The Insulin Wars: Addressing Rising Costs

Brandon Cohen

Disclosures

October 22, 2018

A recent article on Medscape Diabetes & Endocrinology delved into the difficult financial decisions that many people with diabetes need to make. With rising costs of syringes, test strips, and, above all, insulin, some have begun rationing supplies. Others resort to using insulins intended for animals. Some purchase through an informal black market when lack of coverage makes prescriptions prohibitively expensive. The article spurred discussion among Medscape readers about the problem and potential solutions.

Many blamed pharmaceutical and insurance companies for putting prices out of reach. One physician was outraged:

This is unbelievable. That American healthcare should be so flawed, so impotent, and so head-in-the-sand that access to insulin for diabetics, a fundamental human right, should be mired in so many difficulties.

Another physician cited the extreme behavior that this money-crunch could engender:

Had a patient who sold his syringes to junkies to meet his needs on the streets as a homeless person. He'd come in...about once a month with plenty of insulin but no way to administer it. Now he is probably also using that money to pay for his insulin. That is, if he is still alive.

A colleague saw this as part of a broader problem requiring forceful redress:

I suggest that we have more than an inulin cost crisis: we have a pharmaceutical cost crisis. I suggest that the outrageous overpricing of essential medications is, or should be, criminal. Pharmaceutical companies will not regulate themselves and should be regulated as public utilities, in the same way that other purveyors of the essentials of life are regulated.

Another professional saw the system as not just unfair but also unsound, jeopardizing the economic health of the nation:

A drug that is essential to preventing a long list of debilitating and deadly complications for a large group of people is unaffordable and/or not covered by insurance. However, the hyperglycemic events, dialysis, cardiac care, etc. will be paid by Medicare, Medicaid and private insurance at many times the cost of the insulin. No drug company should be able to market an essential human hormone like insulin and then play pricing games that kill the people for whom it was developed.

But there were some who thought the system was not broken. One professional had limited sympathy for patients with diabetes struggling with costs:

Yes, it does cost a lot of money to treat chronic illness... Yes, it would be really nice if everyone lived a healthy, low-risk lifestyle... We know what risk factors contribute to the development [of diabetes] and what people should do to avoid it. I have watched people who have high risk factors for chronic diseases of all kinds over the past 42 years decide to spend money on everything else except a healthy lifestyle. The levels of risk very often correspond to the latest smartphone, newest tattoo job, street drug use, etc... We have the freedom to live and make choices.

Another professional found this view misguided:

I have had type 1 diabetes for 49 years at no cause of my own making. Insulin is required to keep me and others with T1D alive. You have just demonstrated why it is so hard for many to understand our anger at these inflating prices. Insulin is not a luxury drug. No one taking it wants to be chained to this lifestyle. There have been no major advances in insulin for over 20 years, yet the prices continue to soar. This is simply greed at all levels.

Quite a few others also offered personal accounts of their struggles to maintain health. One professional wrote:

As a survivor of diabetes treatment since the second generation of insulin therapy who has experienced everything in the environment, what is happening is simply insanity and corporate greed. The 700% price increases on a product that has advanced little in the last 50 years is outrageous... OTC insulins are problematic, so to list them as a stop-gap may be true but is also problematic.

But a physician with diabetes was less critical of the over-the-counter options:

NPH [an over-the-counter insulin] has been a lifesaver for many of my patients, especially Medicare patients when they fall in the donut hole every year. Most of my patients do just as well on NPH, and sometimes better... it does take more effort and education, but it does work. Do I think the other companies are price gouging? Heck yeah! But maybe if more providers recommended using ReliOn [an over-the-counter monitoring system], it would cut into their profits and make them understand they cannot bully the diabetic community into using their expensive products.

But another physician was dubious of this strategy:

The fact is that all insulin (human or analog) comes out of the same factories and is made by the same recombinant DNA technology. If patients were switched off the newfangled products, supply and demand says the manufacturers would raise their prices on the cheaper products rather than lowering prices on the expensive products.

Still another physician thought that preemptive action could solve many of these problems:

Why are we not helping these patients who are overweight and as a result diabetic--—get help, lose weight, and get healthier, thereby reducing their need for insulin? Those who must have insulin due to genetic factors, not weight, are in a hard spot but this would help many get off it or lower the need. Obesity is an epidemic that needs addressing!

But a colleague disagreed:

Not all diabetics are fat or even overweight. Stop blaming the victims!

The final word goes to a professional advocating change:

Elections have consequences. Make candidates tell their stance on universal healthcare, pre-existing conditions, gutting Medicare and Medicaid, and drug pricing. If you don't agree, vote for the candidate who will fight for preventive and effective healthcare for everyone.

The full article can be found on Medscape.

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