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The insulin racket: why a drug made free 100 years ago is recently expensive

• jostmey 7y ago
  The article seems to blame the Bayh–Dole Act and similar events that allowed Universities to sell government funded research results to the pharmaceutical industry. I don't believe this is the problem--the Bayh–Dole Act incentives new drugs. This explanation doesn't explain why off patent drugs have gone up in price. I suspect the problem is market collusion and the FDA shutting down competitors on drugs where patents expired, which I believe is what happened during the epipen crisis.
  • kyshoc 7y ago
    In the case of insulin, I think it has more to do with the FDA's processes than corruption. It would be very difficult to make a profit on generic insulin because it's a biologic drug, which means a generic manufacturer wouldn't be able to bypass the FDA approval process by proving bioequivalency. EDIT: Upon further reading, there is a pathway[0][1] for "biosimilars", but it seems to have higher requirements than chemical generics. [0]: https://en.wikipedia.org/wiki/Biologics_Price_Competition_and_Innovation_Act_of_2009 https://en.wikipedia.org/wiki/Biologics_Price_Competition_an... [1]: https://www.fda.gov/drugs/biosimilars/biosimilar-and-interchangeable-products#biological https://www.fda.gov/drugs/biosimilars/biosimilar-and-interch...
    • coldpie 7y ago
      The generic insulins that are out of patent protection are also significantly worse than modern, patented insulins. Here's a good article on the topic: https://www.webmd.com/diabetes/news/20150318/why-isnt-there-any-cheap-generic-insulin https://www.webmd.com/diabetes/news/20150318/why-isnt-there-...
  • ldoughty 7y ago
    Also forced non-competition... You simply can't make a generic version without your company being bought and/or litigated to death, preserving the just-barely-isnt-a-monopoly goal. This happens in the garbage collection industry, people make competitors and offer 30% discounts on going rates, Waste Management or similar megacorp loses an entire county or region... Then they buy the company and slowly raise prices back up. There's non-competes in the contract, but the owner doesn't care, they pocket 10 million and take a 1-year vacation then repeat the process. Only customers and employees are hurt (as there's less need for employees when the companies merge) Same with pharma... Though I imagine there's extra pressure on the factories to not serve "little guy" as part of their contract with big pharma. So even if you have all the necessary process and expired patents, the industry stacked agreements and laws to make it nearly impossible. Like many American industries, this is the kind of behaviour that caused Roosevelt (a Republican) to leverage the Sherman Anti-Trust Act... The key point being that mega corps were exploiting the populace and the only solution was to break up these giant monsterous companies that effectively created monopolies. He specifically targeted companies that used this power for ill, jacking up costs to consumers. Now we are back at this point, but the public unrest hasn't reached a critical point while we are upset over other political issues, so big business continues to shovel buckets of money at Republicans to try and maintain the status quo until enough Americans get upset that politicians fear loosing their seat over the money (and right now, thanks to gerrymandering, enough politicians need 10% or more of their loyalty base to convert to the other party for that to be an issue. In reality, this is a genius system that is perfectly legal... On the surface.
• stenl 7y ago
  $1300/month is absolutely crazy. In Sweden, a whole year’s worth of injection insulin is about $600 (actual cost to the government, including the disposable injectors) and $0 to the end user.
  • ataturk 7y ago
    Americans voted for this bullshit.
  • consp 7y ago
    Here in the Netherlands my insulin costs including all other medical necessities are about 1600 euro/year. Do note, this can differ substantially per person. edit: the cost to the end user is the required 385 euro. Here it is happening as well: Novo Nordic set the cost of the - the new - Tresiba insulin higher than the covered amount, it simply wasn't offered as there were fortunately enough alternatives available though the stuff actually works better. A few years back they finally gave in and now it is still sold at the premium price but the apothecaries get back the amount not covered by insurance from the distributor (and I guess thus Novo). Which basically tells me they can offer it for that price but don't want to and hope the covered price goes up (not likely).
  • pimeys 7y ago
    And the crazy thing is you also need strips at least, many of us pumps and CGMs because of being super sensitive to insulin. That is easily 100k per year even in Europe. And due to the mandatory insurance, not that much for the user.
    • GordonS 7y ago
      Easily 100k, just for testing strips or a CGM?! I'm not sure where in Europe you are, but it's nowhere near that in the UK - testing strips are around 0.20 each, (which TBH I think is expensive, but plainly no going to cost 100k/year!). For CGM, if you're lucky enough to get the NHS to pay for it (unlikely), it costs them around 1k for the monitor, and around £1,500/year for sensors. Finally, insulin costs the NHS around £400/year for a T1 diabetic.
• omh 7y ago
  This looks like a case study of what is wrong with the US healthcare system. There isn't much discussion of why it's expensive in the US specifically. In other countries insulin prices haven't risen in the same way and are still affordable. So why is the price gouging only happening in the US? As a T1 diabetic in the UK, where the wonderful NHS covers all of my insulin costs, this is one reason why I'd never be able to move to or work in the US.
  • ataturk 7y ago
    How much is your overall tax rate? Do you even know? The "wonderful" NHS is fucking over somebody so you can have your cheap whatever. There's no free lunch.
  • dx7tnt 7y ago
    And a great reason for why you wouldn't want to.
  • adventured 7y ago
    It's because the US healthcare system is a nightmare combination of extreme government control & regulation, and corporatism. They socialize the cost and privatize the profit, to the benefit of a small percentage of the population that works in those fields or invests into them. It's a very large, regressive wealth transfer. You can only do that with the intentional, direct assistance of the governments (federal + state governments) as enablers that protect the healthcare cartels and worker guilds.
  • coldpie 7y ago
    > As a T1 diabetic in the UK, where the wonderful NHS covers all of my insulin costs, this is one reason why I'd never be able to move to or work in the US. I'm a T1 Diabetic in the US and I consider myself very lucky to work in software. I have good insurance, so my medication only costs me about $200 per month. That's just an additional cost I have to pay to be alive, on top of all the other stuff everyone else has to pay for, too. If I had a lower paying job, or a job with less good health insurance, I can see how I'd be priced out of living.
• Shivetya 7y ago
  One key take away, Wal Mart sells a lower priced version along with supplied for testing. Well that is all and fine, they do list some reasons it isn't ideal but they leave out the big one. Most people under insurance or government provided health insurance are not permitted to use it. Throw in over regulation besides limiting which types are available also can interfere with refills of both insulin and testing materials and even require periodic confirmation by a medical professional you are still diabetic.
  • sithlord 7y ago
    They sell a $25/vial of Regular insulin; its an older style, and can be fairly dangerous to use, as it has quite the different action as the newer 'fast-acting' insulins. With that said, if tight on money, its certainly better to use it, and monitor it closely, than not be able to afford the $225+/vial novolog or humalog.
    • pimeys 7y ago
      Monitoring is expensive. The strips can be 1-2 euros per one.
      • lucaspm98 7y ago
        They are generally $0.15-$0.25 without insurance, and only rarely over $0.6, in the U.S. where this took place.
      • opencl 7y ago
        Walmart sells their own brand for about $0.20 each, the "name brand" ones are about $0.60-80 here. I have a diabetic friend whose insurance will only pay for 2 strips per day and he buys the remainder from walmart (and has 2 meters because the insurance-provided one is a different model that doesn't work with the walmart test strips).
      • GordonS 7y ago
        Not sure where you are in Europe, but they're £0.15 - £0.30 each in the UK. TBH, I still think that's too expensive, but it's nowhere near 1-2 Euros
• WomanCanCode 7y ago
  There should be an alternative way of getting the insulin bypassing the big pharma... Any organizations trying to make that happen?
  • Robotbeat 7y ago
    Dunno why you were downvoted, but here's one such organization: http://openinsulin.org/ http://openinsulin.org/
  • Broken_Hippo 7y ago
    "Big Pharma" isn't really the issue here. I mean, it is, but going around "Big Pharma" is a high hurdle to jump over, if you can jump it, and it isn't such an issue in other countries - which leads me to think this is a regulation problem. First things first, though, simply "bypassing the big pharma" means you need to jump through regulartory hurdles. You need to produce insulin in a manner that won't kill folks, test the finished product for strength, and get it to the patients safely without the product spoiling. You'll need to invest in logistics. To get it to the final patients, you'll either need to hire pharmacists and support and send insulin directly to the patient, making sure you keep records as the FDA requires. Or you'll need to make sure that you can supply pharmacies with your products. This will often be shipping your product to warehouses. The second one is more difficult to control costs, but the first option - direct to consumer - means you hire more folks yourself and have more risk. None of this stuff means your insulin will be used instead of the more expensive ones. This is likely especially true if you are using an older version of the drug - though I doubt one would bypass using bacteria to produce and use animals instead. And then, after all this investment, why in the world would you, the new insulin maker, charge a reasonable amount for your drug when your competitors are charging outrageous prices? But again, this isn't the issue. Really. From the article: " The three pharmaceutical companies that manufacture insulin—Lilly, Novo Nordisk, and Sanofi—rake in billions in profits annually from insulin sales alone, with the U.S. market accounting for 15 percent of global insulin users but almost 50 percent of its worldwide revenues. Insulin ranks among each company’s top-selling drugs; one BMJ study showed that prices could be slashed considerably and the drugs would still be profitable." US patients are paying a lot more for the drug. This is, in part, because of the fragmented health care system and I'm guessing it is, in part, regulation. In a small way, it might be patents, but at one time, folks were shy to enter the market since there wasn't as much being made. Seriously, this calls for a legislative fix instead of "bypassing the big pharma". Sure, they raised their prices but only because the legislative environment allows it to do such things. It isn't just in the US, by the way, as folks in some parts of Africa pay more for basic, not-as-effective medicines, but it seems to affect the average HN reader more. And it isn't like this is something special to "Big Pharma" either - other countries gouge folks on any number of things and take advantage of folks.
• chadcmulligan 7y ago
  Maybe the Red Cross should parachute Insulin into the US like in any other war zone. It is a war zone, the owners of the health care system have declared war on their customers it seems, they are only now becoming aware of it.
  • mruts 7y ago
    Why hasn't Amazon declared war on their customers? It doesn't have to do the market, and it certainly has nothing to do with capitalism. It has to do with rent seeking on behalf of lobbyists are the corruption of government. Imagine a world where drugs go off-patent in 5 years (or if you really want to be radical, no patents at all) and every drug was available without any prescription whatsoever. I guarantee you prices for pretty much all drugs would be 10-100x lower. How do I know this? Because I moved to a country (Tanzania) in which no one has health insurance and there are practically no controls on any drugs at all. Medications that had costed me $500 with insurance per month in the US I can buy for $20/month. One of my friend's father is diabetic, and he spends maybe $40/month on insulin. The patent system in the US combined with the 3rd party payer system has created astoundingly bad incentives for every party. And the result of all of this is sky high drug prices. People seem to think that the defective US healthcare system is an indictment on free-market capitalism. But there's nothing free-market at all about our system. What it's really an indictment on is cronyism, corruption, and rent-seeking. The question becomes, what do we do about it? The tangled and corrupt web of healthcare will be almost impossible to undo. I'm a staunch neoliberal but even I don't think it's going to be possible to go back to that in the US. It pains me to say/think this, but maybe the only solution for us is single-payer. Single-payer has pretty terrible incentives too, but probably not even as bad as the current system.
    • imtyler 7y ago
      >People seem to think that the defective US healthcare system is an indictment on free-market capitalism. But there's nothing free-market at all about our system. What it's really an indictment on is cronyism, corruption, and rent-seeking. Isn't the allowance of 'cronyism' etc, what makes the market "free?"
• otikik 7y ago
  I must say, the lack of ... rage ... on this article surprising. I would expect there to be a leaked list of names of the executives responsible for this, with pictures and home addresses. I would expect people protesting in front of their homes 24 hours per day. And covering their cars with rotten eggs when they went out. That's the kind of thing that would have happened in France.
  • SolaceQuantum 7y ago
    From what I understand, the US culture is one in which it is generally considered the fault of someone for being unable to pay for their own healthcare and living circumstances. Because there is the sentiment that it is possible to not be oppressed through one's personal power, cleverness, and considerate behavior, the people who claim to be oppressed are actually lazy, stupid, and inconsiderate. You can see this whenever someone claims that they individually were able to climb out of poverty but know other people who, through their own stupidity or ignorance or bad luck, were not able to- and therefore less sympathy should be garnered to the whole of impoverished americans as there exists a subset that is comfortable leeching off the extremely poor social safety net that exists. In short, a poor person egging a rich person's car would be seen as an aggressive, unprovoked action on the poor person, and the poor person should focus their efforts on being less poor instead. That the egger is focusing instead on protesting is an evidence of their screwed up priorities.
    • chadcmulligan 7y ago
      indeed there are the stories of people who have managed to raise themselves from poverty and gone on to be CEO, and it is possible if all the dominoes line up, there will always be the exception where this occurs, in general the odds are not in your favour. I can't help but think if the line from the hunger games - may the odds be ever in your favor.
    • Frondo 7y ago
      This is absolutely the story of the American ideal. We're a nation of Horatio Algers -- the quintessential "rags to riches" story. Poverty, in the US, is a personal shame, not a systemic failure. The successful end result of centuries of propagandizing in favor of the Individual, and against organizing. We're a fractured people, to our detriment.
• Cenk 7y ago
  * in the US
• inflatableDodo 7y ago
  As far as I am concerned, the people engaged in price gouging for insulin are essentially committing mass murder for profit. It is so far outside of any kind of moral standard, that I have no problem in categorising it as just straight up evil.
  • MrTonyD 7y ago
    I'd prefer that our society classifies it as illegal rather than evil or immoral. We need to have laws which also take away the acquired wealth from those who benefit from such practices.
    • inflatableDodo 7y ago
      Illegal is a classification a state makes about things considered immoral or evil. Or sometimes neither and someone is out to make a quick buck by corrupting the law. I cannot classify something as illegal, but I can point out that it is downright evil. If enough people do this then eventually the law might catch up, that is if the law hasn't been bought out already by the evil bastards out to make a buck. Which it has, unfortunately.
  • maxxxxx 7y ago
    Mass murder for profit is normal operating procedure. Otherwise we wouldn’t have cigarette companies, mining companies fighting safety regulations or companies fighting tooth and nail to keep leaded gas.
    • marnett 7y ago
      Also weapons technology!
      • supergauntlet 7y ago
        The entire military industrial complex is predicated on murder for profit. Remember this every time someone tries to sell you the lie that we need to airstrike Iran because they shot down a drone. Guess who's really winning there? Lockheed Martin, Raytheon, General Dynamics and their shareholders. Certainly not the Iranian or American people at large.
• rb808 7y ago
  I dont understand why there aren't more generic competitors. If 20 years ago companies were profitable selling at a much lower price, surely a new biotech company could do the same now? We're all looking for startup ideas with subscription models, this looks obvious.
• pattisapu 7y ago
  Heartbreaking. And ludicrous. For what it's worth, there seems to be a silver lining for some diabetics today, separate from the issue of insulin pricing -- the technology available now for continuous glucose monitoring, that takes a lot of dangerous guesswork out of day to day living. It is another ongoing cost, but, it seems, not quite as devastating as what is going on with insulin.
• maire 7y ago
  This is an issue beyond insulin. I hope they don't just focus on insulin. Generics do not work to lower prices on drugs because there is price fixing between companies. Price fixing is illegal in the US but does not seem to be enforced. I discovered this because my sister in law has a rare disease and she depends on a rare drug called syprine. Her drug costs went from 177.00 a month to $8000.00 a month where it hovered there for a year, then it went up to $43,354.73 a month. The US funds the manufacture and research on drugs for rare diseases but only while the drug is under patent. Once the drug is out of patent then there is no regulation. These are called "orphan drugs." It turns out that Valeant (the maker of syprine) was guilty of price fixing and was under investigation by the federal trade commission. The case went all the way to the supreme court which came down against Valeant. The end result seems to be nothing.
  • stunt 7y ago
    > Price fixing is illegal in the US but does not seem to be enforced Those companies are too powerful. There have been many investigations, but you never hear anything back.
    • RobertoG 7y ago
      In order to fix a price with your competitor, the only thing you need is an information channel with them. The price in itself carries information, so, I would not be surprised if in many cases not conversations are happened between the parties, but all the necessary information exchange have happened through the prices. That would be very difficult to police.
      • JustSomeNobody 7y ago
        This works for competing gas stations. One raises the price by a penny, the one across the street sees this and does the same thing.
    • rtkwe 7y ago
      It's also that the insurance and medical care markets don't work properly as markets because of a whole host of factors, eg who has the time or knowledge to comparison shop drugs (if there's even multiple drugs that will treat your condition!) and even for the few people that do have the knowledge insurance disguises the true cost for most people. Combine that with the difficulty of becoming a drug manufacturer and the fact that there's only a handful making each drug we don't even have to have coordinated price fixing, if you competitor raises their prices there's very little reason to not raise yours as well because there's either a) no substitute to that drug or b) patients and doctors are shopping by effect not cost for 99% of the time.
• deleted 7y ago
  [deleted]
• RHSeeger 7y ago
  > The price of his insulin had apparently gone up again to $1300, which was more than he had in his bank account. > Five days later, he was dead. I don't mean to sound insensitive here, but... last I checked it's possible to pick up insulin (without a prescription) for $25 a bottle. Sure, it's not the same insulin he was probably on, but it does work (I was on it for many years). A little bit of searching on the web would have turned of this information; so why is he dead instead of on a different insulin?
  • wccrawford 7y ago
    I'm guessing it was because people are more scared of taking unknown drugs than stopping taking their known-good drugs. IMO, we've gotten to a point in our society where there are risks we used to take routinely that we no longer think are acceptable, even when the alternative is complete failure. Prescribed medicine and other healthcare-related areas are some of those things.
    • ozmodiar 7y ago
      Also keep in mind that messing up an insulin dose can kill you pretty quickly, so I can see why it would be particularly frightening. Not that it’s worse than certain death.
  • alistairSH 7y ago
    Yes and no... https://www.snopes.com/fact-check/insulin-walmart-vial/ https://www.snopes.com/fact-check/insulin-walmart-vial/ There are other articles available that describe the situation. tl;dr - Yes, you can get a vial of insulin for $25. But, it's not the same kind of insulin most diabetics take. They are typically prescribed insulin analogs, which still require a prescription. The $25 version could likely keep them alive, but the dosing/usage/effects are not as consistent.
    • UnpossibleJim 7y ago
      But it does work. I was on 70/30 when I was a kid and, while not as flexible, it will keep you alive. You have to be VERY strict about your diet and exercise regimen when you're older, while doing blood sugars on the regular, but you don't fucking die. (Well, far less likely, I should say)
• bawana 7y ago
  If we didn't let the rich get richer, would they then figure out other ways to enslave the poor and make their lives ever more miserable? It seems humans have a built in need for win-lose scenarios (schadenfreude?) and winning races by ever increasing margins. Cant we make a logarithmic scale for money so that 10x more money is only double the buying power?
• dusted 7y ago
  The state, not private interests, should spearhead production and research of pharmaceuticals, it should be part of basic developed-country infrastructure, like transportation and education.
  • pojzon 7y ago
    When you look closely at developed countries, you will see that they actually cut funds for healthcare and education. Healthy and educated ppl are too hard to manipulate..
    • dusted 7y ago
      Interestingly, it's those same healthy, educated people who vote for those changes.
      • pojzon 7y ago
        Im not so sure about that, people who finished college or high school in my country are in minority. Im sure this is also the case in most modern countries. I also think that considering voting as a valid way to influence politicians in an age of corpo-corruption is pretty silly. Sure you can pick politicians but if there are like 4 major parties which all sellout to highest bidder, voting is pretty pointless because result is always the same. Creating new parties is out of question because you need vast amounts of funds to accomplish it. (https://www.russellsage.org/sites/default/files/Fig10_Comparative_hires_0.png https://www.russellsage.org/sites/default/files/Fig10_Compar...)
  • vonmoltke 7y ago
    Why has no state stepped up to do this yet?
  • specialist 7y ago
    The system I imagine: * drug development being funded by government; * thru misc stages (research, clinical trials, certification, mfg, etc); * at every stage third parties (public, private, or both) bidding on time boxed rights to license drug and carry drug thru remaining stages; * licensee paying royalties. Earlier involvement in the most promising drugs is incentivized by allowing third parties to license earlier, taking on more of the risk, getting a better deal. Orphaned drugs can still get some love by do gooders. In fact, government can pay (subsidize) third parties when there's no profit. I'm a total noob, and have zero idea if this worldview has any merit. Also, prohibit advertising and all forms of payola.
• colechristensen 7y ago
  >So he made a rational decision: He’d go uninsured, save the cost of the premium, and just pay for his meds out of pocket, while racking up work experience that could serve as a springboard to a better position with health insurance. He did not make a rational decision. This is the most upsetting part. I looked. You can buy an insurance plan in Minnesota with a $750 deductable $6000 out of pocket max for $350 per month. It is not possible with that plan and a few more like it to spend more than 1000 per month. If you are planning to spend that much anyway it is irrational to pick anything else. What seems to have happened is he was using expensive autoinjector pens while on good insurance and then didn't adapt when he lost it and didn't get the right advice for purchasing his own insurance or the right education to be able to pick an appropriate plan.
  • beached_whale 7y ago
    Those pens allow for accurate dispensing.
    • colechristensen 7y ago
      Who wouldn't choose to learn how to use a syringe well instead of paying a third of their income for auto pens?
      • inflatableDodo 7y ago
        Looking at what a good friend of mine has to put up with, I'd say someone with severe diabetes. You have periods when you cannot think very straight and it is easy to fuck up with standard syringes. Auto injectors should not cost a third of your income, they are not complex devices.
        • colechristensen 7y ago
          They shouldn't. But you also have a tiny mass produced machine that is life and death for people. Insuring quality is expensive and the cost of mistakes is extreme. If you want cheaper medicine you have to also have cheaper mistakes and there aren't many people arguing equally loud for both. (Just one issue of many)
• ptah 7y ago
  this only applies in US
• mrosett 7y ago
  Obviously this is a huge problem. For a more analytical perspective, take a look at Slate Star Codex on drug shortages and price gouging: https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-healthcaristan-ssr/ https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-...
  • makomk 7y ago
    That explanation of the economics and poor regulatory choices that led to all this certainly makes a lot more sense than the explanation in the other aricle. Unfortuntely, it's also less condusive to thinking that it's all the fault of mass-murdering villains running pharma companies who should be harassed for every second of their lives, and that anyone who even thinks this is worth discussing wants people to die. So I guess it's not surprising those comments are up top and this is languishing near the bottom.
• qaq 7y ago
  So any startup that basically provides insurance that covers 10 cents but gives access to insurance pricing for like $10 a month?
• tobyhinloopen 7y ago
  Why is insulin not being sold illegally? Like a black market of imported insulin? Or is it?
• cproctor 7y ago
  Some big hospital chains are starting a nonprofit generic drug manufacturer, Civica Rx. This seems like a promising step forward. For those more inclined to direct-action, there's Four Thieves Vinegar [1]. [1] https://fourthievesvinegar.org/ https://fourthievesvinegar.org/
  • dev_dull 7y ago
    Why not just import it from foreign manufacturers for a fraction of the price?
    • vonmoltke 7y ago
      The FDA won't allow that unless those manufacturers go through its approval process.
      • dev_dull 7y ago
        Sounds like a fixable problem.
        • JustSomeNobody 7y ago
          Exactly. Instead of spending 10Bn on R&D, spend 10Mn on lobbying.
        • zaroth 7y ago
          If you’ve read the stories on some of these foreign manufacturers, you might reconsider trying to bypass the FDA inspection requirement. Here’s just the first hit I saw on Google, there have been quite a few exposés on the topic. https://www.npr.org/sections/health-shots/2019/05/12/722216512/bottle-of-lies-exposes-the-dark-side-of-the-generic-drug-boom https://www.npr.org/sections/health-shots/2019/05/12/7222165...
        • BurningFrog 7y ago
          How exactly would you fix it?
• pg_bot 7y ago
  What's left out of most conversations around insulin. - The incidence rate for diabetes has skyrocketed over the past 25 years. It's estimated that 100 million Americans are now living with diabetes or prediabetes. - Most of the patents for the newer insulins are mostly on manufacturing processes. Read up on Lusduna if you want to see how difficult it is to bring an insulin to market in the US. - Biosimilars are significantly more costly to bring to market than generic drugs. - Alex Azar, and every other secretary of HHS have had the ability to allow legal importation of drugs from Canada since 2003. We actively choose not to. While IMO the risks are worth the benefits, I will concede the other side does have a valid argument against importation. - The price difference is with fast acting insulins. These insulins offer a higher quality of life relative to the older insulins. The clinical benefits of using a fast acting insulin versus something like Novolin 70/30 (aka Walmart insulin) are negligible, while the price difference is substantial. (Talk to your physician before switching insulins) From the people I've talked with, fast acting insulins are a godsend if you have diabetic children or can't keep a regimented schedule. - All of the companies that manufacture insulin are public and you can read through their financial statements to verify that what they are saying is true. All that being said... I'm surprised that an enterprising Canadian has not exploited insulin arbitrage. You can buy insulin over the counter without a prescription in the USA and Canada. Canadian law does not prohibit exportation of drugs to the United States. Theoretically you could set up an escrow service that connected Canadians who wanted to make a buck with American diabetics. The service could offer insurance in case a delivery was not made and you needed to buy insulin in the US. Obviously this would complicate things with your insurance. No insurance company is going to cover bootleg Canadian insulin when it comes to your deductible.
  • skohan 7y ago
    > It's estimated that 100 million Americans are now living with diabetes or prediabetes. Holy cow - that's like 1/4 to 1/3 right? That seems insanely high!
    • jandrese 7y ago
      Prediabetes is broadly defined, it catches a lot of people who aren't necessarily going to become diabetic.
• Circuits 7y ago
  We need to hold these people accountable for their actions. Life sentences or if necessary capitol punishment sentences for the players and actors who are responsible for hiking up prices on drugs for no better reason than increased profit margins, enough is enough. It doesn't matter if its diabetes, ms or cancer if the the drugs aren't affordable then the people producing the medication should immediately be taken to court and if found guilty of price gouging should be punished accordingly.
  • anonuser123456 7y ago
    As long as future citizens can hold people like you equally culpable for the predictable result, sure. Here is my prediction; no one enters/stays in the high risk drug market because whack jobs want them dead for getting a return on R&D. In fact, I would take this one step further. You my dear comrade, since you don't work in the field trying to invent drugs and lower drug prices, are obviously part of the problem. Since you rent your labor elsewhere for your own benefit you artificially distort the market and keep prices high. Since you seem to believe capital punishment is an appropriate sentence, I only ask that you put a little skin in the game and mark your beliefs to market.
    • Circuits 7y ago
      The high risk drug market? What are you talking about there's nothing high risk about the drug market. Their profit margins are enormous, absolutely gigantic. If you are under the impression that the people setting drug prices are good people trying to make an honest living then you are very, very confused. The industry is thick and rife with corruption and greed. Their paying off politicians and doctors left and right. Have you any idea the kind of people your defending? Go discover a cure for cancer tomorrow, you will be dead by Monday. They will pay to have you killed, that's the kind of people your defending. Skin in the game? Anyone who is dependent upon drugs to live already has skin in the game, I already have skin in the game. If they so choose any one of us who is depend on these drugs to live could be dead within the year, how's that for skin in the game?
• inflatableDodo 7y ago
  Those poor, poor drug companies, it is not their fault they acted like utter cunts. After all, they were allowed to act like utter cunts, so they just had to. So lets solve this by removing all regulation that stops them from acting like utter cunts in other interesting ways, that couldn't possibly backfire.
  • felipeko 7y ago
    Your tone seems very uncalled for. All I am arguing is that if you prosecute people from selling drugs, or make more regulations, fewer people will sell drugs - at a higher price. It shouldn't matter people are cunts, if they have competition they will have to provide better satisfaction. As of now, american people are prohibited from importing drugs, and that's exactly what utter cunts lobby and fight for.
    • cf141q5325 7y ago
      >... or make more regulations, fewer people will sell drugs - at a higher price. Which just doesnt happen in countries with stricter regulated medical markets. Quite the opposite, it happens in the US, thats what this article is about. Its a nice theory but not something that can be observed in reality.
    • inflatableDodo 7y ago
      >"All I am arguing is that if you prosecute people from selling drugs, or make more regulations, fewer people will sell drugs - at a higher price." Looking at the other drug market, not only does this not stand up, but also the quality is a crapshoot.
      • felipeko 7y ago
        The other drug market has fewer people selling than otherwise, at a higher price (for the quality) than otherwise. I'm not sure how you are able to the opposite conclusion.
        • 7y ago
• todipa 7y ago
  How come there are no startups disrupting this market and producing it cheaply?
• mparramon 7y ago
  Capitalism.
• dmitryminkovsky 7y ago
  "...made free 100 years ago..."??? What? > Insulin from cattle and pigs was used for many years to treat diabetes and saved millions of lives, but it wasn’t perfect, as it caused allergic reactions in many patients. The first genetically engineered, synthetic “human” insulin was produced in 1978 using E. coli bacteria to produce the insulin. Eli Lilly went on in 1982 to sell the first commercially available biosynthetic human insulin under the brand name Humulin. [0] This process—programming bacteria to generate complex human biomolecules for our consumption(!!)—was a crowning human achievement. It did not occur 100 years ago. Insulin is not simple [1], and making it in the current pharmaceutical form that we expect, at the scale we need, is not some simple, 100 year old thing. We can't take these things for granted. No comment on how much makers should charge for insulin. [0] http://diabetesstopshere.org/2012/08/21/the-history-of-a-wonderful-thing-we-call-insulin/ http://diabetesstopshere.org/2012/08/21/the-history-of-a-won... [1] https://en.wikipedia.org/wiki/File:InsulinHexamer.jpg https://en.wikipedia.org/wiki/File:InsulinHexamer.jpg
  • makomk 7y ago
    As far as I know, current clinical evidence shows that modern porcine insulin isn't actually any better or worse than synthetic human insulin overall. However, it's also not any cheaper these days either - in fact, I think the NHS pays slightly more for it than human insulin. Sure, managing to program bacteria to produce complex human biomolecules was a major breakthrough, but the tech is old and refined enough that companies can churn the stuff out relatively cheaply.
    • aeorgnoieang 7y ago
      > churn the stuff out relatively cheaply The marginal costs (per unit) are relatively cheap but the fixed costs, especially regulatory costs, are very much not cheap; which is one reason why there's so little competition.
  • WhompingWindows 7y ago
    Can we use synthetic biology to create an open-source bacterial strain that produces insulin, then distribute the incubators and purifiers to diabetics? Something akin to 3-d printers but for home-brewed medications.
• userulluipeste 7y ago
  "the Toronto team sold their patent rights to the university for $1 apiece in an effort to protect its integrity from greedy commercial enterprises" "Eventually, Banting and his team reluctantly agreed: Lilly was granted exclusive rights to manufacture and distribute insulin in the United States for one year" This makes no sense to me! If they were not interested in making money, as to donate their patent rights, why not letting it be public? Why selling it to a university? Then why get shocked that an academic organization does a poor job on scaling up production and on other non-academic related things? Oh, and the cherry on top, why did it have to be manufacturing exclusive rights?!
• LargeWu 7y ago
  I think there is a very good argument to be made for nationalizing drug production in the USA, at least for generics. The idea that private companies have the power to gouge people just for the privilege of staying alive, in the name of profit, is reprehensible.
• tomxor 7y ago
  Why is there no exact pricing regulation for such widely needed drugs? Capitalistic models don't work for everything, it certainly does not benefit this type of drug in an oligopoly... there is no competition and there is no need for it, the research is ancient history. Price fixing is not the problem, it's an inevitability, which is why the government should do it for them: 1. Regulate exact price, zero flexibility. 2. Require production of specific drugs as requirement for access to _any_ government research grants. Alternately to avoid production issues entirely: production is simply the cost of _being_ a pharmaceutical company selling any drugs to your country. 3. Meet demands through responsibility proportional to net profit. Make more money? great, but it has to benefit availability of basic drugs.
• joelx 7y ago
  Patent ownership does nothing to encourage innovation. Most of the innovations are based on prior research, and most are done in publicly funded labs that would do the research regardless of the profit motive. Allow full competition to work or you end up with a corrupt version of capitalism.
• hk2001 7y ago
  I work for one of the companies mentioned in the article. I too am troubled by the increasing burden on those unable to pay for their insurance, and feel that something must change, and quickly. However, I’m shocked when I read articles like this one that manage to miss the crux of the issue so badly (though, to be fair to the author, most articles on the subject make the same mistakes). Perhaps it’s because I work in the industry and have more insight that I take for granted, or perhaps I’m simply blinded by personal biases and I’m the one off base, but the issue driving insulin price increases seems to be obvious: to he insurance system in the US is irredeemably broken. A few facts, considered together, support this: 1. The number of diabetics in the US has skyrocketed in the preceding decades. 2. The list price for insulin has also skyrocketed in the last 20 years 3. The amount of money the main insulin makers are paid per insulin fill is actually down during this time So you have an increasing demand for a product, combined with an increased price, but less money per unit being made by the parties allegedly jacking up the price for profit. So where is the excess money going? Middlemen. Insurance companies in the US have enormous leverage over just about every other party involved in healthcare: the patients, the providers, and the pharmaceutical manufacturers. This is even more true for medications like insulin, where there isn’t much difference in efficacy between brands. In a normal market, these companies would try to compete on price. But for insulin, price continues to rise. This is because insurance companies, and their negotiators, Pharmacy Benefit Managers (aka PBMs) have a vested interest in prices rising. PBMs make their money by negotiating prices with pharma companies to secure discounted prices for insurers, and in doing so, create the insurers’ “formularies”, which are basically the list of all the medications an insurer will cover, the prices they will pay, and the conditions that must be met. PBMs get a cut of the discount they negotiate with the pharma company. If drug A has a list price of $200, and they negotiate it down to $150 for their insurance clients, they take home x% of all the savings that are made at $50 a pop. This creates a perverse incentive however: a PBM stands to make more from a drug that costs $300 and is negotiated down to $150 than a drug that is $200 that is negotiated down to $150, even if everything else is the same. That means you are more likely to get better insurance coverage for your drug by starting high and giving deep discounts. And for drugs like insulin, where similarities between products are so small that the only place you can compete is price, how well you are covered by insurers compared to your competitors will make or break your business. Insurance companies themselves also love drugs with high costs that are then discounted deeply, because when they charge a patient coinsurance, it’s based on the list price, and not the price the insurer is paying. So even though they’ve negotiated the price of insulin down by over 50% with the pharma company, they are still going to charge you y% based on the full price. So if they continue to get insulin from manufacturers for $Y per unit every year, they continue to charge you 20% of a cost that continues to rise further and further away from $Y, meaning they are actually paying less and less as prices rise. They will claim to be using the reduced costs to lower premiums, but if reduced costs are only the result of increased costs for the sick, then all we’ve done is create an insurance system where the sick are subsidizing the healthy, which is entirely backwards. So now we have a system where manufacturers raise prices year after year, only to also give ever increasing discounts to insurance companies and PBMs, in hopes that it actually increases the number of patients who can afford their products (i.e. those with decent insurance). But those left holding the bag are the individuals without insurance or those with high deductible plans (which are becoming increasingly common). It’s also important to note exactly how much power these middlemen have. It’s a common narrative that Big Pharma is able to get away with bad practices because of their power. But in reality, only a single pharmaceutical company is in the Fortune 50, and none of the insulin makers are. In contrast, 80% of the PBM market is controlled by 3 companies, 2 of which are Fortune 50, and the third is a subsidiary of United Health, which is an insurer and is also Fortune 50. In fact, 10 of the Fortune 50 companies are middlemen (insurers, PBMs, or drug distributors) in the healthcare industry. Again, maybe my view of the issue has been entirely skewed by my personal biases. Also note that this isn’t necessarily the cause of all price gouging in the pharma industry. There are certainly bad actors that are jacking up prices simply because they can. But it seems to me like the true issue at the heart of the insulin pricing problem (the insurance system in the US) is being skipped over to focus on the symptom because the idea of rich pharma companies reaping in profits from price gouging because it is a simpler narrative.
• phlogisticfugu 7y ago
  If nobody has yet started one, sounds like an opportunity for patient-owned collectives to manufacture and distribute off-patent drugs for chronic diseases. I'm thinking similarly to what was done for medical marijuana, but with more a credit union-type feel. So long as legislation clears the hurdles to such organizations, it wouldn't cost taxpayers, and seems more in-line with the spirit of patent expiration.
• wolfi1 7y ago
  I don't know how long a pen lasts, but the insurance in my country pays about 40€ for five pens.
• WalterBright 7y ago
  I don't understand why competitors don't enter the market with older versions of insulin that don't require biologic methods to create.
  • officialchicken 7y ago
    They exist (most insulin produced today is rDNA biologics), and are about $25 at Walmart. Of course, the same thing at CVS or Walgreens is $100+. I know b/c I switched back to using them after needing to travel internationally for more than 1 month at a time... my expenses went from $2500+/mo to under $200/mo, including the extra testing supplies required to support this regiment. At the same time, I take up to 7 shots a day and am definitely now a "Medical Tourist". Yes, I can go to Europe or Canada and buy supplies (at retail cost) for less than the US, including travel. But - that's actually MORE FREEDOM for me. YMMV.
    • WalterBright 7y ago
      If they exist, why doesn't the article mention it and why don't patients use it?
• AngeloAnolin 7y ago
  Lots of comments focused on having a good paying job with comprehensive benefits (insurance). I don’t think that is even the solution here. The main problem is that lifesaving medications have prices spiralling out of control to the point where it becomes unaffordable for people to get it. Not everyone will be lucky or capable enough to have a job that will allow them access to the medicines they need through some benefits or financial salary. Will regulations work such that medicines categorized as lifesaving will be capped at a price that is affordable for people? Or is a solution based on ensuring patents are used not as a leverage to gouge prices but to protect the intellectual property and not financial commodity? Solutions abound but when the greed of a few is being upheld, then it just becomes a reality that people becomes the bearer of bad news and in turn have to swallow the bitter pill of unaffordable medicines.
• dang 7y ago
  Related from 2016: https://news.ycombinator.com/item?id=11154237 https://news.ycombinator.com/item?id=11154237
• sytelus 7y ago
  This is a unnecessorily long article where the central message gets lost. My understanding is that there were two major insulin manufacturers and in past, they competed which kept prices down. Then suddenly they realized that if they stop wasting their resources in competing and instead cooperate then they can get arbitrarily high profits. With this internal understanding, one would raise the price and soon other would match that high price. They did this over and over to their great surprise that customers are just eating up the higher cost. This was the much better and shorter path to huge profits! I have a general theory that in any two-party system where rewards are potentially unlimited and at the expense of someone else, the parties would sooner or later learn that its better to cooperate instead of competing. We have seen this movie in cable industry, cell phone industry and so on. I expect this to happen also in political parties in US, UK and elsewhere. In those scenarios, parties will soon learn that if they cooperate then they can acquire unlimited power, funds and control at the expense of resources (i.e. people) and divide these spoils between themselves which will be much higher than if they tried to compete with each other.
• rayiner 7y ago
  The article and title start with a false premise. The insulin made free 100 years ago is very different than the insulin you get today. It’s faster acting, etc. nothing is stopping someone from manufacturing the circa 1992 version (or even the very good versions developed in the 1990s). But so long as doctors prescribe, and insurance companies are willing to pay for, the newer stuff, there is little market for the older versions. Ironically, the heavy subsidization of health insurance is what’s actually causing the problem. When there is no reason to control costs (especially under the ACA, where insurance companies cannot increase profits by doing so), there is a huge incentive to keep pumping out marginally better versions of a drug, because you’re not competing on price with the old, out of patent versions.
• vlindos 7y ago
  As European and T1 diabetic - my monthly insulin dose is covered l in the poorest European country - Bulgaria. Even if I need to pay it it is still way much afordable - around 130 dollars. Looks there are many troubles over the ocean... One more thing - I get quality insulin that is latest tech and improves my life much. Much better products than I was getting for example 15 years ago and probably the same or better than than my fellow Americans are getting for there. But I bet the corruption is so high that if I want to import the same products from Europe there will be a law against it.