As a type-1 diabetic of 17 years now, I can confirm that the price of Insulin has been steadily rising over the years.
I can also state that the majority of my medical expenses go to insulin pump supplies, not insulin itself. On average, I'm paying roughly $250/mo out of pocket, after 90% insurance coverage for the whole diabetic kit-and-kaboodle. I would be quite troubled if I were to lose my job and/or medical insurance. Thinking about the future, it's definitely a fear of being in a circumstance where I will be without supplies for any amount of time.
As another commenter noted, and got down-voted instantly, a large cause of the insulin usage increase (and therefore pump increases) is due to a dramatic increase in the diagnosis of type 2 diabetics.
Depending on where you're treated, many type-1 diabetics are given a rather thorough crash course on the disease (and it's symptom-based-cousin, type-2, for comparison). In my opinion at least, I don't feel like many type-2 diabetics are given as much information, or are potentially more reluctant to absorb it.
It's a broad generalization, but not necessarily inaccurate, to state that most type-2 patients rely on medicines to treat their symptoms and will not adjust their diets even under the worst case scenario. Type-2 in many ways can have it's symptoms reduced/resolved by something akin to a keto diet. That said, sugar is ridiculously hard to quit.
I think the reason the other comment about the effect of increased type-2 diagnosis on price was downvoted was that it stated a simple and direct causation between growing demand and prices.
I agree that type-2 patients should receive better orientation in terms of dietary treatment, but this growth in demand could (should?) also lead to an economy of scale, especially for pump supplies, and a price drop. I have the impression that it is not the free market (through demand growth) that is increasing the prices, but rather a lack of free market (through cartel).
T2 diabetes can be resolved with a high carb diet too, but people dislike eating vegetables. There's nothing as satiating as fibre filled meal filled with slow release/absorption carbs. No sugar spike, nothing, after 1500kcal cooked beans meal.
Thanks for sharing your experience. I have a close friend with type 1 who feels quite trapped in his profession because of dependence on insurance for supplies. It's difficult to see it from afar and not have any solution to offer. Is this a problem unique to the US health care system, or in every first world country?
“I don’t think it takes a cynic such as myself to see most of these drugs are being developed to preserve patent protection,” said David Nathan, a Harvard Medical School professor. “The truth is they are marginally different, and the clinical benefits of them over the older drugs have been zero.” -- quote from article
And there you have it. I have seen this myself. One year ago, the insulin I was on was removed from the pharmacy, and coverage by my insurance company was also voided. My only choice, I was told, was to switch to a new insulin (which - as article states - was only marginally better, if at all), but which had a fresh patent and thus ensures new profits for another 20 years to come.
And so the wheel keeps churning. Patients are not given a choice, because we are not humans. We are merely a commodity to pharmaceutical companies' profits and shareholder value.
I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper.
What is different for diabetes, or the United States, to cause this to not be an option? Seems almost like a human rights violation, or at least deeply unethical.
Insulin is being “grown” genetically modified organisms in vats. It is not a simple molecule you get by mixing chemicals together.
The very first application of the human genome project.
The whole process of production is non-trivial, every step heavily patented and secured. Also pretty expensive.
There are new biotechs currently working on CURING diabetes, but no one is doing trials on humans yet. Means we’re at least 10 years away from a cure.
And no, those are not crazy 18 year olds in a garage. Spark Therapeutics now has an injection to cure macular degeneration, Moderna is building a whole RNA modification platform with 19(!) individual drugs in the pipeline.
It is very likely that we’ll see a major shift of medicine to curing, rather than treating in the next 20-25 years. Hep-C now has a cure. Still so, so amazing. The Human Genome project will turn out to be one of the most live-saving accomplishments of humanity, next to the green revolution in farming.
Many generics in the US do cost around $5 a month or less.
For some drugs, the manufacturers work the system, withdrawing their previous version from the market and launching a new version with some tweak. Withdrawing the old version makes it more difficult for someone else to get permission to manufacture and sell it.
The basic problem is that (the majority of) the engaged, wealthy part of the country gets their insurance from someone else and doesn't give a shit about how much medical stuff costs. And we have a medical system where the primary regulatory impact on prices is from capture.
Don't forget that switching insulin is not easy. You have to adjust and refine the amounts you take for several days or even weeks, while closely monitoring your blood sugar during that period. It's stressful and unpleasant. Here, you are forced to do that once (one year before the patent runs out) and it sucks. Why do it twice? If the insurance company covers the new insulin anyway?
But the insurance company masks the real price. All our insurance policies are getting more expensive and cover less because we are all paying for it, together. We all know it, but we all take the easy way out. Including me. You are right, it is deeply unethical.
Europeans more often think holistically about health care (and its cost), which is a good thing. In the US, health care (and its cost) is primarily driven by corporations whose primary goal is profits and shareholder value. They are not aligned.
Generics still require FDA approval, which costs on the order of single digit $millions to obtain. Plus you’ve got to set up the plant to create the drug, which costs more $. Would you invest $millions in a product when a competitor (who probably already has plant capacity from when they made the drug while it was under patent) could come in and undercut you at a moments notice?
Obviously not - so the system ends up in a metastable state where one monopoly producer can charge high prices for a drug & no competitor will enter the market because they know the producer can and will undercut them the moment they try and do so.
This one of the reasons why the health care system in the US is completely borked.
> There have been few efforts to create a cheaper insulin. Walmart, for instance, sells Novo Nordisk's human insulin under the name ReliOn for $25 a vial. Eli Lilly is expected to release the first copycat insulin analog, a chemically altered form of insulin, at the end of this year.
As the husband of a type-1 wife, I just wanted to add that there is a difference in insulin that isn't just long-acting or short-acting. Different people can react differently to different insulins. My wife used the ReliOn brand for both for a while, and even though the short-acting was fine, the long-acting was way too inconsistent (some very non-deterministic lows and highs). Switching to Levemir long-acting smoothed those out.
That said, nothing inherently wrong with the ReliOn brand if that's all one can afford. My wife forgot her short-acting insulin for a long weekend trip one time and it was nice to know what we could simply buy some insulin out of pocket and not get gouged to death.
> am amazed by how many diabetics and GPs don't know this exists.
I've noticed that GPs don't know enough about diabetes, one needs a specialist to really get control of it.
That's incredible. Humalog is a quite similar low price in Canada. It's strange that it'd actually be economical for many American diabetics to just book a (yearly) flight to Canada and buy 12 months worth of insulin.
Drug pricing in the US is complicated. Humalog list price has doubled in the last few years, but the rebates have increased faster and the average net price is actually going down. The average discount is 75%!
As others have stated, pricing and insurance in the US is a complete rats nest. There are rebates and discount card programs available to the vast majority of patients that mean that most patients are paying much much less than that.
Interesting, the response in the UK has been to address this by attempting to pump money into programmes to to try and prevent type 2 diabetes or at least reduce its growth. Still too early to see how these efforts will be.
There have been a few small scale trials in the UK where type II people are put on diet of around 600 to 700 calories a day for a couple of months. Indications are for about 40% of those who took part they returned to normal levels - i.e. no longer had diabetes.
Anecdotal but a 50ish year old friend had Type2 and went to stay with relatives on a farm for a few months. He spent 10-12 hours a day helping out and when he came back he'd lost weight and also was no longer diabetic.
That should be the response everywhere. The soaring cost of diabetes is largely tied to the soaring numbers of Type 2 diabetics, and the treatments are really just alleviating symptoms, and aren't actual cures. The only way to tackle the problem is to get (Type 2) diabetics to lose weight. Though this is obviously easier said than done.
Dr Fung's article [1] is a good complement to this one and explains how the market for insulin has been deliberately increased. As other commentators mentioned, once you can have carbs with insulin, why bother changing and looking for an alternative? Dr Fung treats patients with fasting protocols, where compliance is harder, but costs lower. FTA I just learned that Dr Banting is famous for both insulin and the original (proto) Atkins diet.
Insulin is just like when you have performance problem in a monolithic app and you throw more hardware at it, but at some point you can't upgrade your server anymore.
Not sure if there's much you can do while diabetic, but cut bread-like and sugary foods, these spike your insulin the most and your body becomes insulin resistant and so you need more and more insulin, more that you can make.
As a type-1 diabetic, your body no longer produces any insulin at all. This means even without eating any carbohydrates, your blood glucose rates will elevate every hour until you eventually succumb into a coma and shortly after, perish. I use about 34 units of insulin per day, excluding any carbohydrates -- this largely depends on body type as well, some people use much more.
A type-2 diabetic on the other hand, depending on how far their disease has progressed, could potentially ween themselves off insulin entirely if they were to completely abandon carbohydrates. These diets are extremely hard to maintain, especially indefinitely, however.
Yes, sorry, I was thinking at type-2 diabetes, I have a relative with type-2 and doctor told her to cut alcohol, sugar, carbs, etc, type-1 is entirely different, the immune system attacks the pancreas.
Readit News
I can also state that the majority of my medical expenses go to insulin pump supplies, not insulin itself. On average, I'm paying roughly $250/mo out of pocket, after 90% insurance coverage for the whole diabetic kit-and-kaboodle. I would be quite troubled if I were to lose my job and/or medical insurance. Thinking about the future, it's definitely a fear of being in a circumstance where I will be without supplies for any amount of time.
As another commenter noted, and got down-voted instantly, a large cause of the insulin usage increase (and therefore pump increases) is due to a dramatic increase in the diagnosis of type 2 diabetics.
Depending on where you're treated, many type-1 diabetics are given a rather thorough crash course on the disease (and it's symptom-based-cousin, type-2, for comparison). In my opinion at least, I don't feel like many type-2 diabetics are given as much information, or are potentially more reluctant to absorb it.
It's a broad generalization, but not necessarily inaccurate, to state that most type-2 patients rely on medicines to treat their symptoms and will not adjust their diets even under the worst case scenario. Type-2 in many ways can have it's symptoms reduced/resolved by something akin to a keto diet. That said, sugar is ridiculously hard to quit.
I agree that type-2 patients should receive better orientation in terms of dietary treatment, but this growth in demand could (should?) also lead to an economy of scale, especially for pump supplies, and a price drop. I have the impression that it is not the free market (through demand growth) that is increasing the prices, but rather a lack of free market (through cartel).
And there you have it. I have seen this myself. One year ago, the insulin I was on was removed from the pharmacy, and coverage by my insurance company was also voided. My only choice, I was told, was to switch to a new insulin (which - as article states - was only marginally better, if at all), but which had a fresh patent and thus ensures new profits for another 20 years to come.
And so the wheel keeps churning. Patients are not given a choice, because we are not humans. We are merely a commodity to pharmaceutical companies' profits and shareholder value.
What is different for diabetes, or the United States, to cause this to not be an option? Seems almost like a human rights violation, or at least deeply unethical.
The very first application of the human genome project.
The whole process of production is non-trivial, every step heavily patented and secured. Also pretty expensive.
There are new biotechs currently working on CURING diabetes, but no one is doing trials on humans yet. Means we’re at least 10 years away from a cure.
And no, those are not crazy 18 year olds in a garage. Spark Therapeutics now has an injection to cure macular degeneration, Moderna is building a whole RNA modification platform with 19(!) individual drugs in the pipeline.
It is very likely that we’ll see a major shift of medicine to curing, rather than treating in the next 20-25 years. Hep-C now has a cure. Still so, so amazing. The Human Genome project will turn out to be one of the most live-saving accomplishments of humanity, next to the green revolution in farming.
For some drugs, the manufacturers work the system, withdrawing their previous version from the market and launching a new version with some tweak. Withdrawing the old version makes it more difficult for someone else to get permission to manufacture and sell it.
The basic problem is that (the majority of) the engaged, wealthy part of the country gets their insurance from someone else and doesn't give a shit about how much medical stuff costs. And we have a medical system where the primary regulatory impact on prices is from capture.
But the insurance company masks the real price. All our insurance policies are getting more expensive and cover less because we are all paying for it, together. We all know it, but we all take the easy way out. Including me. You are right, it is deeply unethical.
Europeans more often think holistically about health care (and its cost), which is a good thing. In the US, health care (and its cost) is primarily driven by corporations whose primary goal is profits and shareholder value. They are not aligned.
Obviously not - so the system ends up in a metastable state where one monopoly producer can charge high prices for a drug & no competitor will enter the market because they know the producer can and will undercut them the moment they try and do so.
This one of the reasons why the health care system in the US is completely borked.
> There have been few efforts to create a cheaper insulin. Walmart, for instance, sells Novo Nordisk's human insulin under the name ReliOn for $25 a vial. Eli Lilly is expected to release the first copycat insulin analog, a chemically altered form of insulin, at the end of this year.
You can buy this product right now, it is the same formulation you would have taken if you were diabetic in the 1990s. https://www.walmart.com/ip/Pharmacy-Relion-Humulin-Insulin/1...
I am amazed by how many diabetics and GPs don't know this exists.
That said, nothing inherently wrong with the ReliOn brand if that's all one can afford. My wife forgot her short-acting insulin for a long weekend trip one time and it was nice to know what we could simply buy some insulin out of pocket and not get gouged to death.
> am amazed by how many diabetics and GPs don't know this exists.
I've noticed that GPs don't know enough about diabetes, one needs a specialist to really get control of it.
https://www.bloomberg.com/news/articles/2017-06-29/the-crazy...
Not complicated at all, insulin keeps people alive and our shareholders need a return on their investment.
Anecdotal but a 50ish year old friend had Type2 and went to stay with relatives on a farm for a few months. He spent 10-12 hours a day helping out and when he came back he'd lost weight and also was no longer diabetic.
Interestingly, the other thing that's a risk factor is lack of sleep. Huge commutes put you at risk for type-2 diabetes. Who'd have thought?
BMI>23 if you are South asian
https://www.diabetes.co.uk/south-asian/
[1] https://medium.com/@drjasonfung/the-diabetes-payroll-291649d...
Not sure if there's much you can do while diabetic, but cut bread-like and sugary foods, these spike your insulin the most and your body becomes insulin resistant and so you need more and more insulin, more that you can make.
A type-2 diabetic on the other hand, depending on how far their disease has progressed, could potentially ween themselves off insulin entirely if they were to completely abandon carbohydrates. These diets are extremely hard to maintain, especially indefinitely, however.