Alec Smith was 23 when he was diagnosed with type 1 diabetes. He
worked as a restaurant manager in
Minnesota. At age 26, he could no longer
stay on his mother’s health care insurance
plan and needed to find his own coverage.
On June 1, 2017, he was on his own. The insurance available to him came with a $7600
deductible and a monthly premium of
approximately $440.1 Because he could not
afford this, Alec decided to temporarily
forego insurance coverage and purchase insulin with cash. Unfortunately for him, the
cash price of insulin was far beyond his
means.2 He decided to try and ration the
amount of insulin he took till he had enough
savings to purchase insurance. Sadly, on
June 27, 2017, he was found dead in his
apartment of diabetic ketoacidosis.
The most commonly used forms of analog
insulin cost 10 times more in the United States
than in any other developed country.3 There
have been many other recent reports of deaths
in patients with type 1 diabetes because of lack
of affordable insulin.4,5 The high prevalence of
diabetes, the chronic lifelong nature of the disease, and the fact that patients with type 1 diabetes will die without access to insulin make
this an urgent problem that must be solved
expeditiously. The price of insulin is also a
stark and troubling example of the rising cost
of prescription drugs in the United States and
highlights a systemic problem with how drugs
are priced compared with every other commodity.6,7 This commentary will address the
reasons for the high cost of insulin and
examine possible solutions. By understanding
and solving this problem, we can create a roadmap that brings much needed reform and fairness to the existing system and helps make all
prescription drugs more affordable.
Reasons for the High Cost of Insulin
The number 1 reason for the high cost of
insulin is the presence of a vulnerable population that needs insulin to survive (Table 1).
This population, which numbers in the millions,14 is willing to pay anything to have
access to a lifesaving drug. The desperate
need for a lifesaving product allows insulin
to be priced at high levels because it is not
a luxury item that one can forego. The manufacturers of insulin know that patients who
need it will spend whatever it takes to
acquire it, regardless of price. It is a matter
of life and death.
Second, there is virtual monopoly on insulin that has been sustained for decades.
Three companies, Novo Nordisk, SanofiAventis, and Eli Lilly control most of the
market.2 Until recently, almost every insulin product sold in the United States was
made by these 3 companies. They still
continue to have a monopolistic hold on
an essential product, with limited competition, and no regulations in effect to cap or
control prices.11
(snip)
https://www.mayoclinicproceedings.org/article/S0025-6196(19)31008-0/pdf
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