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Why is insulin so expensive? The absurd price for a diabetes drug, explained

When inventor Frederick Banting discovered insulin in 1923, he refused to name his patent. He felt it was unethical that a doctor could benefit from a discovery that would save lives. Banting's co-inventors, James Collip and Charles Best sold the insulin patent to the University of Toronto for only $ 1. They wanted everyone who needed their medicine to afford it.

Today, Banting and colleagues will spin in their graves: Their substance, which many of the 30 million Americans with diabetes are dependent on, has become the poster child of pharmaceutical merchandise.

The cost of the four most popular types of insulin has tripled over the last decade, and the extraordinary costs that patients have now doubled. In 201

6, the average price of insulin rose to $ 450 a year. Month – and the cost continues to rise, so much so that as many as one in four people with diabetes now skimp on or skip life-saving doses.

Members of Congress have been urgent drug companies and pharmacy benefit managers to control insulin costs. And on Wednesday, a health care company showed it was trying to respond to the problem.

The insurance promotes Cigna, and its pharmacy distributor Express Scripts, announced a new program that will cover 30-day insulin price at $ 25. This is a 40 percent reduction from $ 41.50 per day. Monthly fee people with Express Scripts services paid in 2018.

The program is expected to start later this year for insurance plans that work with Express Scripts benefits. Next year, all diabetes patients at the Cigna Plans will be able to attend, according to the Washington Post. It can affect as many as 700,000 patients who rely on Cigna or Express Scripts for insulin coverage, and will apply even before they have met their deductible.

But there are more catches here. In order for Cigna patients to participate, their employers must opt ​​for inclusion in the plan change, Stat said. And Cigna is just one of many insurance companies out there and covers less than 1 percent of the 23 million living with diabetes in America.

"Any measure that only helps a part of the population through opaque offerings between players responsible for this crisis is not a solution," said Elizabeth Pfiester, founder and CEO of the T1International patient group, to Vox. "We need long-term assurance that manufacturers will be held accountable and prices will be affordable – not another band-aid."

Most patients with diabetes will still be vulnerable to the lungs of the drug company pricing, as companies can still set prices at the level they want. And no substance is better to understand how it happened than insulin.

How Businesses Justify Their Price Increases

With type 1 diabetes affecting about 5 percent of people with diabetes in the United States, the immune system attacks the insulin-producing cells in the pancreas and leaves the body with little or none of the hormones. With type 2 diabetes, the pancreas still makes insulin, but the body has become resistant to its effects. In both cases, patients rely on insulin medicine to keep energy from food flowing into their bodies.

But the United States is a global money-spent emitter on the drug, which represents only 15 percent of the global insulin market and generates nearly half of the pharmaceutical industry's insulin turnover. According to a recent study in JAMA Internal Medicine Medicaid paid in the 1990s between $ 2.36 and $ 4.43 per day. Insulin Content; In 2014, these prices more than tripled, depending on the wording.

Medical Refund Trends for Covered Insulin Products from 1991 to 2014.
JAMA Internal Medicine

The doctors and researchers studying insulin say it is another example – along with EpiPen's and decades-old generic drugs – of companies raising costs by their products because of the salmon regulatory environment on drug pricing. "They do it because they can," Jing Luo, a researcher at Brigham and Women & # 39; s Hospital, told Vox in 2017, "and it's scary because it's happening in all kinds of different fabrics and fabric classes."

In countries with single payer health systems, governments have far more influence over the entire healthcare system.

In England, for example, the government has an agency that negotiates directly with pharmaceutical companies. The government sets a maximum price that will pay for a drug and if companies do not agree, they simply lose on the whole market. This puts drug users at a disadvantage and kills the price of drugs.

The United States does not. Instead, America has long taken a free market access to drugs.

Drug companies boast separate drug prices with a number of private insurance companies across the country. In the meantime, Medicare, the public health program for those over 65 who is also the country's largest drug purchaser, is actually prevented from negotiating drug prices.

It gives pharma more leverage, and it leads to the kind of price increases we've seen in EpiPens, newer opioid opposites – and insulin.

Insulin Producers as Eli Lilly, who has raised prices every year since 2014, say that the increases are only the price that comes with innovation – creating more effective insulin formulations for patients.

According to a 2017 Lancet insulin price increase document, "Older insulins have been successively replaced by newer, step-by-step products covered by several additional patents." The result is that more than 90 percent of privately insured type 2 diabetes patients in the United States prescribe the latest and most expensive versions of insulin.

However, it is not clear that these newer formulations are significant improvements in the elderly. The researchers wrote: "The data is not final on whether insulin analogues used today are safer or more effective for most patients with type 2 diabetes than human insulins widely used in the 1990s, for which the main patents has expired. "

Luo, the lead author of the Lancet paper, does not find the argument of" cost of innovation "very convincing. In his research, he is crossing many examples of the same insulin products that have been continuously available for years without improvement, but their price tags have increased much higher than inflation.

"The list price for these products is already out of reach for most Americans living with diabetes – in some cases over $ 300 a vial," he said. "It's also strange to see Humulin still priced at over $ 150 a vial, as this product was first sold in the United States in 1982."

Drug makers do this because they can

So the price policy of insulin is much larger than any other Cigna alone can repair. But several changes on the market may be on the horizon.

The three major insulin producers – Eli Lilly, Novo Nordisk, and Sanofi – will witness House Energy and Commerce's monitoring subcommittees next week and focus more on the problem. Lawmakers, including Chuck Grassley (R-IA) and Ron Wyden (D-OR), have also investigated the problem and sent letters to drug companies asking them to take into account their outrageous price increases.

But while the pressure around insulin can be mounted, we also see the terrible effect of increasing insulin prices on patients: People are forced to take off insulin so they can pay their medical bills – and settle with kidney failure, blindness or even death.

A clear solution to the problem would be to bring a generic version of insulin to the market. There are currently no genuine generic options – although there are several rebranded and biosimilar insulins – partly because companies have made gradual improvements to insulin products, allowing them to keep their formulations under patent and because older insulin formulations have declined out of fashion.

However, history has shown that when cheaper generic options are introduced on the market, total drug prices fall. "There are no generic competitors for any of Eli Lilly's insulin," Luo said. A century after insulin was discovered, it was time we had one.

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