The Politics of Insulin

Blog#144- 1/21/23

By Richard Davis

A reasonable person might think that if a disease affects the lives of 38 million Americans, or 11 percent of the population, that measures would be in place to make life a little more bearable for them. Don’t hold your breath. Diabetes is a difficult disease to manage under the best of circumstances, but when people with the disease don’t have enough political power their needs take a back seat to the profits of the pharmaceutical industry.

This is not a revelation. What I am mostly talking about is the obscenely high price of insulin. People with Type I diabetes require daily insulin and they make up five to ten percent of all diabetics. About 30% of type 2 diabetics require insulin.

About eight million Americans rely on insulin to stay alive. Not a critical mass for politicians to get worked up enough, especially when you consider that lower income people and people of color represent a higher number of insulin-dependent diabetics.

A vial of insulin can cost $200 to $300 in this country compared to $20 in places like Canada and other countries. The recently passed Inflation Reduction Act caps the cost of insulin at $35 a month, but that only affects people who have the Medicare D drug program.

It is not clear if the rest of us are subsidizing this program because the manufacturers or insulin haven’t lowered their prices. Is the government paying the drug companies the difference between $35 a month and the hundreds of dollars, which is the actual cost of insulin? The government is now in a position of negotiating prices with insulin manufacturers and I doubt they will be able to get the price of insulin even close to $35.

According to CNBC,” The high costs of insulin result in 14% of patients having “catastrophic” levels of spending on the treatment, according to recent research from Yale University. For Medicare patients on insulin, catastrophic spending affects one in five patients, the research found. Starting in 2023, the Inflation Reduction Act will cap the cost of insulin for Medicare beneficiaries at $35 per month and will include those who use insulin pumps.”

Some states have come to the conclusion that whatever is done about insulin prices at the federal level will be too little, too late. That is why California and five other states are suing insulin manufacturers over the high price of their product.

According to a January 18 New York Times article, “With a population of 39 million, California has now become the largest state to sue the major companies on the insulin market, accusing them of illegally inflating the price of the treatment and spawning a financial and public health crisis.”

They continue. “Rob Bonta, the state’s attorney general, said in announcing the lawsuit late last week that the companies had engaged in “unlawful, unfair and deceptive practices” in violation of California’s laws on competition. Characterizing the U.S. insulin market as “an oligopoly,” Mr. Bonta took aim in the state’s lawsuit at three pharmaceutical companies, Eli Lilly, Novo Nordisk and Sanofi, which control 90 percent of the global insulin supply, and the pharmacy benefit managers, CVS Health, Express Scripts and OptumRx, which manage 80 percent of the U.S. insulin market.”

The lawsuit by these states provides some hope that the companies that control the lives of insulin-dependent diabetics will be forced to account for their immoral profiteering. Keep in mind that when insulin was discovered over 100 years ago the scientists who did the research made it clear they did not want business to profit from this life-saving drug. That level of ethical accountability lasted for a short period of time. The vultures have prevailed.

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