More Americans can now get insulin for $35 | Hacker News Reader

More Americans can now get insulin for $35

cnn.com

96 pointsMilnerRoute61 comments

Thanks to the current administration and the government of California's program to manufacture and sell Insulin at cost, the preexisting monopoly is forced to lower their prices. They are not doing this out of the goodness of their hearts.

This has nothing to do with California's program at all. I'm not even sure they've started and I highly doubt it'll be successful. California can't produce the new patented insulins, so they'll be forced to produce older versions that don't work as well.

This was an agreement between manufacturers and the government to guarantee a $35 co-pay for insulin.

Before the agreement came a negotiation and it seems like the threat of doing the aforementioned thing may have been useful for that.

Not really because California isn't producing the most profitable insulins.

Governments don't need to be profitable.

It's the undesirable kind of insulin you can already get cheaply from Walmart though.

Let me restate that - California isn't producing the insulins that people want.

Surely this is an expansion of the previous administration forcing $35 insulin?

https://www.cms.gov/newsroom/press-releases/president-trump-...

The recent news is leaps and bounds beyond the token efforts by the previous administration.

https://apnews.com/article/fact-checking-845638742817 [ Separately, the Trump administration implemented a program in which some Medicare Part D and Medicare Advantage plans voluntarily set the maximum copay for insulin at $35 per month. However, not all insulin products are necessarily covered by the plans that participate. It also does not affect costs for people who are uninsured or have other coverage.

That program remains in place, and Cubanski pointed out that the Biden administration supported expanding that initiative. A provision under the idling Build Back Better Act would have applied it to private insurers, for example.

That legislation also proposed allowing Medicare to negotiate the prices of certain drugs, including insulin. ]

> By cutting the list prices for Humalog and Humulin, Eli Lilly could avoid having to pay an additional $430 million in Medicaid rebates in 2024

It seems like there's more to it but I'm not sure.

Good news, but it is decidedly not a good thing that the price of insulin is a major issue in American politics.

Given there are 8 million people that take it regularly, I'm not sure I agree.

...that the price of a biologically-necessary medication is even an issue, at all. It should be affordable/given to all, seeing how it does not cost much to manufacture at scale.

Essentially, businesses are charging people to stay alive.

https://medicine.yale.edu/news-article/the-price-of-insulin-...

I think you're willingly missing what OP is implying.

I don't think it's a good thing, but I do think it unfortunately is a real political issue.

The marketing around this is will win the best newspeak of 2024 - the pharmaceutical companies are making it sound like they're selling it at this price out of the kindness of their hearts. No mention of the decades of price gouging and the new laws to put a stop to it.

For real. It's like if outlets were writing stories praising generous employers for paying the minimum wage permitted by law.

This 100% happened because of the Biden Administration got the Inflation Reduction Act passed, which has resulted in a cap on the price of insulin for Medicare beneficiaries by allowing the government to negotiate the price of certain drugs.

People remain deeply ill informed about the IRA because the media doesn't cover it at all. Normal Americans can't make an informed decision about what's going on if no one is telling them. It's very disappointing.

CNN is making it sound like that. CNN's journalistic integrity compels them to explain that to us. Instead, CNN gives big pharma a nice little PR boost by burying the lede.

They were only price gouging before because of other bad laws that prevented others from producing it and selling it at lower prices.

The state created their monopoly.

"it's not our fault, we had to price gouge"

Yeah no. There is no benign justification for the three main insulin manufacturers raising prices in lockstep like the cartel they are.

Which specific laws are you referring to? Older formulations of insulin have been out of patent for many years, so in principle any company can produce generics for sale at lower prices. It can be expensive for generics manufacturers to get through the FDA certification process.

Obviously: the ones that require expensive certifications to make and sell drugs, the reason that there are only a few brands’ products for sale.

There are lots of people who would happily produce insulin and undercut the existing prices, but the pharmaceutical industry pays a lot of money to keep the barriers to entry in place.

> any company can produce generics for sale at lower prices

Which maybe explains precisely why we don’t see it happen: race to the bottom on pricing means reduced profitability. Why would you sign up your company to make less money?

There are a lot of companies producing generic drugs. Teva alone sold $9B worth in 2021.

https://www.fiercepharma.com/pharma/top-10-generic-drugmaker...

> There are a lot of companies producing generic drugs. Teva alone sold $9B worth in 2021.

Yes! Note though that I'm not claiming a company cannot make money from producing generics.

But the question remains: why isn't some generic drug company then producing and making a killing (because they could underprice) in the insulin market? I think my original argument is the most likely reason, but I'm open to a stronger argument.

Eli Lilly and Novo Nordisk are now producing generic insulins.

https://www.goodrx.com/healthcare-access/research/how-much-d...

Actually, the price of insulin has be going down over time, not up for insured patients.

But due to the bizarre regulatory system around healthcare in the US, manufacturers were incentivized to increase the list price (public price) all the while dropping the net price (confidential negotiated price with insurers).

This graph halfway down this page sums it up nicely: https://www.drugchannels.net/2020/08/five-top-drugmakers-rev...

Seems like lot in USA healthcare could be solved if it was mandated that everyone must get the lowest net price, plus at most some unreasonable margin like 100%.

Interestingly the government tried something similar - out of all the negotiated prices for private insurance, the government has to get the best one.

Good idea right?

Well it ended up raising prices. Because companies were happy to tell a small insurer with a good price "too bad" so they didn't have to take a massive hit on their government account.

Incredible that a drug discovered >100 years ago can still be used to price gouge Americans... Thankfully now there seems to be some semblance of rationality?

Executive branch had to threaten Big Pharma to make this happen. FTC is similarly pursing pharma companies who improperly submitted patents to the FDA’s orange book to extract more profits.

https://news.ycombinator.com/item?id=37561696

https://www.ftc.gov/news-events/news/press-releases/2023/11/...

https://www.ftc.gov/legal-library/browse/warning-letters/819...

> Thankfully now there seems to be some semblance of rationality?

Rationality? No. Regulation.

https://www.whitehouse.gov/briefing-room/statements-releases...

It's not the same drug. You can get the same insulin produced 100 years ago (well you can't because it was extracted from animal pancreases) for cheap, but guess what? Nobody wants it.

These are newer, better versions of insulin.

Modern insulin analogs were not invented 100 years ago.

It isn’t the same drug as 100 years ago. The 100 year old insulin is long off patent and cheap.

No one is purifying insulin from ox pancreas anymore

Although it’s a shame for profit’s have taken over drug discovery this way

From the article it seems it's from self-imposed price caps. I wonder how long they will be able to keep this up or if they will use this as a moral capital to spike the price (non pun intended) of other medications.

It seems to me the main problem in the US healthcare is not the question if it's public or not but its large insane costs. The fact that other countries produce the same drugs for a small fraction of the price, sometimes pennies, is very telling of how rotten and inefficient the whole system is.

Imagine the price of milk slowly increasing to $100 per gallon over decades, due to greed, regulations, price cartels and speculation, and nobody noticing to ask why. People would probably being to ration milk only for those who need it the most like mothers who can't breastfeed their babies and there would be political pressure to create public milk banks and milk insurance and other public mechanisms. But all of that political energy would not solve the root causes of the problem.

That's not really a good description though. Milk is still relatively cheap - the problem is that there a number of new milk substitutes (soy milk? yogurt?) that have come one the market that people want more then plain old milk.

Those new milk substitutes are great but they're not cheap. We can certainly get the people making them to sell them cheaper. The only downside is that the disincentive to create still newer milk substitutes.

If you're really happy with the status quo - or even really happy with plain old milk - then this is a good situation. If you wonder about something better then this is good touched by a bit of worry.

I picked milk as an hypothetical example but it could have been anything that's essential in some way. Could have been salt, sugar, fertilizers, etc.

> From the article it seems it's from self-imposed price caps.

It does. Except it happened because the Biden administration forced them with threats. This was not done out of any kind of kindness.

Threats or merely a deal. Remember, Big Pharma is to Democrats what Big Oil is to Republicans.

My question is always how much are the real effective costs monthly/annually? The numbers always seem wild and are frequently quoted in thousands annually, so when you read things like: > “The amount of profit that they might be giving up [by capping costs] is relatively limited,”...

I am honest, I don't know what to believe, and I don't directly know anyone who uses insulin to even have any anecdota.

Tangent and I don't know how productive it is to discuss, does this have anything with the GLP-1s (Ozempic/Mounjaro et al.)?

The pressure is coming from legislation, and while there is no doubt lobbying going on, am I wrong that it doesn't feel like the same relentless pushback from the triumvirate? Is it just that there is critical mass to drive change, or is the bitter fight not worth it when they have potential weight management products applicable to a much wider audience?

> The pressure is coming from legislation, and while there is no doubt lobbying going on, am I wrong that it doesn't feel like the same relentless pushback from the triumvirate?

part of it is because medicare has to cap it because of biden. the other part is that california said "screw it we'll manufacture it and sell it at that price" so they didn't want to lose all money from the 6th largest economy in the world with the highest population in the us states.

> Is it just that there is critical mass to drive change

kinda if you count california

California is not manufacturing insulin. They are buying it from a non-profit drug maker that was already in the process of setting up a series of insulin production lines.

Brazil has free insulin since 2006.

It's the older versions of insulin that Walmart sells today for cheap. Issue is, it doesn't control blood sugar as much. The better, newer versions of insulin aren't free in Brazil.

“But drugmakers also faced changes to the Medicaid rebate program that would have likely cost them hundreds of millions of dollars each if they didn’t lower their list prices.“

This should have been the opening paragraph.

I have a feeling the drug companies are doing just fine. The high quality marketing and TV commercials during every episode of Jeopardy! (USA) indicate that they’re not cutting back anytime soon.

Does this help everyone? There was a story awhile ago about Walmart selling insulin for cheap, but it was only an older formulation that’s way more difficult to dose

It looks like it's a step in the right direction.

There are several classes of insulin products available today:

Rapid-acting insulin, short-acting ("normal insulin"), intermediate-acting, long-acting, ultra-long acting and pre-mixed (a combination of the above).

Lantus, the first one mentioned in the article, is a long-acting insulin. Novolog, novolin, and levemir are rapid, sort/intermediate, and long respectively.

So it's not just basic insulin that is seeing the price reduction.

Obviously this means a bunch of drug companies went out of business or stopped producing insulin because it was no longer profitable to make?

> Obviously this means a bunch of drug companies went out of business or stopped producing insulin

If they invested the money they've earned by selling insulin at very high margins for many years into research (as drug companies usually claim), then they should be fine.

If their business model depended solely on selling a single product and enjoying the margins, then it's good for the society. Someone else can produce it.

The price cap just brings down the price to the same amount other countries pay. It's perfectly profitable for the pharmaceutical company to sell at that price. The ones who will suffer are all the middlemen between the end user and the pharmaceutical company.

Who would have thought that having a single entity(not focused on profit) negotiating prices for pharmaceutical products would benefit consumers. Well, except every single country with universal healthcare.

8.5 million Americans need insulin. Why doesn't our government just fund and produce it for the people?

Because they might not do it in the future.

If I've correctly understood the messaging around "if they give it to you, they can take it away".

“Sanofi is joining the nation’s two other major insulin manufacturers in offering either price caps or savings programs that lower the cost of the drugs to $35 for many patients”

Amazing how they manage to not mention that was forced by the Biden administration.

I don't know much about diabetes, but I do know that:

- Diet and moderate exercise are associated with a reduction in all cause mortality across the board.

- 'Blue Zones' are people who live to be 100 years or older. There's a great Netflix show about it if you want to learn more.

> More Americans can now get insulin for $35...

So most of them can keep enjoying their addiction to ultra-processed food?

That’s inappropriate. There are millions out there who are born with Type 1.

That's why I said "most", not all. Type II is 95% in USA.

[0] https://www.cdc.gov/diabetes/basics/type2.html

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