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Rising insulin prices
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By Ernest Gurulé

Every single day in America, millions of men, women and children will medicate with insulin. They are diabetic. Most of them will also consciously or unconsciously give thanks that they or a loved one has this medicine without which the unthinkable---death---could occur.

According to the Centers for Disease Control, there are approximately 30 million Americans---including children---or nearly ten percent of the population that has diabetes. More than 7.2 million are also undiagnosed. But sooner or later, they too will need insulin to manage their condition.

Insulin is a hormone produced by the pancreas and regulates blood sugar levels. Its job is to take the food we’ve eaten, break it down into glucose or sugar and get it into the cell for energy. Essentially, it’s the body’s fuel. When the body---the pancreas---doesn’t produce enough insulin or doesn’t bring it to the cell, excess glucose is accumulated in the blood stream.

But no American group is impacted more by this disease than Latinos. It is estimated that one in ten Latinos age 20 and older is diabetic. Latinos are also the population most likely to be undiagnosed. In a study published by the Illinois Disability and Health Program, it was estimated that as many as half of Latino children born in 2000 are likely to develop diabetes in their lifetime. But that’s only one part of this painful, everyday equation.

Beside having to administer a life-saving drug on a daily basis, the costs of insulin are high and on a steady upward trajectory. Since 2012 insulin prices have doubled, this after having tripled in the previous ten years. According to the Congressional Diabetes Caucus which is co-chaired by Colorado Democrat Diana DeGette, “a patient’s out-of-pocket insulin cost can exceed $300 per vial.”

Without a good health insurance plan, many diabetics have found themselves unable to pay for this life-saving drug and are at serious risk. Their options are bleak. Rationing insulin, which many diabetics have been forced to do, is a potentially fatal choice.

The American Diabetes Association estimates that as many as 25 percent of people with diabetes are rationing their insulin. It’s an economic choice that can have deadly results. Side effects of rationing, said the ADA, can cause nausea, vomiting, frequent urination. It can also lead to uncontrolled blood sugar levels and put a patient’s life at risk.

Diabetes is the most expensive chronic disease in the U.S. Just one vial of insulin can cost a patient $300 in out-of-pocket costs. Some diabetics can go through two or more vials per month. In a single year, the government estimates the cost of the drug is nearly $240 billion with an additional $90 billion in lost productivity.

DeGette’s inquiry found multiple factors in the ever-rising price of insulin. It also learned the complexities in this financially challenging puzzle. It’s a puzzle linking together “manufacturers operational expenses, research and development costs and marketing expenses.” The investigation also found “the cost is affected by intermediaries in the supply chain and incentives that drive up the price further.”

Brought together in February to testify before a congressional committee, seven heads of pharmaceutical companies took no responsibility for drug prices but blamed ever rising costs on middlemen or pharmacy benefit managers who negotiate the price with manufacturers and insurers.

One problem associated with costs and cited in a report in the New England Journal of Medicine is that, unlike with many drugs, diabetic patients cannot purchase a generic brand of insulin. The report said that while pharmaceutical companies continually improve their product, they’re simultaneously extending their patents. The Journal found that generic drugs cannot be made until a patent on a brand-name drug expires.

The downrange repercussion of this ‘groundhog day-like’ cycle is more and “higher costs in hospitalizations and treatments from complications related to undertreated or untreated diabetes.”

While the price of insulin continues to be a daily challenge for diabetics and their families, its history began in the most modest of ways. Insulin was discovered by orthopedic surgeon Frederick Banting and Charles Best, one of his medical students at the University of Toronto.

Because they knew almost immediately that they had no means of producing it in the quantities required to impact the number of patients who could benefit by it and that it could be a life-saving drug, they sold the patent for their discovery for one dollar. Their discovery was amazing and only got better.

The evolution of insulin has been remarkable. Its first incarnation was animal-based and made from beef and pork. This presented some built-in problems, not the least of which were impurities and reactions after injection. Improvements were gradual and in the late 20th century, the first synthetic insulin was developed and approved by the
U.S. Food and Drug Administration.





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