Article on insulin pricing in today's Washington Post

I did respond to the main article as well as a couple of the comments. Always plenty of ignorance in comment threads for D articles, including the apparently inevitable advice re cinnamon–sheesh…

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For quite a while I have felt that our government has failed “people.” They have let corporations systematically corrupt the system. That is why we have these high drug prices. Because government law and policy allows corporations to charge whatever they want with no transparency and no regulation. And it isn’t just the pharmacy companies, it is the benefits managers and insurance companies. Insurance loves higher prices as long as they can estimate the demand for the coming year and get their percentage.

I think the best solution would be to socialize insulin development and production. We already have NIH perfectly capable of developing new insulin products. We would just need the policy and regulation needed to “take over” insulin production and a surprisingly modest funding to support it. If people knew how little it actually costs to produce these products in an ongoing basis we would be even more upset.

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Brian, you just hit that ugly nail square on its head! :+1:t2:

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I am going to contact the author and ask her to follow up on the quality of life vis-a-vis older and modern insulins and cue her in to some of the concerns we share on the forums. I am wondering if she’d be willing to pass along comments to those quoted in her article, as well.

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There is no doubt that quality of life is better using newer insulins… that does however in no way justify the price increases that modern insulins themselves have incurred-- 450% above the price of inflation during last 2 decades (humalog from $21 to $250/ vial). That’s the real problem. I didn’t perceive from the article that anyone was suggesting we should go back to R and NPH

it ain’t gonna happen brian, the corps run the world, we all have the best gov money can buy. an honest politician is one when’s bought, stays bought.

Maybe. Some people are swayed by emotional invective.

Just be sure you invect enough.

:stuck_out_tongue:

I can see that. If you have a routine and aren’t always meeting up with friends or others who could throw it off, you know your digestion, and you don’t mind taking a drug a little in advance, it can probably be better. in fact, I’ve even wondered if some of those slower acting versions of insulin would be better for those high fat, high-protein meals that take forever for my son to digest. But the idea that you basically have to live a regimented life in order for it to work for you seems to be neglected in this article.

If manufacturers in other industries operated in a similar cartel it would be deemed illegal price fixing.[quote=“Brian_BSC, post:22, topic:57062”]
I think the best solution would be to socialize insulin development and production
[/quote]

Unnecessary. In the UK the NHS negotiates the price - a 10 ml vial of Humalog costs £16.61. Even if you calculate that at the exchange rate before the Brexit vote that works out at around $26. A box of 5 disposable Lantus pens are around £42 (= $63). If when the agreement came up for negotiation and Novo Nordisk (who dominate the market here) were to announce they were hiking the price of Novorapid, the NHS would simply remove them from the approved list and substitute Apidra or Humalog. Attempts to co-ordinate a price rise by the different manufacturers would be illegal price fixing under EU rules (potential for huge fines).

Simples!

I think there is a project trying to make a fast-acting insulin open source. Not sure though whether it has come very far, and then even if it is made, how they would scale up. Not many diabetics are willing or able to engineer their own bacteria/algae to produce insulin.

[quote=“Brian_BSC, post:22, topic:57062, full:true”]I think the best solution would be to socialize insulin development and production.[/quote]No. This would be an absolute disaster. If this sort of scenario were in place shortly after insulin were discovered, we’d all be using animal insulins today with no alternative. [quote]We already have NIH perfectly capable of developing new insulin products.[/quote]No, they are not. They truly are not.[quote]We would just need the policy and regulation needed to “take over” insulin production and a surprisingly modest funding to support it. If people knew how little it actually costs to produce these products in an ongoing basis we would be even more upset.
[/quote]Brian, I’m very surprised to see you posting something like this. You’re generally a pretty well-informed person.

“Modest funding”? It took tens of billions of $$ to develop the evolution path of insulin. First human insulin via recombinant DNA techniques, then engineering insulin analogs.

Imagine trying to get the Congress to allocate billions for R&D for insulin. Keep in mind that there are all sorts of other diseases that everyone else is screaming to have research funding for – RIGHT NOW. Diabetics would be competing with that.

Your approach would make treating diabetes chiefly a political issue rather than a health issue. Most diabetics can be treated “well enough” in the eyes of the majority non-diabetic population without insulin. Quality of Life issues cease to matter in this sort of decision process.

That leaves the T1s. There are so few of them, and there IS insulin for them (the public is never going to come to understand the differences between animal, human recombinant, and insulin analogs), so we can’t waste billions developing better insulins when there are all these other diseases with no cure at all – like BREAST CANCER!!

I bring up breast cancer because is it one of the best examples of how politics distorts health research funding.

The fact that not a single insulin advance since discovery of animal insulins has come from any government funded health R&D effort anywhere on this planet ever is the strongest evidence that this model does not work for generating new advances in medicine.

Where the NIH and similar public institutions provide a needed service is in “filling the gap” researching that which has no adequate incentive in the private market to develop a solution.

Does the government have an oversight role in stepping in and prevent abuse? Certainly. We have plenty of economic history to spec what is “reasonable” in terms of profit and investment return. When a company can’t defend its pricing for medical treatments with well-accepted financial business models (read: Recouping R&D costs with a reasonable profit over the patent life of the drug), there is a reasonable basis to step in and regulate.

However, the fundamental problem of laying the R&D costs for the entire world nearly entirely on the backs of US consumers must be addressed somehow. I don’t know what the answer is, but that’s the biggest reason these drugs are so much more expensive here than in other countries.

I want smart insulin. I want to at least have the OPTION, even if I can’t afford it, so I can concentrate on figuring out how to afford it. That, to me, is a far more preferable situation – not having it because its too expensive – than the alternative… not having it because it doesn’t exist.

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@Tia_G I used to live that regimented life you speak of where you had to know what you were going to eat well in advance of eating it (worked really well when eating in a restaurant :slight_smile: ) When Humalog came out, it was really life changing for me in a positive way and made my life much happier. It gave me freedom. When Levemir came out, it stopped those scary early morning lows I occasionally got with NPH. I could probably go back to R (and stop eating at restaurants) but I don’t think I want to go back to R/NPH.

Out of interest, my very kind insurance company in Canada just paid $138.88 CAD for 5 x 3mL Humalog pen fills. If I get the math right, that would be about $92.59 CAD for a 10 ml vial. In US Dollars that would be $69.00 USD per vial. Which poses the question - Is Lilly loosing money selling insulin in Canada or where does the other $186 US go out of that $255 USD vial of Humalog? For comparison Levemir is about 85% the cost of Humalog.

It’s a hard balance to strike between pointing out that the cost of the new insulins is far out of proportion to their benefits as compared to the old analogues, on the one hand, and on the other deprecating or minimizing the benefits they do have, which for us are totally non-trivial. The question is whether these discussions lead more in the direction of “Why does Big Pharma have to charge so much!” or “Why don’t you guys get along with the old cheap stuff, it works fine!” I think the latter implication was discomfortingly present a few points. My own endo has told me she sees that attitude in her professional circles and I thought it was important to push back on. But I think we basically agree.

oh I started reading some of the comments and one of the first ones was about how diabetes is a “lifestyle” disease, so I stopped reading…

[quote=“DrBB, post:33, topic:57062, full:true”]

It’s a hard balance to strike between pointing out that the cost of the new insulins is far out of proportion to their benefits as compared to the old analogues,
[/quote]You see, this is precisely the sort of judgement I want to make for myself, without anyone else inserting their perspective.

No one lives my life. Therefore, no one has my perspective. No one, other than me, is in a position to decide if the cost of new insulins is far out of proportion to its benefits, fair and reasonable, or an incredible bargain.

Who, but I, can determine the “value” of faster insulin in living my life?

And the elephant in the room: This judgement is, OF COURSE, impacted by one’s means as well. I’m not rich, but I’m doing well enough that I am not financially unable to afford my health care.

I spend money on recreational stuff too. Trivial things, like dining out, entertainment (seeing Colt Ford at the Catalyst in Santa Cruz Friday!), and on and on. We were without health care for 6 months, and I had to cover $700 of insulin a month instead of my $50 copay.

It sucked, but it wasn’t hard to make the decision to cut a lot of other stuff out of the budget, and figure out other ways to have fun.

The point I’m making is these sorts of balancing acts, judgments, value decisions, etc. are highly personal and individual. My postings here contrasted with those of others like Brian (and Brian’s views are every bit as valid as mine) demonstrate how variable these priorities can be.

Put this in the hands of the government, and I don’t get to decide any more what’s important to me. Some bureaucrat somewhere distant, who knows nothing about me and my life, will make those choices.

I noted in an earlier posting that the Humalog (insulin lispro) patent expired in 2013, and was wondering why there was no cheap generic. Based on this article, it looks like it’s simply because it’s really hard to figure out how to make it:

Generic drugs are amazing. They offer lifesaving promise for a cheap price tag, and given that the underlying drugs have been tested and proven, there’s no doubt about safety or effectiveness. But don’t expect to see generic “human” insulin any time soon. If you do spot it eventually, don’t expect it to be too cheap or widespread.

It seems that the complex manufacturing involved in insulin drugs isn’t easily duplicated. The processes are so complicated–and government guidance in the area so lacking–that there are still no generic alternatives to insulin brands with expired patents in the United States.

If there were a good place to target some NIH public funding, this would be it.

[quote=“AE13, post:32, topic:57062, full:true”]Out of interest, my very kind insurance company in Canada just paid $138.88 CAD for 5 x 3mL Humalog pen fills. If I get the math right, that would be about $92.59 CAD for a 10 ml vial. In US Dollars that would be $69.00 USD per vial. Which poses the question - Is Lilly loosing money selling insulin in Canada or where does the other $186 US go out of that $255 USD vial of Humalog? For comparison Levemir is about 85% the cost of Humalog.
[/quote]I’m solidly on the side of the critics when it comes to Humalog pricing, and support regulatory intervention.

The patent has run out. The pricing has been grossly increased well beyond the original pricing that had been put in place to amortize development costs over the life of the drug patent, which has now expired.

There is no argument that Lilly needs these high prices to recoup sunk costs. Humalog is now in the “golden period” of its life, where those costs have presumably been recovered, and now the only costs that can be reasonably accounted for are the direct manufacturing, sales, and administrative costs.

Heck, marketing costs should be pretty close to $0 – it’s a well-established product that doesn’t need marketing to get prescribed.

So, the $21/vial that Lilly priced Humalog at when it was introduced – $36 in 2016 dollars – should be what we’re paying for it now. Hell, even $50.

Given the nature of the product government intervention, via regulation, is reasonable here, and something I support.

With great trepidation, I might add. Because once the regulation starts, it’s driven more by politics and political considerations than matters that most of us would instead consider proper.

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Not that I’ve found private insurance bureaucrats any less remote or easier to deal with (or even reach) than the government kind… :wink:

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Agreed! The only perfect solution is one where everyone does what I want them to, providing all goods and services I want, at the prices I want.

Since that ain’t gonna ever happen, I prefer a solution where I can fire the provider and find another if I’m unhappy.

I note that w.r.t. insurance, my freedom and choices in this regard have been greatly reduced, and the return on my $ increasingly inferior over the last several years.

And the reason for this? Not insurance companies WANTING to do this to me. Rather, once again government with it’s big ham hand has done it through something called the Affordable Care Act that was promised to save me money, give me lots of competitive choices, better care, etc.

There were many of us that, while this debacle was being crafted, saw that what has happened was exactly what was going to happen.

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Taking Levemir and novorapid was life changing for me. I hated the regimented life i had to lead for the first 2 years i was on a mixed insulin… i had to eat lunch every day at 12 otherwise i woul have a severe hypo.
I live in Australia so the price for me was the same. As jack16 stated earlier $37.50. $28 US. My supply of pens lasts about 4 months, so we are lucky. I woul never go back to mixed.
I had the chance to trial a cgm for a week here and it was amazing but cant afford a pump or cgm as they are thousands of dollars here and only partially covered by insurance unless you are under 21.