Everyone who has type 1 diabetes has to use insulin, and about 25 percent of the people who have type 2 diabetes rely on it to control their blood sugar. But its costs are skyrocketing and no end is in sight.
At the annual convention of the American Diabetes Association in Boston this June I listened with perhaps 1,000 other diabetes professionals to one of the world’s top experts on diabetes talk about insulin costs. Irl Hirsch, MD, is the professor of medicine at the University of Washington School of Medicine, also treats patients with diabetes, and has type 1 diabetes himself.
For several years, readers of my articles have written me to complain about the rising cost of insulin. Because I know how expensive that insulin has become, I made sure to hear Dr. Hirsch’s presentation. But I was surprised to see that he cited one of my articles in a slide that he presented.
The Patent Problem
Dr. Hirsch reviewed the cost of insulin from 1921 when Drs. Frederick Banting and Charles Best discovered it. “In a generous gesture that unfortunately didn’t start a trend, they sold the patent for $1 so that cheap insulin would quickly become available. It worked like a charm: within two years Eli Lilly had sold 60 million units of its purified extract of pig and cow insulin.”
But after 1977 Genentech began to produce the first genetically-engineered, synthetic human insulin. This led to the first “dramatic increase” in the price of insulin. Since 1982 Eli Lilly has marketing it as Humulin.
In 1996 the development of the first insulin analog, lispro, led to another increase in the cost of insulin. Eli Lilly markets lispro as Humalog.
Citing My Article
Here, Dr. Hirsch cited an article that I wrote in 2001, “Is the Cost of Insulin Skyrocketing?” At the time I wrote, the net wholesale cost of a vial of Humalog was $35/vial, while a vial of Humulin was $20.
By 2005, people worldwide were spending more than $7.3 billion for insulin. “But no one could have predicted what would happen over the next decade,” Dr. Hirsch said. By 2013 we were spending $21 billion for it.
Between 2005 and 2015 the cost of a lispro vial went up 264 percent, while a vial of insulin glargine went up 348 percent, and a vial of NPH went up 364 percent. That’s a lot, but other insulins went up even more.
The cost of an aspart pen rose in this 10-year period by 389 percent. And the cost of a vial of U-500 regular insulin jumped a staggering 508 percent.
Dr. Hirsch noted that one year ago Sanofi increased the price insulin glargine 16.1 percent. “And literally the next day, Novo Nordisk increased the price of insulin detemir (Levemir) 16.1 percent. In fact, this pattern repeated six months later, and this has actually happened 13 times for these two products that have total U.S. sales of $11 billion.”
In the question and answer period following Dr. Hirsch’s presentation, a doctor who said that he is in private practice in Northern California commented that the prices of these two competing insulins going up in apparent lockstep “looks suspiciously like price fixing.” Dr. Hirsch refrained from replying.
Why is the price of insulin skyrocketing? “The actual cost of insulin manufacturing is extremely cheap,” Dr. Hirsch says. “My question is whether it ethical to charge such a price for a medication required for survival by some people with diabetes?” He left this question hanging.
What We Can Do
But meanwhile he suggests four things that we might do:
1. In general, Walmart and Costco are the cheapest when we pay in cash.
2. The cost of human insulin (NPH and Regular) is still quite cheap at Walmart.
3. All insulin companies have special programs for the very indigent.
4. We might consider online international pharmacies, although he is concerned about the problems of how to confirm factors like the potency and sterility — not to mention that it’s not legal.
Dr. Hirsch concluded his presentation by stating, “We have never had such challenges with insulin costs, as it has become unaffordable for many of us.” Biosimilar insulins, which are on the horizon, are unlikely to have much effect on the cost of insulin, and “we don’t know where the cost rise will end.”
One of his final comments is that the role of patient advocacy groups is unclear. It’s our job now to help clear up this travesty.
This article is based on an earlier version of my article published by HealthCentral.
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A few weeks after my last post, I can report that by getting stricter with my carb intake (20-40 mg per day now) I have reduced my insulin requirement from about 60 units total of Humalog and Lantus to zero, (though if I want to eat something like yogurt and berries) I will use a little insulin to cover that. My blood sugar readings now range from 80-110, though mostly under 100 with no insulin. This is after 20 years of insulin use for T2D. If I can do it, as David and others have done before me, I think most type 2s can do it as well. It does involve some creative cooking and baking to have enough low-carb foods and variety to keep eating somewhat pleasurable. But rest assured, the sugar cravings subside quickly once you slash the refined carbs.
This is all new to me . I have been using insulin for 20 years+, but I had a very good insurance program before retirement. I did not know the real cost of my insulin until I left work and my insurance plan. Then came Medicare when I least expected it. My body does not make insulin anymore so I need very large doses 3-4 times a day. I can not keep paying these prices for the drug.My “gap insurance” is not happening at the right time for my income. What happens if you get the insulin from Canada??? Also are there any advocacy programs about trying to get these costs down,I would like to join one ?? I personally would like more information about getting the drugs cheaper out of country.
Dr. Irl Hirsch, who made the presentation that this article is based on, is probably our leading advocate for lower insulin prices, Juanita. You may want to contact him at:
University of Washington School of Medicine
1959 NE Pacific Street
UW Mailbox 356426
Seattle, WA 98195-6426
There was an excellent piece on CBS this morning about skyrocketing prescription drug costs. For those of us being held hostage by our employer-provided health care plans, we don’t have the luxury of purchasing insulin outright from Canada (unless we want to pay for it 100% out of pocket).
Here’s a link to the news pieces:
Stephen, I don’t know what country you are in. If you are in the U.S., Regular and NPH insulin can be purchased in almost every state without a prescription (along with syringes). Wal-Mart has the lowest price for insulin (about $25 a vial the last time I checked).
Yes, a low-carb diet will work wonders for type 2 diabetics, but not everyone can stand to give up most carbs. They say that after a couple weeks you stop wanting carbs, but I don’t know a single person who hasn’t gone back to eating carbs, with perhaps the exception of David.
Extremely low-carb diets will reduce insulin demand significantly, especially in insulin-resistant type 2s. As for older, cheaper insulins, my endo won’t precribe them, and in a small city there hasn’t been much choice in doctors.
In the big picture the failure of our political system continues to ramp up the unconscionable profiteering of the pharma industry. Obviously the free-market game is rigged if no one can produce generic insulin, years after patents should have expired.
One question for Robert Ezra: Do you know if Mike’s Marine Pharmacy has an equally reasonable price for Lantus or Levemir?
since we’re repeating ourselves.
Mike’s Marine Pharmacy in Canada $56.33 ea for Humalog – inc shipping.
I just want to add to what I said above that diabetes can be controlled with Regular and NPH insulin. The expensive engineered insulins are not necessary. All you have to do is to match your carb intake to the size of your shot, and spread the carbs out over several hours. It’s not difficult to do. Take a shot of mostly R cut with some NPH at 8:00 a.m., eat breakfast at 8:30 a.m. and lunch at noon. Do something similar for dinner and a bedtime snack. You can achieve good control with the inexpensive insulins.
Good point, Caleb. I actually covered it in a recent article I wrote that may not be posted here yet.
There is a “we” or “them” situation created. “We” have he right to bare arms if they are going to try to kill us off. Big Pharma & all associated with the money-making had better start now hiring security guards…it appears. There are enough diabetics to cause some real problems iF someone doesn’t find a way to lower insulin prices. [An insulin user for 68+ years.]
I just bought 3 vials of Humalog from Mike’s Marine Pharmacy in Canada for $169 inc shipping.
It’s one way to avoid the Medicare doughnut hole.
I agree that insulin costs are skyrocketing, even for those of us who have insurance. A couple of months ago, I paid $90 out of pocket for three vials of Novolog. This week, I paid $155 for four vials. The increase of $30 to $38.75 per vial for my co-pay represents a 29% price increase. That’s huge, and way above a normal production cost increase. I believe we are paying for the tremendous amount of prescription drug advertising during prime television programming as well as contributing to the huge profits being enjoyed by both the pharmaceutical and insurance companies. It’s a case of capitalism run amok.
I have type 2 and luckily was taken off insulin cuz costs are high yet I was put on 3 pills one being januvia which if wasn’t for drug plan would cost me over $400 a month for 30 pills so now luckily I only pay $3.60 I can honestly say I see no end in costs going down in future insulin used to be for us diabetics but now you have body builders using it as well
no generic because of patents
Some of the comments on this article are truly bizarre. Brenda says that Medicare can demand a discount, but the law says that it can’t. Josef is glad that the price is exhorbitant. The fact is, if it is cheap to make it should be cheap to sell. The reason for the high prices is the same reason it always is: the drug manufacturers are greedy. We need government regulation of the drug market, as I said in my first comment. If research and development slows down, I don’t see that as a problem. I think the pace at which new drugs are coming to the market is too fast anyway, and many of the new drugs turn out to be ineffective. I wonder why a manufacturer of generic drugs hasn’t jumped in and started producing insulin?
ballpark…humalog was $90 a vial 3 yrs ago and now it’s $250. Why?
Not sure about Brenda’s explanation because under Part D Lilly get’s it’s money.
I’ve been t
I don’t know about you guys but I think that when I was diagnosed at 13, I should have been told that I mine as well forget about any kind of savings account. I am so sick of insulin prices going up. It is not like people are becoming less and less diabetic. This is total thievery. Diabetes is a death sentence unless you are in the military, marry into the military, or win the lottery. I cannot believe that we allow the pharmaceutical companies to run this country. These are people’s LIVES here. How can people be so unethical. I want these companies outed.
So much for NOT having DEATH PANELS…they are doing it by regulating and interfering with doctor’s orders. Why doesn’t medicare(our government) just have food rationing for diabetics allowing for only minimum calories and you have to get your food through special GMO monsanto warehouses….that way they can chop off our legs, lead us around by our white canes and just rob us of everything…oh wait, they are….
In my opinion, I am glad companies can make huge profits selling insulin. I see it as a great incentive for them to continue selling it. Also, the higher the profit margin, the greater the window of opportunity for someone to come in and compete. Although this is unlikely since developing a new drug costs A LOT of money most of it thanks to the FDA (who is there keep companies from making drugs than can kill us because as we all know, the best way to make money is to kill your customers right?).
To all those who complain and insist that insulin should be cheaper I say, stop your whining, go for it and create it!
One reason for an uptick in the price of an entire class of drugs is, quite literally, how much of a discount Medicare insists upon (e.g., paying $10 for a $100 drug), which trickles down into how much of a discountprivate insurance requires. The government-required discount for drugs in most socialized-medicine nations adds to this burden on the manufacturer (as well as do the increasing costs of advertising and lawsuits). These costs must be recouped somehow. The only viable method is by raising the retail price, which raises some of the wholesale pricing. The large increases are because most of the world refuses to allow pharmacos to recoup their investments in research and development (it all falls down to free-market medicine in the US).
I am turning 65 in August, and I am facing the donut hole too. I use 3 vials of insulin a month. If I can reduce that to 2 vials, I might be able to avoid the donut hole, but I don’t know if I can reduce my carbs that much. If you are using an expensive engineered insulin, you really don’t need to — R and 70/30 are quite capable of controlling your BS levels. As for test strips, if you vary the times that you use them, 3 strips a day should be enough. If you need more, there are lots of people on eBay selling their strips to make money, and you can get them cheap there.
Even worse, there is no generic on the horizon to keep Medicare prescription plans from forcing those of us who use insulin into the donut hole. We have to beg our doctors for samples or else go to Mexico. So ironically for Medicare costs, what they won’t pay for up front is probably going to wind up costing a lot more when diabetics undermedicate and then develop complications. (While we’re at it, how about the restrictions on test strips under Medicare part B, which require filling out logs of blood glucose results if you test more than three times a day?)
I’ve been using insulin for only four years, and Walmart’s price hasn’t gone up, so I assumed that the prices were stable. I’d love to see a government investigation. Better than that, I’d like the drug industry to be regulated. In my opinion, the FDA should have control of drug prices. Furthermore, companies that wish to discontinue a drug should have to get the FDA’s approval.
Patents expiring would theoretically allow competition and make prices go down. Why hasn’t that happened like it does with other generic medications?
Probably regulatory strangulation. Big Pharma makes sure that complex and strict regulations limit new entries into the market.
It would be interesting to see what the cost is in India, where many US patents are invalid.
This article does not answer why the price has skyrocketed. It just confirms what us type 1’s already know.
I thought it had to do with patents expiring?