The production cost of insulin is incredibly low. The pricing on it in the United States is systematic criminal manslaughter.
The thing we can't talk about without risking cancellation is that nearly all Type 2 Diabetes is preventable. In other words, the choices of the many have a significant negative impact on those (i.e., Type 1'ers) who don't really have a choice.
I’ll never know and I’m stuck with it.
Diet. Exercise. Etc. All known to change T2D.
Insulin is made in massive facilities in large batch runs. Making 5X to 10X is basically cost of materials, which haven't really increased enough to justify the price increase.
This is (mostly likely) a rent-seeking situation where a few providers who are allowed in the market are milking it for all the profit they can.
That is also known as demand. They do because they can.
1) Healthcare is a limited resource, like anything else.
2) Prevention, which few if any "leaders" highlight, is a viable alternative to healthcare price increases.
Are there there some nefarious undercurrents? Yes, of course. But to blame all our ills - and remove diet, lifestyle, etc. - on ever increasing demand only makes the current system stronger. People who believe they have no control aren't part of the solution.
Our situation has nothing to do with demand and everything to do with corporate greed. Many western European countries empower their governments to set upper bounds on the costs of medication to reduce the ability of pharma-bros to make disgusting amounts of personal wealth off the suffering of others.
Exactly. The preventable T2D is driving up demand (read: prices) for both T1D and T2D.
I don't know about Canada. I do know about supply and demand. We all do. In the context of healthcare it makes no sense that ppl abuse their health and then expect prices to fall.
What you fail to consider it that the company that controls the particular type of Insulin that Type I diabetics require is charging 80% less in Canada than in the USA with everything else equal.
Do you get it?
Do you get it?
Our real issue here is that there is absolutely no incentives to control costs.
You’d think our ins companies would do it, but I’m practice, they end up negotiating sweet deals with the drug manufacturers. say med X @ $1000/mo msrp, but the ins companies negotiate it down to $400/mo. The drug company makes out like a bandit, and the ins people get kick backs for buying from the drug co, and passes on the costs to the insurance buyers.
I believe they offer R (short acting / 2-5h), N (medium), and L (long acting / 24h). The problem with the older insulins isn't so much that they're faster, it's that they're less "specific" (from my experience). A newer short acting insulin (Apidpra, etc) has a spike in the 15-30 minute range and the spike is steep and the tail (while up to 5 hours) is low. Whereas R peaks in the 30m-1h range and the peak is low and the tail is much higher. As such, you need to plan ahead much better for your eating. It's frustrating, but not horrible. The N and L have similar problems (L is the reverse, where you want a tail equal to the spike, but it isn't).
The newer insulins a just much more convenient and require a lot less planning of what you eat and when... and not as close an eye on your blood.
I wonder how different the production costs are though, my understanding is the costs to consumer are greater than 10x
Source: a T1 diabetic, used all possible insulins in my life. Very happy in Europe.
However, actually _saying_ that tends to get people up in arms, harassing you about how it how it shouldn't be necessary for people to use the older insulins, and how the newer insulins shouldn't cost what they do. Even though everyone actually agrees with them and they're arguing against a point that nobody it actually trying to make. It is... frustrating trying to get people to understand that you agree with them, but you're talking about something different.
I had this exact discussion with one such person yesterday, and I was trying to explain that they are sabotaging their own goals by misrepresenting the issues. And that I WANT them to succeed in changing things, but they're making it harder to do so.
Edit: You're already being downvoted for stating something that is obviously and undeniably true, because people are not bothering to understand what you're saying. I'm sorry for that.
In a way it is killing people, blood sugar control is much easier with a mix of the newer insulins, and patience compliance is much higher. This directly translates into better quality of life and lower disease burden from diabetes complications.
No one can argue that pharmcos shouldn't be paid for R & D that increases quality of life, in civilized countries the taxpayer should and will pay for your medication if it's an improvement over what's already at market.
But here people seem to be arguing that if you can't afford anything else there's still Walmart short-acting Humalog, and you get to bear all the risk, and that's just fine.
Like I actually use an open source pancreas to control my glucose levels so now I can sleep every night without having to worry about dying. This is in Europe where the insurance covers everything and prices are cheaper than in US.
Using the Walmart insulin makes everything much much more complex, and even for the smartest of us, even with the best possible insulins, managing T1 is a HUGE pain and can kill you quite fast.
I hope I misread your comment...
> The high price of tier 1 insulins is killing people
Is (more or less) a lie. While
> The high price of tier 1 insulins is making people's lives considerably worse and their diabetes harder to manage.
Is (more or less) true.
When you try to push for change and use, as part of your argument, a lie, you sabotage yourself. People can point at what you're saying and, ignoring the validity of what you're trying to achieve, say "you're lying". That's bad.
The truth is that there are good reasons why tier 1 insulins should not cost as much as they do, not by a long shot. And destroying your own progress towards changing things is counter productive. Just don't do it.
One in four patients in the US have rationed insulin because of the cost: https://news.yale.edu/2018/12/03/one-four-patients-say-theyv...
It is simply untrue to say the high cost only forces people to use the cheaper Walmart generic. That isn't what happens. They ration it, and sometimes they die.
Finally, it doesn't make sense to say that the high price is making diabetes harder to manage, but isn't killing people. That's like saying speeding doesn't kill, it just makes the car harder to manage.
> One in four patients say they’ve skimped on insulin because of high cost
> say they've
^ is the key component. I expect the vast majority of those people had a choice, and they chose not to take it. A poor choice, and a choice they shouldn't have to make, but a choice nonetheless.
The point is, if you're going to fight for positive change, use an argument that can't be trivially dismissed because it isn't true. Fight effectively.
I would argue these two statements are equivalent:
- My patient was killed by the high price of insulin.
- If the price of insulin had been lower, my patient would still be alive.
I suspect that you accept the second statement, but not the first. What's the difference?
1. If the fatty and sugary foods were too expensive for them to buy, they would not have died from those things.
2. They did not die because fatty/sugary foods weren't expensive. They died because they chose to eat fatty/sugary foods. [1]
Just because X (good insulin being cheaper) would have helped prevent Y (deaths) doesn't mean that <not X> caused Y.
[1] I'm ignoring the fact that truly healthy foods tend to outside the price range of the poorer segment. The analogy only really goes so far here.
- People drive cars.
- Cars are car jacked.
- If people did not drive cars, carjackings could not happen.
- People driving cars is a requirement for carjackings.
- People driving cars is not a cause of carjackings.
I understand that it is possible and truthful to argue that people driving cars is a cause of carjackings; it's just not my view of the meaning of those words.
When people learn that the "old insulin" and "new insulin" are completely different products and that "old insulin" is still available at a low cost, the narrative and goodwill is shattered.
People hate being lied to and they hate being manipulated.
If you want to have a discussion that we should make the "new insulin" available for at low cost of for free, that is great! We can talk about the cost to manufacture and to develop drugs.
There are many smart people here and around the world, when we put our minds to a problem, we can find a solutions.
But by not acknowledging and downplaying the time and effort that companies and people have put into the "new insulin", then you are cheapening the work they have done and are signaling to everyone that you would do the same to their time and effort as well.
It's well known that you need to keep all sorts of things under control with type 1 to avoid long-term health complications. Blood sugar is the most obvious.
I watched my father manage his for decades, starting in the 1980s. The technology improvements were interesting - his first insulin pump (about the size of a VHS tape), the custom software to data-dump his glucose meter, "supply-hacking" to keep the infusion sets affordable...
He still had management challenges despite being a dedicated, disciplined, marathon-running Mormon on the leading-edge of treatment. He was fortunate enough to be involved in the DCCT/EDIC trials at the University of Washington, and took the early lessons about future complications very seriously.
You make Diabetes harder to manage by removing modern improvements to the standard of care, and you are certainly going to see increases in deaths and severe negative outcomes.
I pay zero attention to people and news sources that repeat that behavior more than once. Lead with the truth.
I found some references for "old" versions that claim price increase from $17 in 1997 to $138 today, another from $21 to $255.
Going by inflation only those would be around $30-40.
I don't know how much a typical diabetic needs per month (I imagine it varies) but I could see that being a problem for a lot of people if that is, say a monthly supply.
About $25, that last I checked. The ones you're talking about, I believe, are the "newer" ones (which are not very new). The prices of those have shot up over the years (in the US) for no good reason. It's shameful.
For example, Basaglar is a "generic" of Lantus, but it's still expensive.
Here’s How to Save on Basaglar, the Expensive Lantus “Generic” https://www.goodrx.com/blog/basaglar-expensive-lantus-generi...
> Basaglar contains the same kind of insulin as Lantus (insulin glargine), and while it is cheaper—Basaglar costs about 15% less than Lantus—it is still expensive, with a cash price of around $450 for a 30-day supply.
Unlike normal generics, the bio-similars need to go through their own clinical trials and prove they work the same as the original. They can't just "use the same ingredients" and release it. Mind you, that doesn't explain the extreme price markup, but it does explain why these "generics" don't follow the same "85% cost reduction" of normal generics. They still have, effectively, a costly R&D phase.
At least, that's my understanding.
By the way that same site had an interesting article breaking down costs normalized by insulin unit
https://www.goodrx.com/blog/how-much-does-insulin-cost-compa...
By that table and some assumptions about approx 40 IU/day it looks like the cheapest you could get away with at full retail would be about $120/mo, assuming optimal usage etc. The most expensive version would be at least 5x that.
There are plenty of cases of people literally dying because of difficulty managing insulin due to cost. It’s nice to say other low cost forms are available while handwaving away actual deaths as well as accumulative long term damage from difficult insulin management.
https://khn.org/news/insulins-high-cost-leads-to-deadly-rati...
Many of the “newer” forms are 20+ years old, and are also extremely low cost to produce.
Admittedly, they're not cheap w/o insurance, which sucks. But if you can get one, so do. You won't be disappointed.
We should ask what are the outcomes that these systems produce, not how new the drugs are.
A cutting-edge healthcare system plagued by inequality and extreme costs can produce worse results than a more efficient healthcare system which is not as high-tech.
But yes, I agree. Sometimes the juice isn’t worth the squeeze.
Just repeating the question, when I gave you the answer, isn't very productive.
It’s a for-profit system where literally every cog from drug company to pharmacist has an incentive to separate you from your money.
When Europeans can pick from 5 different spring loaded epinephrine injectors and Americans can only legally buy one from a specific manufacturer, of course Americans pay 5x as much.
In plenty of places around the world you can buy all humulin you want without a doctor or the FDA for $30 vial.
If the state was the single largest negotiator for purchasing hamburgers and representing tens of millions of people odds are you would have more competitive hamburger supply bids.