “We don’t want these companies to go out of business. They’re manufacturing something that’s keeping our children alive,” says Nicole Nichols, who started a petition calling on Congress to intervene. “We just want to them realize that while they’re taking home billions of dollars -- millions in their CEOs' pockets -- there are middle-class and poor American families who are suffering.” Nichols lives outside Jackson, MS. Her husband and 8-year-old daughter have type 1 diabetes, which requires them to take insulin so their body can process sugar. And she’s watched as the price of that drug has climbed steadily. While her daughter’s costs are largely covered by the Children’s Health Insurance Program, Nichols says that her husband ends up shelling out about $600 a month for his insulin, on top of what they pay for health insurance. “You can go to Canada and buy a vial of insulin for $35. I can go to Europe and buy a vial of insulin for $35. I can go to Mexico and buy a vial of insulin for $35,” Nichols says. We are not the greatest country in the world if our health care is that prohibitively expensive.” About 6 million Americans require daily insulin to manage their diabetes. And the cost of that medication has been climbing since the 1990s, when faster-acting and longer-lasting insulin hit the market. That’s put more strain on families and on organizations like the Diabetes Foundation of Mississippi, which tries to help low-income families that struggle with the costs. “It certainly Continue reading >>

Several Probes Target Insulin Drug Pricing

Several Probes Target Insulin Drug Pricing

With the price of a crucial diabetes drug skyrocketing, at least five states and a federal prosecutor are demanding information from insulin manufacturers and the pharmaceutical industry’s financial middlemen about their business relationships and the soaring price of diabetes drugs. Attorneys general in Washington, Minnesota and New Mexico issued civil investigative demands this year and are sharing information with Florida and California, according to various corporate financial filings. Insulin makers Eli Lilly, Novo Nordisk, Sanofi and top pharmacy benefit manager CVS Health are targets in the state investigations. Several of the financial filings note that the state and federal prosecutors want information regarding specific insulins for specific dates in relation to “trade practices.” They appear to be looking into potentially anti-competitive business dealings that critics have leveled at this more than $20 billion niche market of the pharmaceutical industry, according to analysts and court filings reviewed by Kaiser Health News. These include whether drug makers and middlemen in the supply chain have allowed prices to escalate in order to increase their profits. At the same time, prominent class-action lawyers are bringing suits on behalf of patients. Steve Berman, an attorney best known for winning a multibillion-dollar settlement from the tobacco industry, alleged collusion and said it was time to break up the “insulin racket.” The price of insulin — a lifesaving drug — has reached record highs as Eli Lilly, Novo Nordisk and Sanofi raised prices more than 240 percent over the past decade to often over $300 a vial today, with price rises frequently in lockstep, according to information technology firm Connecture. Those prices take a toll on patien Continue reading >>

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