You think?

You think this thing goes through in special session? It passed for Medicare, so now they will try to get three more votes in the Senate. They say it puts a cap of $35 on what insurance can charge because it only costs $6 to manufacture a bottle of insulin.

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Unless you’re eating right, insulin is doing you no good…

Just kidding!

:joy:

Couldn’t resist.

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God help us all, Eric.

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There is a problem that I see. I have no idea what it costs to manufacture insulin. And we do have a warped system of costs of pharma drugs in the US. But it obviously is a lot cheaper to produce Novolin versus Novolog and I do not trust any politician enough to know the ins and outs of which is what insulin?

As patents run out, it would be a lot easier to put a price cap on insulin. But I would not like it at the expense of having a new and better insulin come out and pharma deciding not to develop it or market it because it couldn’t meet the $35 required cap on any and all insulin being sold. That decision is already being made in other countries because of costs of certain insulins, they just do not have access to even being able to get them.

If they could figure out to maybe control the costs of insulin that had been out, maybe when the patent ends, but allow newer insulins to be more expensive? Then the newer ones would also be trying to be competitive against the $35 ones?

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Humalog was 19 dollars a bottle when it was introduced.
The increase wasn’t inflation. It’s the same thing as introduced more than 20 years ago. There is no more additional research costs. It’s pure greed.

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“A 2018 study estimated that one vial of human insulin costs $2.28-$3.42 to produce, and one vial of analog insulin costs $3.69-$6.16 to produce. … The study measured the manufacturing cost only. It did not include administrative fees, sales, and research and development for improving medications.”

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Do you know of a list of the senators current supporting the $35 copay cap? This isn’t a $35 cap on the price of insulin - only a cap on the cost to a person enrolled in a health plan. I’m sure the health plan will pay a portion on top of the $35.

If the insulin costs <$6 to manufacture, I think it’s pretty reasonable to cap the copay at $35. I think the copay cap would apply to one insulin (defined by insurer which is how it typically works today but without a cap) from all the different types, but it can be difficult to correctly interpret a bill. The language of the insulin act includes the following:

“at least one of each dosage form (such as vial, pump, or inhaler dosage forms) of each different type (such as rapid-acting, short-acting, intermediate-acting, long-acting, ultra long-acting, and premixed) of insulin (as defined below), when available, as selected by the group health plan or health insurance issuer.”

https://www.congress.gov/bill/117th-congress/senate-bill/3700/text?r=1&s=1&format=txt

Is there a reason to believe that 60 senate votes can be achieved? I was under the impression that this wasn’t going anywhere soon.

Edit: @mohe0001 it looks like the link you sent might be referring to a different bill which builds on the one linked above, but may also help reduce premiums by eliminating manufacturer and pbm rebates.

Let me check on that, katers. There’s a million bills with the word “insulin” in the title. I think they are going to send someone to speak with us directly on the forum and answer detailed questions.

I believe they require three more senate votes to make it law for private insurance. It already passed for Medicare.

That’s correct, it’s a COPAY cap - not a price cap, per se. That’s a significant detail.

I think that they are close. I think this leg pops like hot popcorn kernels soon.

I feel like they are trying to put the burden of increased cost back on the insurers as a mechanism for decreasing prices because of the collusion between the PBMs, insurers, and the manufacturers. The diabetics appear to be really tearing stuff up at the federal level. Ten years ago, none of us thought this would be possible. It’s interesting. It took them a decade to pull this off. It took some of you, near ten years just to explain to me what a PBM was. Fatboy Slim ft. Bootsy Collins - Weapon Of Choice [Official 4k Video] - YouTube

I checked. The individuals moving the leg write this…

"Correct that it is a cap on copays. Copays, or what insured patients pay at the pharmacy, are determined by their health plan, or insurer. PBMs negotiate prices from the manufacturer on behalf of the health plans for whom they work (or, in a majority of cases, are owned by!) and the health plan determines the price. As of 2021, insurance companies and health plans receive significantly discounted prices from manufacturers but do not pass along those savings to their plan members (people like us).

Commercially insured patients (also Medicare beneficiaries) don’t buy their medications from the manufacturers. We buy it from our health plan, who buy at steeply reduced bulk rates, but charge patients the full price, if not more."

“…because commercial insulin was eliminated from the Inflation Reduction Act that passed caps ONLY for Medicare, it’s anybodys guess as to whether they will bring the original INSULIN Act in its exact original form to vote. It will still benefit the same people with the same cap, and it will still be called the INSULIN Act but the language may change a bit.”

“Right now, we are calling for the original text to be brought to vote again (hopefully with the +3 needed), and other orgs are anticipating the same. But we also know things change a LOT so we evaluate every single detail as they are published.”

I see. This news article lists the seven republicans that voted to keep the insulin act in the inflation reduction act. That must be the 57 that is being referenced.

“Republican lawmakers who voted to keep the specific provision in the legislation included Sens. Bill Cassidy of Louisiana, Susan Collins of Maine, Josh Hawley of Missouri, Cindy Hyde-Smith of Mississippi, John Kennedy of Louisiana, and Lisa Murkowski and Dan Sullivan of Alaska.”

It’s got bipartisan sponsorship. It needs three more votes in the Senate. That really close to passing. They are starting up a special session. It just needs a little nudge. This is ten years in the making.

I guess we’ll have to wait and see. It just depends on whether they can recruit the 3 and if they can get those same 7 to vote for the bill again.

I don’t mean to be a Debbie downer, but it feels unlikely. Who knows though?

So you, “don’t think.” That’s interesting. They say that if 7 constituents bring up the issue to a member, then it’s a high priority issue for them. It feels “do-able” to me, but I do know a lot of diabetics in town. Just last week, my friend asked me to come meet his new diabetic friend. He’s demanding that we be friends because we are both diabetic. I don’t know what we’re gonna talk about. I hope it’s not diabetes.

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I’d rather talk about almost anything else. Motorcycle maintenance. There’s a good topic.

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I see another light in the tunnel. The Medicare site Plan D shopper has the generic options listed for Novolog and Lantus. Maybe compaies like Humana will change their minds abiut not covening Walmart’s distributed Novo “generic” insulins. (Those dumbbells lost a lot this year by paying the higher price for the same product in a differnt carton. )

Anyway, this suggest that Medicare will be open to them for Plan B pumps which should help control the overall cost of the Part B premiums.

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What’s the deal with Walmart? How come Walmart can offer $30/bottle without an RX or insurance? I’ve ALWAYS wondered how they pulled that off.

The $30 stuff is not for the insulin analogues.

The analogues are NovoLog, Humalog, and Apidra. Along with their siblings like Fiasp and Lyumjev. Those are the faster acting ones. But they are not $30 at Walmart!

The cheap stuff Walmart has for $25 - which does not require a script - is for the slower stuff, which is referred to as “human insulin”. But don’t freak out, they don’t take it out of the Walmart employees in the backroom and put it in a vial. It is a synthetic that is just modeled after human insulin.

The cheap stuff at Walmart works, but it is slower. Those are generally called R or Regular (for meal boluses) and NPH for basal.

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  1. They buy direct from Novo.
  2. Those Relion-labeled Novo products weren’t directly profitable for Walmart - they were and are an investment that has had a greater returns than advertising does for their pharmacy competitors.

Lilly and other companies originally got licenses in the late 1920’sto produce animal-derived Insulin at very low cost. Lilly got a license after commiting to initially reduce the selling price of the priduct low enough to drive prices down.

They did this to stop animal products companies from becoming competitors, tirs and as a loss leader to build their brand sales of other products And they did that for a while.

Then they started raising the prices to generate a profit large enough to satisfy shareholders and to finance other product development. They rode the literal cash cow (and pig) until increased demand and cost of animal pancreases started huriting profits.

SInce then every new form has required R&D, and after it’s cost has been recouped has become a cash cow - until its patent protection expiring threated that income. Since the 1990s the number of countries with the capability of producing insulin using well-understood technology has steadily increased,.

By 2008 it was becoming obvious that Lilly and Novo would be seeing declining sales of Humulin and Novolin. Soon after, Walmart wanting to bost its pharmacy sales, and Lilly wanting to keep production leveks hiugh enough to make the continued sale if Humuin profitabie, creared the co-branded Relion Humulin products in 2010.

After a few years Walmart, with its brand established, started aggressively negotiating with both Lilly and Novo to buy direct and exclusively sell just one of them as a house brand at a time. After a few years Lilly stopped negotiating. As its largest single direct customer, by guaranteeing sales, Walmart was highly influential in Novo’s continuing to manufacture human synthetic insulin without interuption. . Lilly continued so it could have a direct competitor to Novo’s branded product, but not the co-branded/white label one until recently.

Since the 1985, every 10 year Lilly and other companies have been introducing new version of insulin, and older insulns are phased out. Part of of the reason is patent protection, the other is efficiencies of manufacturing. Neither has a direct realtionshp to end purchaser price. Pharmaceuticals are sold at whatever the market will bear, with more profitable drugs covering ones whose sales haven’t paid back their R&D costs - and providing dividends to the shareholders of the company.

Why no competition?
There’s a lag in comoetition when a company holding a patent won’t release trade secrets and sell affordable licenses to another to use its processes. That requires a new company to go through new clinical trials to get regulaiory approval to market them products. This has to happen while the original competitor continues to promote its product and reinforce its brand. Fior a bioengineerd procut like insukin, its not unusual for this to take 10 years and it takes comitted investors to stay the course knowing a new product will replace the old.

The sale price of insulin ( not the copay) and growing demand for it have increased to where the tipping point has been passed. The white box versions of Humalog and Novolog are still priced at multiples of their production costs, but low enough to discourage competitor’s returns on investment.

Short history:

In 1982 Humulin was introduced
In 1996 Lispro/Humalog was approved
In 2005 Lilly started phasing out Humulins; U and L were the first.
In 2006 Humalog was aggressively marketed to replace Humulin
In 2009 Humulin 50/50 was discontinued.
In 2010 Lilly and Walmart introduce Relion insulins.
In 2014 Patent protection for Humalog expired.

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The “cheaper stuff at Walmart” is Novolin, identical to that not sold without the co-branding. Novolog has never been proven to have better outcomes or lower risk than Novolin.

The difference between Novolin R and Novolog is for boluses. A group of people using Novolin who are very careful and consistent with meal timing and content will see less variation of their blood glucose after meals over time than an similar group using Novolin. I wish those groups were typical of most persons with T1D.

That’s the entire difference, medically. For everyone else, Novolog has greater risk within 45 minutes if injection and is less effective 3 hours after injection than Novolin R.

How much variation, risk, effectiveness? Your guess is as good as anyone’s . Like most marketing information, the response curves you see lack important information. They are from lab tests with peopel whohave thie blood glucose elevated by a pure glucose load. They aren’t objective, don’t represent any real world condition. I’ve never found any curves for a standardized meal load besides my own CGM reports.

Novolin is only slower than Novolog and Humalg in onset time. With equal method of infusion/injection Humulin R causes a slower drop in blood glucose level, requiring, on average, a pre-meal bolus 30 minutes before a meal vs 15 minutes. Unit for unit Novolin and Novolog have nearly the same ICR. After 4 hours it’s impossible to tell which was taken.

The advantages of the different types depends on advance knowedge of:

  • when you are going to eat,
  • exactly what you are going to eat
  • how your body digests that kind if mealk

If you know all 3 three, then a single Novolog injection based on carbs alone will produce for multiple identical meals:

  • a lower average peak for a balanced meal of carbs, protein and fat.
  • a lower average prolonged peak that doesn’t return to preprandial for high fat/high protein meal.

If you don’t know all three, and you arent using a closed oir hyc-brid loopinfusin system, Novolog is higher risk for a delayed balanced meal and less effective than Novolin for a high fat and protein meal.

For many years the quesion for me came down to "is 15 minutes less uncertainty in timing worth a 6:1 cost difference for Novolog:Novolin R and $341:$25 for Lantus :Novolin N, buying Novolins in boxes that had a small Relion logo on them? The answer was always “no”. I was meeting the ACE ACE and ADA targets for A1C using MDI.
Only when until Medicare B and Supplement Insurance that I needed anyway, eliminated the cost of insulin, a pump, and CGM and I hoped that the equipment could do as good a job as I was doing, did that change.

Financially, Novolog is covered by Medicare for insulin pumps (as a supply/accessory) because Novolin R wasn’t clinically tested and submitted for recent pumps. Also new pump algorithms “smart” algorithms have fixed insulin absorption curves based on Novolog/Humalog. They make micro-corrections adjusting basal delivery and half-hearted boluses.

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I know this will be a controversial statement, but I feel I have to make it. I wanted to know why my local politicians were against this bill. When I dove in, they claimed to be against it because it does nothing to address the actual cost of the insulin. It’s just passing the excess cost off to the insurance companies. While I have no love for the insurance companies (who does?), the point is, they will just pass it onto us in the form of higher premiums/copays/deductibles, and there is nothing in the bill to prevent them from doing that. It does nothing to address the root problem of price gouging at the source: Big Pharma.

Sigh… Same song, second verse.