Insulin Is Too Expensive For Many Of My Patients. It Doesn't Have To Be.
At age 15, I developed an unquenchable thirst and frequent urination, and 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 insulin companies of price collusion for allegedly raising 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 248,000 people. Because insulin is so expensive, some people take less than their prescribed dose, causing higher blood sugars, which may lead Continue reading >>
What’s Behind Skyrocketing Insulin Prices?
Here’s a sticking point for diabetics: the cost of insulin more than tripled — from $231 to $736 a year per patient — between 2002 and 2013, according to a new analysis. The increase reflected rising prices for a milliliter of insulin, which climbed 197 percent from $4.34 per to $12.92 during the same period. Meanwhile, the amount of money spent by each patient on other diabetes medications fell 16 percent, to $502 from $600, according to a research letter published Tuesday in the Journal of the American Medical Association. “Insulin is a life-saving medication,” said Dr. William Herman, a coauthor of the analysis and a professor of epidemiology at the University of Michigan School of Public Health. “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.” The analysis also found that the cost of various widely used oral diabetes drugs either dropped in price or did not rise nearly as significantly as insulin. Metformin, for instance, which is available as a generic, fell to 31 cents in 2013 from $1.24 per tablet in 2002. And the newer class of diabetes drugs known as DPP-4 inhibitors rose 34 percent since becoming available in 2006. The researchers analyzed data from nearly 28,000 diabetes found in the Medical Expenditure Panel, a database on health care costs maintained by the US Department of Health and Human Services. About 1 in 4 people used insulin and two-thirds took a pill. Toward the end of the study period, a small percentage began taking new injectable medicines that are designed to complement pills. There have been previous efforts to track insulin prices in recent years, bu Continue reading >>
Heres Why Insulin Is So Expensive And What You Can Do About It
The numbers are in: U.S. spending on diabetes drugs increased from $10 billion to $22 billion per year between 2002 and 2012, according to a recent study . And most of that cost was due to skyrocketing prices for one diabetes medication: insulin. Take, for example, Lantus , one of the most popular insulins on the market. The price of a 10-milliliter vial has shot up from under $40 in 2001 to around $275 today. And these costs are hitting more people every year. About 30 million people in the U.S. have diabetes up from 10 million 20 years ago with another 89 million experiencing prediabetes. One study estimates that up to one-third of Americans could have diabetes by 2050. With so many people affected by rising insulin costs, it makes sense to wonder why prices are so high. Today there are two major categories of insulin. Synthetic human insulin was introduced in the early 1980s and appears under brand names like Humulin R and Novolin 70/30 . Genetically modified analog insulin was developed in the 1990s to provide several benefits over human insulin. Analog insulins take effect more quickly, their effects are more consistent and predictable, and they reduce the frequency of low and high blood sugar. Popular analog insulins are Lantus , Humalog , and Novolog . The prices for both types of insulin have risen over the years, but analog insulin is often much more expensive (compare $25 for Novolin 70/30 versus $323 for Humalog 50/50 ). Due to the added convenience and benefits of analog insulin, 96% of insulin prescriptions in the U.S. are now for analogs. However, a growing body of research suggests that synthetic human insulin is just as effective for managing diabetes. Get the best ways to save on your prescriptions delivered to your inbox. Producing insulin is more exp Continue reading >>
Getting Insulin Abroad (in France)
This story was originally published as a guest post in 2 parts for the Type 1 Diabetes Blog I write bi-weekly for Diabetes Sisters. Before moving to Europe both times, I’ve gotten this question quite often: But how will you get your insulin over there? While studying abroad in France when I was 21, I brought enough insulin for a 3-month stay. I was to be there for 4 months (which turned in to 9 months but that’s another story for another time), but I was supposed to get my visa by the second month. That visa would grant me health benefits akin to French citizens. However, if you’ve ever lived in France, you know how the French bureaucracy works. Read: slowly. Fast forward to month #3, visa “on it’s way- should arrive within the month,” and I’m cracking open the last of my Humalog supply. Obviously, I had to get more- but how, without insurance, without a visa? Without really speaking French? Without a doctor, or any clue where to begin? I emailed my study abroad advisor, and asked for her advice. She wasn’t extremely helpful, but she did send me the address to a walk-in clinic in the area. The next day, with a map in one hand and copies of my American prescriptions in the other, I began Mission Insulin. When I opened the door to the clinic, I was instantly confused. I was expecting what I am used to in the states: walls lined with clean, comfortable chairs, a plethora of health-related magazines, an unenthused secretary perched behind a wall of glass. There were indeed many chairs lining the walls of the small, stuffy room, but there was no secretary. No clipboard where you sign in, no ticket machine to get a number in line. There were 5 other people in the room, speaking quiet French to each other or coughing or checking the time. Because I didn’t kno Continue reading >>
Insulin Quality Questions Have Diabetes Experts Scrambling
Insulin quality questions have diabetes experts scrambling Pharmacist and researcher Alan Carter raised a stir with his recently published study finding that a variety of insulin vials he tested seemed to hold far less of the lifesaving hormone than they should. RENTON, N.J. Preliminary research suggesting that some diabetes patients may be injecting medicine that has partially disintegrated is causing concern even as serious questions are raised about the research itself. The study author, a pharmacist, bought vials of insulin at a number of pharmacies and found that on average the vials had less than half of what was listed on the label and none met a minimum standard. The study tested just 18 vials of insulin far too few to be definitive and questions have been raised about the methods used to test the insulin. Insulin makers, patient advocate groups, and diabetes experts say if the findings were accurate, diabetes patients would be getting sick. But given potentially serious implications for millions of diabetics, many of these groups are now trying to reassure patients in the wake of the research. All say that patients should continue to taking their insulin as prescribed. The Real World, Diabetes: As cameras roll at a Jamaican resort, desperate patients seek healing The groups are discussing how to quickly mount a major study that would ease fears by involving multiple research labs, different testing methods and many more samples of various insulin types. We want to make sure the study, when completed, will be well accepted, said Dr. William Cefalu, the American Diabetes Associations chief scientific officer. Roughly 6 million Americans inject synthetic insulin every day. Most patients use a syringe to draw insulin from a vial, like the ones tested in the study, Continue reading >>
Good Lord. Even The Price Of Insulin Is Skyrocketing.
Reuters At this point, it’s getting hard to keep track of all the stories of drug companies jacking up the prices of prescription medications to nauseating heights for little identifiable reason other than the fact that, unlike in other developed countries, the U.S. government lets them. At the moment, Congress is getting exercised over EpiPens, the fast-acting epinephrine injectors made by Mylan that are used to stop potentially deadly allergy attacks. (I carry one myself, because bees.) Mylan has upped EpiPen prices by 400 percent since it bought the decades-old device from Merck in 2007. The company says the moves are justified by “product improvements,” a line that presumably even they couldn’t possibly believe. Sen. Chuck Grassley has some questions. On Wednesday I noticed yet another disturbing story about drug prices—one that, despite some coverage in the New York Times and elsewhere, hasn’t become a national scandal quite on the order of the EpiPen or the adventures of Martin Shkreli. It turns out that 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.” Drugm Continue reading >>
Uninsured With Diabetes In The Usa
The USA is in the midst of some very scary changes in healthcare. As a type 1 uninsured diabetic for the past six years, I have miraculously been able to survive. I have not had an A1C test in those six years, I cannot afford to test my blood sugar every day, and I have gotten off the insulin pump that I depended on for 20 years. I have had times of desperation where I have used expired insulin, skipped some meals and diluted my insulin with water until I could afford to buy my next vial, but I am alive. I would like to suggest a few things to those who are possibly facing a future with no insurance. Hoard as many supplies as you can. Ask your doctor to give as many refills or samples as they can, because when you lose your insurance those supplies are no longer covered. My insulin at one point cost me $800 a month. I bought it until I could no longer afford it. Because I was no longer insured and unable to afford to go for doctor visits, my prescription eventually expired. When this happens, you are left with going to an emergency room or, like me, you have to go back to basics with no pump and old, cheaper insulin that I found barely works for me. Do not expect a pharmacist to help you. Some might, but I was told that I had no business buying insulin if I did not know how to use it correctly. I suggest coming up with a game plan. Ask your doctor for an emergency sliding scale to figure out what happens when you cannot get the insulin you need. Ask about any equivalents of what you use now and learn about the prices of them. If you are not already in a patient assistance program, I suggest you join one. If you qualify, don't wait until you have no prescription and/or doctor, as most programs require them. Some doctors will help you, even if you are not able to pay for Continue reading >>
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How Insulin Became So Expensive – A History
At the ADA Scientific Sessions, an endocrinologist chronicles how incremental improvements have curtailed pricing competition. Dr. Kasia J. Lipska, a Yale School of Medicine endocrinologist, opened up her presentation on rising insulin costs by sharing the story of a patient with diabetes in crisis. The 68-year-old man had glucose levels which were out of control, and his A1C score had climbed north of 16] sponsor Dr. Lipska learned the patient wasn’t in denial or noncompliant – he simply couldn’t afford his insulin. He had hit the dreaded donut hole of his Medicare Part D coverage. The plan only provided some coverage for his drug costs of up to $2,800 a year. After that, he paid all drug costs out of pocket. The patient couldn’t keep up with the costs and had taken a full-time job to try to pay for the medications he needed. “This kind of patient is not uncommon in my practice, or in many of your practices, I suspect,” Dr Lipska said. Speaking before doctors, patient advocates, and drug company representatives at the American Diabetes Association 77th Scientific Sessions in San Diego, Dr. Lipska chronicled how repeated cycles of innovation, and the patents generated from them, have given patients with diabetes insulin that was much better than it was 90 years ago, but at great cost. In 1922, Frederick Banting, Charles Best, and John Macleod celebrated the first insulin injection into a human, 14-year-old Leonard Thompson. Shortly thereafter, the trio agreed to partner with Eli Lilly and Company to help with production. Their process for refining insulin from animal pancreas was painstaking and imperfect, yielding just half a unit of insulin from a pound of pancreas, Dr. Lipska said. ”There were a number of desperate patients with diabetes like Leonard Th Continue reading >>
Here's Why Insulin Is So Expensive, And How To Reduce Its Price
She drew the life-saving medication into the syringe, just 10cc of colorless fluid for the everyday low price of, gulp, several hundred dollars. Was that a new chemotherapy, specially designed for her tumor? Was it a “specialty drug,” to treat her multiple sclerosis? Nope. It was insulin, a drug that has been around for decades. The price of many drugs has been on the rise of late, not just new drugs but many that have been in use for many years. Even the price of some generic drugs is on the rise. In some cases, prices are rising because the number of companies making specific drugs has declined, until there is only one manufacturer left in the market, leading to monopolistic pricing. In other cases, companies have run into problems with their manufacturing processes, causing unexpected shortages. And in infamous cases, greedy CEOs have hiked prices figuring that desperate patients would have little choice but to purchase their products. Then there’s the case of insulin. No monopoly issue here – three companies manufacturer insulin in the U.S., not a robust marketplace, but one, it would seem, that should put pressure on producers. No major manufacturing problems, either. There has been a steady supply of insulin on the market for more than a half century. And there haven’t been any insulin company executives I know of who have been hustled in front of grand juries lately. Yet insulin prices are rising to dizzying heights. In 1991, according to a recent study in JAMA, state Medicaid programs typically paid less than $4 for a unit of rapid acting insulin. After accounting for inflation, that price has quintupled in the meantime. What explains the gravity-defying cost of insulin? I am not an expert on pharmaceutical pricing, but a few factors go a long way to e Continue reading >>
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’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 >>
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The Real Reason Insulin Is So Expensive
Insulin costs continue to rise and this is unfortunate considering millions of people desperately rely on it. Insulin is the hormone in our body that allows glucose (sugar) to get into the cells of our body that need glucose for energy. Produced in the pancreas, insulin is considered the “most powerful” hormone in the body. It was first discovered in 1922 and first derived from pigs and cows. In an article published by Estay Greene, director of pharmacy programs at Blue Cross Blue Shield’s North Carolina, Greene explains that about 30 years ago insulin manufacturers eventually created biologic insulin that saved us from our reliance on animals for insulin and brought huge improvements in insulin quality. He writes, and this is a fun fact, that “most insulin is made from E. coli bacteria.” These new insulin are much more similar to what we produce naturally as humans but they are incredibly expensive. The cost of insulin has been consistently rising throughout the life of a now 14 year old, tripling in fact, between 2002 and 2013. This isn’t quite the case for other countries outside the United States, however, so what is happening here that is causing Americans to pay so much? Has Competition Been a Negative Factor? Greene writes that “In the 95 years since insulin was developed, a number of drug companies have been making and selling it. But even with all those companies making insulin, competition hasn’t resulted in lower prices – it’s had the opposite effect. In fact, some brands of insulin have seen prices increase by more than 150 percent in the last five years alone.” He explained that “these price increases can spread like wildfire” with any competitors raising their prices in step with one another. Senator Bernie Sanders along with Repr Continue reading >>
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 >>
How Biohackers At Counter Culture Labs Are Trying To Make Insulin More Affordable
According to the World Health Organization, more than 420 million people around the world — including over 29 million Americans — have diabetes. People with diabetes are unable to naturally produce sufficient insulin, a hormone that regulates blood sugar in the body. Over 90 years ago, Canadian scientists discovered a way to extract the hormone from pigs and cattle and purify it for human use. Then, in the 1970s, scientists used a new "recombitant DNA rechnology" using human genes and bacteria to make insulin. Problem solved, right? Wrong, say increasing number of doctors in the U.S. Insulin is one of fewer and fewer drugs for which no generic version is available. According to an NPR report from 2015, as these more expensive, new drugs became available, the older ones left the market. The bill for uninsured patients can be several hundred dollars per month — as a result, one Baltimore doctor told NPR that some of his patients had stopped taking the drug altogether, putting their health at risk. Anthony DiFranco and his team at Oakland's Counter Culture Labs are hoping to change that. DiFranco is a medical researcher, self-described bio-hacker, and cofounder of the Open Insulin Project. He has Type 1 diabetes himself. DiFranco and his team are working on a protocol to extract insulin from genetically engineered yeast cells and produce a generic drug at a cost of around $10 for a month's supply. He says users could even eventually produce the drug in their homes. The project has created a definite buzz, raising nearly $17,000 in a crowdfunding campaign on the science-oriented crowdfunding platform Experiment. Shareable caught up with DiFranco to learn more about the Open Insulin Project and the team's mission to make diabetes management affordable. Ruby Irene Pratk Continue reading >>
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Insulin Users' Sticker Shock
Evergreening, a process that is far less friendly than it sounds, is the reason insulin prices have tripled. Diabetes is a costly disease. Not only for the toll it takes on people's lives and those of their loved ones, but also for the ongoing healthcare costs people with diabetes face every month. One of those costs, the price of insulin, appears to be unnaturally high, far outpacing cost increases of other drugs. People with diabetes paid over three times as much for their yearly insulin in 2013 as they did in 2002. Average costs per year went from $231 a year to $736. And not only did insulin prices nearly triple between 2002 and 2013, the average dose of insulin rose by 20%. [I]t's hard to say that contemporary patients who cannot afford their insulin (let alone the patent-protected glucometers and test strips required to adjust the dose) are well served by having as their only option an agent that is marginally more effective than those that could have been generically available 50 or 30 or 10 years ago The increase was only for insulin; the prices for other diabetes drugs stayed about the same or went down during this period. According to the authors of a new study that tracked nearly 28,000 people, the situation has become so bad that it's time to look at other non-insulin therapies for diabetics. And they don't expect insulin costs to drop anytime soon. In the United States, the more than 3-fold increase in the cost of insulin over the past decade is alarming. It is a burden to both patients and payers and may deny some people access to a lifesaving therapy, said William Herman, one of the authors of the new study and a longtime diabetes care researcher, in a statement. Although the newer, more expensive insulin analogs appear to have incremental benefits compa Continue reading >>