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Insulin Inflation Is Killing People. Something Needs To Be Done 

Judith Garcia, 19, fills a syringe as she prepares to give herself an injection of insulin at her home in the Los Angeles suburb of Commerce, Calif., Sunday, April 29, 2012. (Reed Saxon/AP)MoreCloseclosemore
Judith Garcia, 19, fills a syringe as she prepares to give herself an injection of insulin at her home in the Los Angeles suburb of Commerce, Calif., Sunday, April 29, 2012. (Reed Saxon/AP)

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Earlier this month, 75 people protested the high cost of insulin outside pharmaceutical firm Sanofi in Cambridge, Mass. Two mothers who said their diabetic children died from rationing the expensive, life-saving medicine tried to take their loved ones’ ashes into the Paris-based Sanofi’s offices but were turned away.

At least three diabetics died in 2017 from rationing insulin, a flashpoint in the battle to reduce stratospheric U.S. drug prices. With 30 million Americans having diabetes, the disease is the nation’s seventh leading cause of death. Against that grim backdrop, insulin prices rose 270 percent during the past decade; insulin can cost patients hundreds of dollars a month.

Two days after the protest, "60 Minutes" highlighted the case of drug maker Kaleo, which raised the price of its opioid-overdose drug Evzio — a version of naloxone, which has saved thousands of lives — by 600 percent. That’s not a typo. Evzio, formerly $575, now sells for $4,100.

The company told "60 Minutes" that it covered patients’ out-of-pocket costs for the higher-priced version of its drug, meaning insurance plans got stuck with the sky-high bill. But former Kaleo employees said that insurers would raise their premiums to cover that bill, and that Medicare — which provides most of the company’s revenue for Evzio — forked over millions for it. Facing a Senate investigation, Kaleo says it will charge insurers less than the original $575 price if they make sure needy patients get the drug.

These dreary news items came less than a month after President Trump announced yet another plan to restrain drug prices. And the Food and Drug Administration is trying to encourage the development of generic versions of insulin. I wish I could say these initiatives will save lives and curb Big Pharma’s markups. Sadly, the odds are against it.

Under the latest Trump drug proposal, Medicare would pay for certain drugs in line with what other countries pay — in particular, European nations, where drugs cost far less. The plan has its limits, applying to drugs a doctor administers rather than the ones you buy from your local pharmacist.

It’s such a worthy idea that the Obama administration floated it, and a pharmaceutical industry group slammed the idea. Indeed, Axios reports that the industry was caught off guard by the idea’s resurrection under a Republican president.

All this came on the heels of another Trump idea to allow imports of cheap foreign drugs when domestic manufacturers raise a pharmaceutical’s price substantially and there’s no alternative drug on the domestic market. This idea too came with clear boundaries, applying only to generic drugs, and only for a limited time. But drug companies loathe that concept, too.

The Food and Drug Administration specifically cites insulin as a drug for which it hopes to encourage creation of generics, via fast-track review when a drug maker applies for approval.

Does this all mean that help is on the way for pharmaceutical-dependent patients, and diabetics in particular? Don’t bet the Pharma on it.

Drug makers shot down Obama’s price-control plan, and they come to battle heavily armed: The industry spends more to influence Washington than any other industry, with about two lobbyists on its payroll for every member of Congress.

Ironically, we the people abet the industry’s obstructionism. Other countries control prices by demanding reasonable prices in exchange for approving drugs for use. But patient advocates are wary of the U.S. going that route, fearing that needed drugs might be kept off the market.

Meanwhile, don’t expect help from the drug makers themselves. Responding to the protesters against its pricing, Sanofi told WGBH that it provides no-cost drugs to eligible, low-income patients. The company also said it explores “innovative” ways to reduce or eliminate patients’ out-of-pocket expenses, such as limiting price increases to the government-calculated medical inflation rate and fixing set prices for insulin purchased with cash.

... insulin makers could slash their prices by 90 percent and still earn a 500 percent profit margin.

But family members of diabetics who rationed and died say that their loved ones were over Sanofi’s eligible-income limit yet still couldn’t afford their insulin. And the company’s various price controls, they said, wouldn’t help a patient in a medical emergency who needed the right insulin dose immediately.

Dr. Vikas Saini, co-chair of the Right Care Alliance, which organized the rally, estimates that insulin makers could slash their prices by 90 percent and still earn a 500 percent profit margin. That elegantly simple approach — make your prices affordable while still making a hefty profit — would avert the need for government action.

But if people were angels, we wouldn’t need government. Our only chance, and the industry’s worst nightmare, is the newly Democratic House making common cause with Trump on this issue.

But that will require the president to spend more than a photo-op’s time on insulin inflation. We’ll see if a possible win with Democrats’ help is the shot in the arm it will take.

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Rich Barlow Cognoscenti contributor
Rich Barlow writes for BU Today, Boston University's news website.

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