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Comment by yonran | Hacker News Reader

I listened to the Vox The Weeds podcast interviewing the same author and was frustrated that his many explanations seemed disconnected. Since old insulin patents have expired, is it that you are allowed to buy generic insulin but there are no manufacturers, or that you not allowed to buy generic insulin because recent advancements are so good that doctors won’t prescribe the old stuff anymore? And no one will make generic insulin because the brand-name companies will undercut them and there are so many kinds you need to make, but basically a $100 million donation to the world by California will fix all that?

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You are allowed to buy generic/affordable "older" varieties of insulin. It can be got at Walmart for $25 per vial. It is a "regular insulin" as opposed to the more modern insulin analogs; a functional but inferior technology that requires a very restrictive and rigid diet, as opposed to modern combinations of fast and slow acting analogs that allow for something closer to a "normal", albeit carb-cautious diet. It will, to quote my endocrinologist, "keep you alive". It is not part of a modern regimen for a Type 1 Diabetic.

My understanding is that it is manufactured by Novo Nordisk, the makers of more modern, name-brand insulins, as well (they make the fast-acting insulin aspart called Novolog that I take as part of my own regimen).

For further reference: https://diabetesstrong.com/walmart-insulin/

> Regular / NPH

That's what my brother used to take 20 years ago.

They are not exactly 'inferior technology' and there are uses for them. But you are right that diabetics these days don't generally take them.

There are generic long lasting insulin alternatives, but none that I know of are available in the US. I believe that's what CA wants to do.

Yeah, I don't mean to decry their effectiveness, only what they demand of the user in order to render that effectiveness. They were the gold standard up until relatively recently, and saved a lot of lives.

The modern programs of a combination of fast/slow analogs are more flexible and adaptable. The demand on the user is still pretty high, but it's a bit closer to baseline.

EDIT: and I guess I should say, I've got plenty of bias from my own relatively narrow experience. I'm sure there are different regimens and different opinions amongst various doctors

So is CA going to make the new kind or the old kind? If people don't want the old kind, then I hope they're making the new kind!

> Since old insulin patents have expired, is it that you are allowed to buy generic insulin but there are no manufacturers, or that you not allowed to buy generic insulin because recent advancements are so good that doctors won’t prescribe the old stuff anymore?

Walmart sells human insulin (the previous gen stuff) for $25/vial. It’s manufactured by Novo Nordisk. It’s what was regularly prescribed in the 1990s. It has downsides, such as requiring a strict eating schedule: https://diabetesstrong.com/walmart-insulin/

Most doctors today prescribe human analog insulin. They do this because it is better at controlling blood sugar without requiring strict eating schedules.

In my experience at least, yes, there are many types. However, a few types are remarkably common and overpriced. In terms of a tech metaphor, it’d be like making Ubuntu and Windows 10 available for all after having them severely restricted. And yes, I know Ubuntu is free, but the point was to demonstrate how common the most popular insulins are.

Are the popular types of insulin still under patent, and if so, how is California’s initiative a solution? Are they hoping to license the necessary patents?

Here you go :

https://haiweb.org/wp-content/uploads/2015/05/HAI_ACCISS_fac...

It looks like most patents are expired. I hope this should open the way for effective analogue insulin to be manufactured generically.

The insulin that California would be getting from Civica Rx, at least, would be analog insulins. They are partnering together until California can make its own insulin. The biosimilars made by Mylan (Semglee) and Eli Lily (Basaglar) are both analog biosimilars, specifically biosimilar insulin glargine.

>doctors won’t prescribe the old stuff

whatever the quality of life improvements of the newer stuff is its worth pointing out there's a doctors-getting-kickbacks scandal every few years https://duckduckgo.com/?t=ffab&q=prescription+kickbacks&ia=w...

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