Why is Insulin So Expensive in America?

Shares

I was stuck for many years pushing paperwork in a miserable job that I hated. Why did I stay? Because I needed insurance to afford diabetes test strips, a glucose meter, an insulin pump, all the supplies to make it infuse insulin into my body, and insulin. The only insurance option for me with a pre-existing condition was to join a group plan through an employer. So, there I was, somewhat stuck, definitely underpaid, and absolutely miserable. Just to afford to stay alive. That was not all that long ago.

When I was diagnosed with Type1 diabetes in 1972, each bottle of insulin cost $1.49. One dollar and forty-nine cents. I recently found an ad from 1972 with that very price advertised. We didn’t need a prescription. We just needed to show up at the pharmacy and purchase it. By the time I graduated from college a few years later, insulin was still affordable at about $20 a bottle. Over the next few years, the price climbed to $50, then $75, then $80. Insurance wasn’t exactly paying a lot toward covering it, but that didn’t matter – I was able to afford the bill at the pharmacy window. While it was expensive and took a big chunk out of my monthly budget, I was able to afford it… even with a lousy job I hated.

I changed jobs and I got better insurance, but insulin was still a big part of my monthly budget. By 2010, insulin was close to $100 a bottle. Just last month, my local pharmacy informed me that it is now $330 per bottle of Novolog and Humalog. I use anywhere from 3 to 4 bottles of insulin per month. 

Now, because of the ACA, I don’t have to have to have a job to have health insurance coverage. I can buy insurance on the marketplace without being denied for a pre-existing condition. Yet, many people with diabetes still cannot afford to purchase insurance. Still, even with insurance we can pay a fortune for insulin. If an insurance plan has a high deductible, or if a plan has a high co-pay, or if an employer’s plan has a 3-month waiting time before benefits kick in, or if the plan only covers one or two bottles a month, or if a person makes too much to qualify for Medicaid, but not enough to afford monthly insurance premiums, a person with diabetes will pay an outrageous proportion of their income to stay alive. Just to stay alive, using a medication that has existed for nearly 100 years and was supposed to always be affordable and widely available. The researchers who identified insulin as the life-giving hormone that it is, sold their patents for $1 each to guarantee that insulin would be easily available in perpetuity. That has obviously changed.

Why is insulin so expensive? The short answer is… we don’t know

The pharmaceutical manufacturers have pointed their fingers at Pharmacy Benefits Managers (PBMs) and at health insurance companies while claiming that the price the manufacturers charge has little to do with what patients pay at the pharmacy window. Another factor is that many insurance plans and PBMs receive rebates that are based on the reimbursement price and the price along the distribution route. However, the price that the manufacturers charge is the starting point.

We do know that insulin is affordable in other countries. A recent study showed that the share of insulin users in North America is 14% of all insulin users around the world, while the percent of sales in North America is near 50% of total world-wide sales. Insulin users in North America contribute a disproportionate amount to pharmaceutical companies’ bottom lines. Looking a little deeper, we know that insulin in Canada can be purchased for approximately $30 per bottle with no prescription required, while in the US it is $330 for the same exact bottle of insulin. We have no concrete information to explain this discrepancy, but it is highly likely that the manufacturers are still making a profit on insulin in other countries even when selling at a significantly lower price than in the U.S.

Over the last couple of years, several states have passed legislation to require pharmaceutical manufacturers to report the amount they are charging when a bottle of insulin (and other drugs) leaves their facility. These pieces of legislation are commonly known as pharmaceutical transparency bills. It is a starting point to begin to understand why insulin has such an expensive price tag at the pharmacy window. 

During 2018, several transparency bills were introduced in the Colorado Legislature for consideration. I was there at the Colorado State Capitol to testify at hearings and to speak on behalf of all people with diabetes who struggle to afford insulin. The bills made it through the House side of our Legislature. I then watched those bills die in the Senate committee hearing. Nevertheless, I am committed to working on behalf of all of us with diabetes who need insulin. And I’m not alone. I’m part of a growing group of advocates who are willing to tell their stories at our State Capitol, so that we can afford to stay alive.

 

14
Leave a Reply

avatar
3000
10 Comment threads
4 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
13 Comment authors
PaulMikeantonioDonnaCndT1D Patient and Parent Recent comment authors
  Subscribe  
newest oldest most voted
Notify of
Paul
Paul

If you are using 3-4 bottles of insulin a day, then you need to see an endocrinologist because something is wrong. I have been a type 1 since 1978 and I use 1 bottle of Lantus and 1 bottle of Novolog. My A1Cs are 6.5 every 6 months. Sounds like you are seriously overeating and using extra insulin to cover it.

Mike
Mike

The reason it’s higher here than other countries is because of universal health care. You don’t see the real cost because of the government picking up the tab. You still pay for it through high taxes

antonio
antonio

“Why is insulin so expensive? The short answer is… we don’t know. ”
Actually the answer to this question is very simple – because the CAN charge Americans as much as they want. There is nothing there to stop them (unlike in any other industrialized country). Medicare (biggest purchaser) by law is prohibited from negotiating drug prices. Multiple insurance companies can not effectively negotiate prices exactly because they are not united. And people without insurance ? Who cares about them

Louise
Louise

This was informative and frustrating. I am one of those people that has to make a choice every month! After a divorce which took my “good” insurance away, I’m now a one of those in the ACA HPD insurance group. The stress alone of how to handle your diabetic care knowing full well you pay too much for insurance to be just a backup should a medical emergency arise because you can’t afford to pay the out of pocket for normal visits it is the source of many of my highs, more-so than what I eat. After a move I… Read more »

kristina blake
kristina blake

I had the good fortune to be interviewed for an BC series on $ide Effects, the increasing cost of Rx’s. I had a few moments, so I went on the Eli Lilly website and clicked on “for investors” I wanted to see their financials. Lo and behold (no surprise) they spend more on marketing and admin than R & D – R & D being their usual sound bit excuse for price increases. As Ms Devore stated, these insulins are over 20 years old!

SherylC
SherylC

Hi there Gail, I am a Type 1 diabetic for 48 years. I recently switched to Fiasp and Tresiba. The Fiasp cost me $60 and I received some coupons that provide me with three free packages of Tresiba. I also pay $120/month for Blue Cross insurance which covers 80% of my Levemir and Humalog costs, but does not cover these new insulin. On another note, I just paid $500 for One Drop blood testing strips. It seems to be working quite well and I will try to move it to my Blue Cross next year. Have to also say that… Read more »

Terri Lanigan
Terri Lanigan

Greed on many levels is the bottom dollar folks. Truth. Telling like it is.

Jong S Rho
Jong S Rho

Well the truth is that they do know, but since both political parties in the US are owned by Big Pharma, no one is saying anything. First, there is the fact that most First World countries have National Health Care, which means they aren’t paying very much for meds and the Pharma companies are fine with it since they make an obscene amount of profits in the US. If you look at their balance sheet, their overall profit doesn’t look obscene but that is because it shows their worldwide operations and since they make no money in the rest of… Read more »

CndT1D Patient and Parent
CndT1D Patient and Parent

Just an FYI, I live in Canada and both my daughter and I are diabetic. We pay out of pocket each month for insulin since our private insurance and Pharmacare only cover the ‘lowest cost option’ insulin and if you choose to use something else, you are responsible for the higher cost. The ‘lowest cost option’ insulin is the same type that I used when I was diagnosed 37 years ago. Insulin has come a long way since then but if I don’t want to pay out of pocket, that is my only choice. And no government plan or private… Read more »

T1D Indentured Servant
T1D Indentured Servant

What a story! I hope you can figure out a way to survive. Your not the only one dealing with this tragedy. This story is a stain on the character of this Country. This is Un-American! Thank Congress and the scum who lobby them for this problem..And you thought your vote counted!

Donna
Donna

Unfortunately it is American. While the government can’t afford healthcare for it’s citizens it can afford to give the richest Americans a huge tax cut. And big pharma is getting bigger and fatter by overcharging the sick people of this country for life saving drugs. Your vote does count. It is the only weapon you’ve got. It’s people’s apathy that got us to where we are.

SO VOTE!!!

Miss_X2m1
Miss_X2m1

Wall Street GREED.

Ivan
Ivan

Lots of people sure are profiting from type1 diabetes.

Terri Lanigan
Terri Lanigan

And many other conditions.

Copyright © 2009-2018 Diabetes Media Foundation, All Rights Reserved.
ASweetLife™ is a trademark of the Diabetes Media Foundation, All Rights Reserved.