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.
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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