A Shot Over The Bow

Why is everyone talking about insulin ?

For more than 14% of people who use insulin in the U.S., insulin costs consume at least 40% of their available income, a new study finds. Add that cost to housing, food, transportation, heating, the high cost of other medications and many other financial burdens and we have a kitchen table disaster where people often have to choose between life saving medication and other necessities.

One largely overlooked provision in the Inflation Reduction Act is that Medicare patients pay no more than $35 dollars a month for prescriptions of insulin. This is a boon to 3.3 million Medicare patients with Part D coverage but 5.1 million private and uninsured patients are left out in the cold because Republicans killed a separate provision that would have required private insurance companies to do the same.

So why isn’t this provision extended to private insurers ? Big Pharma’s legislators and lobbyists claim that limiting the price set by private-sector providers of insulin will punish efforts to finance research for new drugs. This disingenuous response has no basis in actual fact. A banner appearing in the very conservative The Economist puts the matter succinctly—“Democrats have a plan to lower drug costs without harming innovation”.

The article goes on to point out that those with insulin dependent diabetes need one to four shots a day at a cost of “$100 a vial—nearly seven times more than in any other OECD [developed] country”. The Kaiser Family Foundation also indicated that Medicare Part D patients paid $1.03 billion in out of pocket insulin costs in 2020. And, of course, the recently passed legislation, thanks to cuts by Republicans, does nothing to help diabetics who are not on Medicare, uninsured or have no Part D coverage. The Guardian offers the experience of a young woman from Jacksonville, Florida who “points out that when you tell the general public that you’re capping the price of insulin, that’s deceitful because millions of Americans aren’t insured and the majority of diabetics who are insured, they still can’t afford the cost and it’s going to go to the premiums.”

It should go without saying that there is more than money at stake. Diabetes is a condition with significant morbidity and mortality. People suffering from Type 1 diabetes cannot survive without daily injections of insulin and even folks with less severe levels are at constant risk of developing insulin dependence. The disease is endemic and widespread. The CDC reports that over 11% of our entire population suffers from diabetes and 38% is pre-diabetic. It is ludicrous to posture that the investments needed to develop new therapies require Americans to pay seven times more for insulin than do patients in Britain or Mexico.

Private insurers should be required to cap the cost of insulin at the same levels now mandated for Medicare recipients. Big Pharma should not reap windfall profits off a drug that is inexpensive to manufacture and essential to health for more than a third of the nation’s population.

Recently, due to increased public pressure and the threat of having to face subpoenaed testimony before Justice Warrior Bernie Sanders (as Chair of the Senate Health, Education, Labor, and Pensions Committee) Eli Lilly has dropped the price for many of its insulin products. We have yet to hear from other mega-corporation insulin producers.

It’s time to put people over profits.

Darryl Wimberley Staunton, Va