This week, Novo Nordisk and CVS Health announced a new program that will offer discounts on insulin, a life-sustaining drug for people with diabetes. CVS says this could result in savings up to $100 per 10ml bottle. Sounds superb, right? And the timing couldn’t be better, coming on the heels of the GOP’s plan to repeal the ACA and replace it with a program that puts millions of people at risk of losing coverage. But before we laud two corporate giants for a big-hearted deed, we should examine what’s actually being offered.
Senator Bernie Sanders of Vermont brought the issue of unaffordable insulin to the forefront last November when he criticized drugmakers Eli Lilly and Novo Nordisk. He tweeted, “Why has the price of Humalog insulin gone up 700% in 20 years? It’s simple. The drug industry’s greed.” Shortly thereafter, he and Representative Elijah Cummings called on the Department of Justice and the Federal Trade Commission to investigate three insulin makers for price collusion, Stat News reported.
The ‘big three’ pharmaceutical companies, Eli Lilly, Novo Nordisk, and Sanofi dominate about 90% of the production and sale of insulin. From 2002 to 2013, the price of insulin increased 197% in the U.S. According to the advocacy group T1International, who conducted a survey that looked at out-of-pocket costs for insulin and supplies, Americans are paying more than any other country for insulin.
Even the American Diabetes Association (ADA), which in the past hasn’t lobbied for affordable insulin, launched a petition and corresponding website in late 2016 about the need for affordable insulin in the U.S. People with diabetes, too, have taken a stand. With the support of the law firm Hagens Berman, a group of individuals filed a class action lawsuit against Eli Lilly, Novo Nordisk, and Sanofi over the high cost of insulin. The lawsuit alleges that the ‘big three’ have unjustly inflated their prices, while keeping the prices offered to pharmacy benefit managers constant over time, or even decreasing the prices offer to them.
An industry response to the high cost of insulin has been the creation of patient assistance programs. But enrolling in such programs can be problematic and they may benefit only a small percentage of people. Some even require an app. Further, the question of who actually benefits from patient assistance programs has been a topic of debate. According to an article in the New England Journal of Medicine, “Assistance programs are a triple boon for manufacturers. They increase demand, allow companies to charge higher prices, and provide public-relations benefits.” And this brings us back to the new Novo Nordisk-CVS deal.
The only insulins that will be part of the Novo Nordisk-CVS deal for now are Novolin R, Novolin N and Novolin 70/30. These are older human insulins, which appeared on the market in the 1980s. By the 1990s, improved insulins, known as insulin analogues, were being developed. Insulin analogues are similar to regular human insulin, but are altered to better mimic the role of endogenous insulin. They are generally much easier to use, enable better blood sugar control, and have fewer side effects, particularly severe hypoglycemia. (In 2010, 96% of insulin prescriptions were for insulin analogues, an increase from 19% in 2000.) In a letter to the New York Times last year, Kelly L. Close*, president of the health care information company Close Concerns, said for her first 12 years with diabetes, she relied on older insulins. “I landed in the emergency room 24 times because of their unstable nature. Upon switching to insulin analogues over 15 years ago, I have never been back to the E.R,” Close said.
While the ability to buy insulin for $25 when you have no other options is better than nothing, it begs a very big question: By giving people an inferior medication that may lead to less stable blood sugar, how much are you really helping in the long run? With inferior insulin, more blood sugar testing is required. The cost of each blood sugar test can be $1.00. (Many people with type 1 diabetes need to test 10 times a day.) The worse a person’s blood sugar management, the more likely they are to develop complications of type 1 diabetes like vision loss, amputations, and detrimental effects to nearly every part of the body. Nicki Nichols at Insulin Nation said, “It [$25 insulin] can save you money today, but it can result in higher costs and poorer health in the long run. These insulins are not the answer to the rapid rise in prices for more popular insulins.”
Moreover, while the new announcement from Novo Nordisk and CVS is being marketed as a gift to patients, it’s more of a re-packaging, or at least an expansion of a similar agreement with Walmart. In other words, it’s a new business deal between two corporations, with precarious benefits for some people with diabetes. It’s far from the answer to the inflated price of insulin. The CVS and Novo partnership announcement conveniently allows companies to avoid the bigger conversation around astronomically high-priced insulin. Insulin should be much cheaper across the board and Novo Nordisk, Eli Lilly, and Sanofi have the power to make that happen.
*As noted in the New York Times, Ms. Close disclosed her relationship with pharmaceutical and other companies.
Elizabeth Rowley contributed to this article.