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Comment by AnthonyMouse | Hacker News Reader

It isn't a 100 year old drug. There are newer formulations that are faster acting, longer lasting, easier to administer, etc. They're newer so they're still under patent so they're a lot more expensive (because the rest of the world makes the US pay to develop the newer formulations). When insurance is paying for it, people prefer the newer formulations.

Then, since most people have insurance, there wasn't enough of a market for the older formulations for anybody to bother making them for the margins you get for making a generic. So the prices were high for people paying out of pocket.

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This doesn't pass the smell test.

Anyone making the decade-old version of insulin and selling it for 1% of the price would corner a large portion of the market immediately. Anyone without good health insurance, which is a large and increasing part of the population, would immediately jump on the lower priced version.

And since when are insurance companies excited to pay for the more expensive drug with limited extra utility anyway?

You are giving far too much credit to what is on the face of it a broken system.

You can buy the old one for cheap now: https://diabetesstrong.com/walmart-insulin/

That's 6% not 1% of the cost of new ones, though.

Since this month - and it is headline news all over the country... It shouldn't be extraordinary that cheap drugs needed by millions are available cheaply. (See also: Epi Pens.)

Since 2000.

>McInnis explained since 2000, Walmart has sold ReliOn insulin, the only private insulin brand on the market retailing at $24.88 per vial.

https://www.wfmynews2.com/article/news/verify-yes-walmart-do...

Walmart just started selling analog insulin(the newer formulation) just recently. https://nypost.com/2021/06/29/walmart-to-launch-its-own-low-...

Still 2 to 3 times as much as literally everywhere else.

> This doesn't pass the smell test.

We saw something similar happen during the pandemic. There has to be infrastructure and people with the skill and knowledge to support an industry available, and even if you had those people available you can't just ramp up production in any old place. That's why there were supply chain problems and will continue to be, the UK won't be making its own drugs (designing, yes, making, no) just because it did in the past, the US won't be making computer chips just because it did in the past. There being a profit to be made isn't enough.

> You are giving far too much credit to what is on the face of it a broken system.

The system may be broken but fixing it takes more than a wave of the hand.

> Anyone without good health insurance, which is a large and increasing part of the population, would immediately jump on the lower priced version.

Medicine isn't like a supermarket, people usually just take what their doctor/hospital prescribes. In addition, I think it's likely that those with no/worse health insurance are on average less informed.

I often talk about costs with doctors. Sometimes they offer things my health care does not (fully) cover, sometimes it's about pure luxury (like a arm bandage that is super nice to wear). Or my dentist, I can choose between different pain killers, one of them costs a little extra but goes away way faster.

I would think it's weird if my doc assumes I just want the cheapest available option.

^ Exactly this. They can sell the premium version for however much they choose to, but the cheaper one - the affordable, the one that should be given out for free - is simply not available enough, it's being suppressed by the pharma industry in favor of their own premium, expensive product.

I mean what are people else going to do, die? Oh wait.

I don't understand commenters in this thread coming out in defense of pharmacy companies using their monopoly or influence to deny health care to people that need it. It should be considered a criminal offense. It's anti-competitive. I mean with insulin it's a massive hole in the market - why hasn't anyone else been able to jump into that gap and make a killing?

That was true at one point, but the newer formulations of insulin are old enough to mostly have biosimilars, aka follow-ons, the equivalent of generics for drugs produced by bioengineering. Humalog/Lispro/Admelog, Lantus/Basaglar and others, in many cases made by the same company as the original.

The prices of insulin have been increased steadily each year by about 11% for the past 20 years. There's nothing about research or costs that justify that for 20 year old drugs.

https://www.businessinsider.com/insulin-price-increased-last...

The old formulations (Human insulin, NPH) can be purchased without a prescription at Walmart for fairly low prices - the price that people pay for modern insulin in the rest of the world.

> Then, since most people have insurance, there wasn't enough of a market for the older formulations for anybody to bother making them for the margins you get for making a generic.

Is there some research confirming that? It doesn't quite match my out-of-us experience with other drugs. I get a choice of 2-3 brands of ibuprofen and another 1-2 generics for it. Why wouldn't the same apply to insulin? I expect that it's also not 100% covered? (please correct me here)

You can buy the original insulins from 80 years ago for $35-50. Those are human/porcine insulin and one called NPH that has an intermediate duration. Some people who used those before the newer long/short/rapid actings were developed still prefer them, and others use them for cost reasons esp. because they can be obtained in the US without a prescription. I only know of one brand, Humulin by Lilly.

For modern insulin, they were indeed patented but mostly generics called follow-ons or biosimilars are available. Lantus has an alternative Basaglar that costs about 1/3 as a much. Humalog can be replaced with Admelog. The manufacturer of Novolog makes a biosimilar of their own insulin and sells it for 1/3 as much, if that makes any sense.

The various types differ a bit... Lantus has a slower absorption and thus longer duration than it's main competitor, Levemir. Novolog differs from Humalog in one protein on one side of the chain or something. Some people can't use one or the other due to allergies to the excipients or unexplained resistance to the effects.

"(because the rest of the world makes the US pay to develop the newer formulations)"

How does the rest of the world make the US do that?!?

At least give the option of the old shit

Walmart sells vials of the generic “old shit” for cheap.

Do you have a source? I wasn't able to find any mention of it on Walmart's website.

https://diabetesstrong.com/walmart-insulin/

> At least give the option of the old shit

It’s available. It’s just far less convenient and much easier to fuck up in a life-threatening way.

The insulin price meme is a particularly bad one.

It is really not. The price disparity between US and rest of world is quite massive.

The often quoted prices do not take into account the actual price paid by consumers, the type of insulin being compared, or relative purchasing power of the countries. I don't actually know how if insulin is actually all that much more expensive across the world when taking those factors into account. Seems like cherry picking without controlling for all of those factors

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