THE RISING COSTS OF INSULIN

By Sanaa Imami Sophia Cariño

There are very few medicines more well-known than insulin, and for good reason. Insulin is an essential hormone that constantly controls glucose levels in the bloodstream. The hormone also is responsible for regulating glucose levels in the body’s liver, muscle, and fat cells. While insulin is produced naturally in the human body, people afflicted with diabetes are unable to produce adequate levels of insulin. Most diabetics need insulin in order to keep their blood sugar levels in check, so the hormone is synthetically produced by pharmaceutical companies to help them live life normally. However, due to significant price increases and noncomprehensive insurance plans, many diabetic Americans are unable to access this life-saving drug.

While insulin is a commonplace medicine today, the drug wasn’t identified as a lifesaving tool until a hundred years ago. Insulin was first extracted and used by researchers Frederick Banting and Charles Best in 1921. The two originally determined that they could keep a diabetic dog with no insulin production capability alive by giving it insulin produced from another dog’s pancreas. From there, Banting and Best, along with J.B. Collip and John Macleod, produced a more refined version of insulin from the pancreata of cattle. The first insulin injection was given to a diabetic teen named Leonard Thompson, and within 24 hours of injection, his formerly life-threateningly high blood glucose levels dropped to a normal amount. From there, pharmaceutical company Eli Lilly began to mass-produce insulin, and by 1923, the drug was widely-available across North America. The availability of insulin was life-changing for diabetics — prior to the production of the drug, most diabetics were put on restrictive low-calorie and low-carb diets that rarely helped them control their glucose levels. Oftentimes, diabetics would die from starvation rather than extreme blood sugar levels.

Some of the most common insulin brands, like Humalog and Admelog (both of which were insulin lispro, or artificially produced insulin), were originally produced in the 1990s. Since their creation, their prices have increased exponentially. For example, the original price of one vial of Humalog was $21. Twenty years later, in 2019, the same amount costs $332, which is an increase of over 1000%. While inflation naturally causes all goods to increase in price, this sharp increase is much more severe. In comparison, prices in other developed countries have remained roughly the same, even as inflation and production costs have changed throughout the years. Ultimately, the added financial barrier in acquiring insulin has dramatically changed how diabetic Americans are able to live their lives, especially when compared to other countries where the drug is more accessible.

What are the reasons for this drastic increase in insulin price for Americans? There are two main issues, both of which boil down to the pharmaceutical companies developing these drugs. There are

The average out-of-pocket cost of treatment in the US is roughly three times higher than that of India, the country with the second-most expensive out-of-pocket costs.

three pharmaceutical companies that control the insulin market in the US: Novo Nordisk, Sanofi-Aventis, and Eli Lilly. These companies have a monopoly on insulin, which means that they’re able to price their insulin at whatever price they’d like - this is because they have no competition nor do they have any restrictions or regulations imposed on them by the US government. Because of this monopoly on this life-saving commodity, corporations are able to abuse this lack of restriction and raise the price exponentially for their own financial gain.. In other words, because they know that diabetics will always continue to need insulin, they have no fear of falling demand due to price increases.

The insulin price increases have caused many diabetic Americans to resort to drastic measures when it comes to the drug. On average, most diabetics need 2-3 vials of insulin a month, which currently amounts to $450 on average per month with no insurance. Oftentimes, insurance companies will not fully cover these costs, and the price decrease is oftentimes not enough for Americans to comfortably afford. Many diabetic Americans skimp or altogether skip doses of insulin, which often causes erratic spikes and drops in blood sugar levels. In severe cases, diabetics who do not have enough insulin in their system experience diabetic ketoacidosis, a deadly condition that develops when the body does not have enough insulin to control where the blood sugar goes in the body. When the body does not have enough insulin, it can’t get energy from blood sugar, and instead, it resorts to breaking down fat. A byproduct of this process is the buildup of acids called ketones. When there is an excess of ketones, the body will go into shock, and oftentimes, diabetics will die from it. Technology has provided the solution to diabetes, yet due to significant financial barriers, many are still unable to access it.

As insulin has become increasingly less accessible and affordable, the government and insurance companies are now involved. The Trump administration ran on the campaign promise that many essential prescription drugs would be less expensive. During his term, Trump began negotiations with many big-name pharmaceutical companies, and many agreed to lower costs. By the end of the administration’s time in office, they had cut upfront insulin costs for seniors and lowered the co-pay (a fixed out-of-pocket cost for insurance-holders) for Medicare to a $35 monthly payment, which is roughly 7% of the average monthly cost of insulin for those without insurance. Beneficiaries who used Medicare would have a significantly cheaper copay but still have access to insulin. Many insurance companies have also pledged to lower copays and make insulin accessible to beneficiaries who need it but don’t have insurance plans where the drug is affordable for them.

This year, the Biden administration has introduced the Comprehensive Plan for Addressing High Drug Prices that aims

to regulate fair prices for live-saving medications, which includes insulin. With this plan, the administration works towards creating a more accessible Medicare program and enforcing regulations on the pharmaceutical companies that hold monopolies in America. By ensuring “equal and affordable access” (McConnell, 2021) for medications like insulin, many Americans will no longer need to sacrifice financially for their basic health necessities. Diabetes — a severe condition shared by over 10% of the American population — is treatable and manageable, but the politics behind insurance and pharmaceutical companies alike leaves countles diabetic Americans in danger of severe health complications. The livelihoods of millions of Americans should not be treated so trivially;policy makers and pharmaceutical companies must work together to eradicate barriers of access for all diabetic Americans, regardless of insurance plan or socioeconomic status.

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