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Why is insulin so expensive? The absurd price of the drug for diabetes is explained



When inventor Frederick Banting discovered insulin in 1923, he refused to put his name on the patent. He believed it was unethical for a doctor to benefit from a discovery that would save his life. The co-inventors of Banting, James Collip, and Charles Best sold the University of Toronto's insulin patent for only $ 1. They wanted everyone who needed their medications to be able to afford it. Today, Banting and colleagues will be rotating in their graves: their drug, which many of the 30 million Americans with diabetes rely on, has become a child on the plate of weakening pharmaceutical prices.

The price of the four most popular types of insulin has tripled over the last decade, and patients who are already faced with pocket recipes have doubled. By 201

6, the average insulin price has risen to $ 450 a month – and the cost continues to increase so that as much as one in four diabetic patients now encounter or skip rescue doses.

Members of Congress are putting pressure on pharmaceutical companies and pharmacies to control insulin costs. And on Wednesday, a healthcare company showed that it was trying to respond to the problem.

The Cigna Insurance Gypsy, as well as its pharmacy help, Express Scripts, announced a new program that will limit the 30-day insulin price to $ 25. This is a 40% reduction of the $ 41.50 fee per month Benefits of Express Scripts in 2018

The program is expected to be launched later this year for insurance plans that work with the benefits of Express Scripts. Until next year, all patients with diabetes of Cigna's plans will be able to join, according to the Washington Post. It can affect about 700,000 patients who rely on Cigna or Express Scripts for insulin coverage and will apply before they have coped with the deduction.

But here are a few catches. In order for Cigna patients to participate, their employers will have to choose the change in the plan, Stat reports. Cigna is just one of the many insurance companies covering less than 1% of the 23 million people suffering from diabetes in America.

"Any measure that helps only part of the population through opaque transactions between the players responsible for the crisis is not a solution," said Elizabeth Pfister, founder and CEO of T1 International Patient Group. "We need long-term confidence that manufacturers will be responsible and prices will be affordable, not other bandwidth assistance."

Most diabetic patients will still be vulnerable to the pricing of companies because companies can still determine the prices at what level they want. And no medicine is better for understanding how this happened than insulin. As the companies justify price rises

With type 1 diabetes, which affects about 5% of people with diabetes in the US, the immune system attacks insulin-producing cells in the pancreas, leaving the body with little or none of the hormones. In type 2 diabetes, the pancreas still produces insulin, but the body has grown steadily on its effects. In both cases, patients rely on insulin medications to maintain energy from the food that flows into their bodies.

But the US is a global diversion from drug money, accounting for only 15% of the world's insulin market, and generating nearly half of insulin's incomes in the pharmaceutical industry. According to a recent study in JAMA Internal Medicine in the 1990s Medicaid paid between $ 2.36 and $ 4.43 per unit of insulin; by 2014 these prices are more than three times, depending on the wording.


Trends in Recovery of Medicines for Insulin Products Coverage from 1991 to 2014
Internal JAMA Diseases

Physicians and researchers studying insulin say this is another example – along with EpiPens and generic drugs from decades ago – by companies raising the price of their products due to the poor regulatory environment around the pricing of medicines. "They do it because they can," said Jing Luo, a researcher at Brigham and the Women's Hospital, told Vox in 2017, "and that's scary because it's happening in all sorts of different medicines and drug classes."

In countries with a payer's health systems, governments have much greater impact on the whole healthcare process.

In England, for example, the government has an agency that negotiates directly with pharmaceutical companies. The government sets a maximum price to pay for a drug, and if companies disagree, they just lose the entire market. This puts drug makers at a disadvantage, which leads to a reduction in drug prices.

The United States does not do that. Instead, America has long adopted a free-market approach to pharmaceuticals

Drug companies are bargaining separately for drug prices with various private insurers across the country. Meanwhile, Medicare, the government's health program for those over 65, who is the largest drug buyer in the country, is actually banned from negotiating on drug prices.

This gives the pharmaceutical market more leverage and leads to a kind of price jump. I saw with EpiPens, the latest opioid antidotes – and insulin. As with Eli Lilly, who are raising prices each year since 2014, they say that increases are only the price that comes with innovation – creating more effective insulin formulations for patients.

According to the paper of 2017 Lancet to raise insulin prices, "older insulins have been replaced successively with newer, progressively improved products covered by numerous additional patents." The result is that more 90% of the privately insured type 2 diabetic patients in America are prescribed the latest and most expensive versions of insulin.

But it is not clear that these newer formulations are significant improvements in older ones, the researchers write: "The data are not conclusive about whether insulin analogues that are used today are safer or more effective for most patients with type 2 diabetes than human insulins. was widely used in the 1990s for which patents expired. "

Luo, the lead author of the Lancet report, does not find the argument for" the cost of innovation "very convincing. In his studies he has seen many examples of the same insulin products that have been continuously available for years without improvements, but their price tags have risen at a much higher rate than inflation.

is now inaccessible to most Americans living with diabetes – in some cases, for a bottle of over $ 300, "he said. "It is also strange that Humulin still has a price of over $ 150 because this product was first sold in the United States in 1982."

Doctors do this because they can

So the problem with the prices of medicines for insulin is much bigger than everything Cigna alone can fix. But there may be more changes on the horizon on the market.

The three largest insulin producers – Eli Lilly, Novo Nordisk and Sanofi – will testify to the Chamber of Commerce's sub-committee on energy and commerce next week, focusing more on this issue. Legislators, including Chuck Grassley (R-IA) and Ron Wyden (D-OR), also investigated the matter and sent letters to pharmaceutical companies asking them to explain their scandalous price rises.

But while insulin pressure is increasing, we see the terrible impact of rising insulin prices on patients: people are forced to reduce insulin to pay for medical bills – and end up with kidney failure, blindness or even death.

One clear solution to the problem would be to market a common version of insulin. There are currently no genuinely available options – although there are several rebranded and biosimilar insulin – partly because companies have made these gradual improvements to insulin products, which allowed them to keep their formulations under a patent, and since older insulin preparations have dropped [19659031] But history shows that when cheaper generic options are introduced on the market, drug prices are declining. "There are no generic competitors for Eli Lily's insulin," Luo said. A century after finding insulin, it's time to have it.


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