Having been a type 1 diabetic for 30 years, I have relied on Eli Lilly to manufacture the insulin that, for me, essentially sustains life. Today, I am so disappointed with the ethics of the company that claims core values of integrity and respect for people.
On a recent trip to the US, my insulin pump failed. For those not familiar with diabetes, this is an emergency situation. This can turn into a severe medical emergency within less than 24 hours. To make matters worse, it was almost midnight, and I was taking the kids to Disney World first thing in the morning.
To my surprise, the price of Humulin NPH insulin in the US is a whopping USD$155. At today’s rates that is nearly CDN$225. I checked at a number of pharmacies to find that the price was pretty consistent. They had me over a barrel and I had to spend the fortune.
To put this in perspective, the price of Humulin NPH in Canada is approximately CDN$30. This seems to be an extreme case of another pharmaceutical company gouging the consumer. They know that people with type 1 diabetes have no choice – buy and take insulin or die.
Well, not exactly - for Americans with insurance, the Humulin NPH pen costs $30 for a box of like, 5 or 6 pens. I think the danger is traveling in a foreign country without traveler health insurance.
It’s still gouging !! If you charge an insurance company USD$155/bottle, the insurance rates increase. I am the administrator for the health coverage for the company where I work. Our rates go up and down based on usage. If our drug costs were multiplied by 10X at the pharmacy, our rates would be multiplied by 10X.
If Eli Lilly can sell NPH in Canada at $30/vial, the rest must be profit. That means there gross margin is about 75% - THAT’S HUGE !! Somebody has to pay for that extravagant profit margin and I’m pretty sure it is the consumer and not the shareholders of insurance companies.
I feel your pain @Michael_Birch! Maybe a bit less dramatically because I have a health plan, but it comes with a high deductible, so my initial Humalog prescription fill each year is well over $1,000. So yes, I feel your pain.
It seems that pharmaceutical companies use the US market to “get healthy” with much higher end-user pricing compared to the rest of the world. This is where I say the “Serenity Prayer”, btw.
In the future, you might want to consider going to Wal-Mart and picking up a vial of ReLion NPH, essentially a generic NPH. I think it is in the $4US range. In fact, I think your US pharmacist may have done a better job in recognizing your emergency.
But…they don’t charge insurance companyies that much. Insurers and pharmaceutical companies agree on a much lower price, which is why insurance companies have different tiers of drugs, depending upon the price agreements they reach with various pharmaceutical companies. The uninsured are stuck paying the HUGELY inflated prices. US health insurance at its finest!
The issue of price highlights one of the ways in which the US medical system is broken. No question.
In Germany, there is a federal law that says NO medication can EVER be marked up more than a maximum of 2000%. So a vial of insulin that costs the manufacturer oh, say . . . $1.50 to make, cannot ever be sold for more than $30. Full stop. That same vial in the US costs somewhere between $100 and $200 over the counter. So your point is well taken. I would only add that it isn’t just Lilly – it’s everybody. My Apidra costs roughly what you paid for your NPH.
Totally sympathetic to your point. Because they do have to negotiate with insurers over price (though even that is forbidden in the case Medicare–Eli et al. say a big thanks Congress!), they seem to regard it as fair game to make up the difference on people stuck having to pay out of pocket. And since other countries also have the power to negotiate (unlike Medicare–thanks Congress!), they try to squeeze the US as hard as they can.
But on a side issue, I’m confused: NPH in a pump?
Ah, gotcha. One reason I asked is because the possibility of using it in a pump has come up here before, partly because of the cost question. I gather there’s a cheap OTC version you can get at Walmart for like $30 a bottle, though it’s not the same formula you were probably used to. But that N stuff is evil no matter where it comes from IMO. Hated it when I was on it. Better than dying of course.
Having come late to the insulin party (within the past 5 years), I’ve never used N either. Everything I’ve learned tells me to avoid it because there are far superior alternatives available, which I do use.
You’ve raised an issue that’s intertwined with the political. Pricing of medications in the US is anything but a free-market system. We more often find ourselves in a oligopoly or a market controlled by just a handful of players. The big three of Lily, Sanofi, and Novo in the insulin market are a prime example of that.
Back in about 2006 the US Congress passed and President Bush signed into law a reform to the US Medicare system called Medicare Part D. Part D is the Medicare drug benefit. This is primarily the system that covers people 65 and older. The Part D law explicitly forbid Medicare from using its rightful influence as a very large purchaser of medications and use that power to negotiate more favorable prices.
Many people in the US love to express their admiration of our free market system but then turn a blind eye when the government ties its hands and prevents the government from exerting its rightful influence in the market on behalf of “we, the people.” I call Medicare Part D the “corporate welfare Act” in that it was a big wet kiss for Big Pharma. Since Medicare is a big drug buyer and it’s forbidden to negotiate drug prices, that sets the pricing tone for the rest of the US private market.
The lawmakers in Canada, however, were a bit kinder toward their citizens in that they allow their public medical system to use its market power and negotiate drug prices down to a much more rational level. The drug companies can accept that lower price since Canada is a much smaller demographic than the US and the drug companies can easily increase their price in the US to make up any shortfall. I tip my hat to the more enlightened citizens to our north.
I apologize if I’ve offended any political sensibilities here, but this is my take of what’s happened to drug prices in the US in the last 20 years or so. As people with diabetes we consume an over-sized amount of pharmaceutical goods.
I agree that Eli Lily is price gouging on insulin and so is the rest of Big Pharma. It’s a shame and we should do something about it.
I second everything Terry said, with this philosophical addition—
It is seductive (and much easier) to see the world in terms of absolutes. But we do not live in a real world of absolutes. Rights, for example, are never absolute despite what the strident pundits of all political stripes would like to think. The classic example is free speech: you can’t yell “fire!” in a crowded theatre, etc. “Rights” are never absolute; they are circumscribed in various ways in order to make it possible for us to live together.
The same applies to terms like “free market”. Do “free” markets have distinct advantages? Of course. Do they also have definite dangers? Absolutely without question. For them to work most fairly and effectively, some judicious limitations are called for. I, too, salute the enlightened approach Canada has taken to the problem under discussion.
I’m T1D since 1996. In the U.S., Humalog has gone from $25 per vial when it was released to $250.83 per vial today. Guess what the price of Novolog is? $250.53 per vial. Apidra comes in at $240.93/vial.
Crony capitalism at its finest. I make six figures with great insurance and live in constant fear of the next price increase. Pay or die. Literally.
Regardless of Medicare, or OHIP, if you walk into a pharmacy and purchase insulin over-the-counter, it is governed by the free market. For some reason, Eli Lilly prices the product at a reasonable level in Canada and yet chooses to rape those in the US.
So, @Michael_Birch, I totally feel for you. Its a racket and wish it wasn’t this way.
I hate to reveal my hidden secret but I get free vials of insulin from my endo at my appointments- I go every 3 months. I take Humolog. Hardly any diabetics in her practice take that anymore but I do. I get 4 vials most of the time. This really helps offset the costs from buying it through insurance. The vials aren’t for resale, but heck, I wouldn’t want to sell them. @Michael_Birch, have you tried this before? I hate to sound mean or insensitive when I ask this, but when I travel, I bring tons of extra diabetic supplies with me. Did you do this, even though your pump failed? Should always plan for the worst, but hope for the best. I had my pump fail on a trip but had extra insulin, syringes, etc. I’m a little confused why you didn’t have any “cheaper” insulin with you. Even flying, TSA has never had a problem with an ice pack and my insulin in my bags. In most hotel rooms, you can request a fridge to keep it cold on your trip too.
I like to focus on things I can control and change, I can’t change the state of health insurance no matter how broken or companies overcharging for the medicines they produce. I can change my behavior and how I prepare, travel, etc.
There is no doubt that the US health system is horribly corrupted. But there are pillars of light. You could have driven less than 4 miles from Disney World to the nearest Walmart and purchased a vial of Relion NPH (Novolin NPH) for $24.88. Pharmaceutical companies have hopeless corrupted the pricing of drugs in the US causing most drugs to be sold at something like 10 times their true cost. And most regular pharmacies are caught in the same tangled web. Fortunately Walmart stepped away and did the right thing.
true but as u says there are pillars of light. so have hope. i think for me one vial of my insulin is about $150. don’t know what i do without insurance.
That is criminal. So assuming Eli Lilly sells at cost in Canada (which I know it doesn’t), that’s more than a 700% markup for American diabetics. And they raise the price by at least 15% every single year.
And yes Lilly enters into discount deals with some pharmacy benefit managers. But here’s what happens to patients - if Lilly doesn’t contract with your insurance company (which is usually determined by your employer), insurance will force you to switch to Novolog. Then the next year, to Humalog. I had to get an override from my doctor for “medical necessity” or I would be paying for Humalog out of pocket right now.
