18 ms·

A Government Guide to Keeping Insulin Unaffordable

130 points by henvic 7y ago

lostmymind66 7y ago
It's unaffordable because there is a monopoly on Insulin. Why is there a monopoly? Because it takes decades of work and close to a billion dollars to get a new drug through FDA approval. We need to work on bringing these costs down, so more companies can actually compete. Government regulation schemes will only reduce the amount of companies willing to go through the process and give us less choice in the end.
- hjk05 7y ago
  There isn’t a monopoly. It doesn’t take decades to get a generic on the market. Insulin is available in wallmart for 25$ per vial. There is a definite problem in the US with drug pricing, and middlemen gauging the market, but it’s a straw man to claim new insulin products don’t bring any change. If you ask the patients there’s a world of difference between the cheap genetics and the main brand products, which is why they want the newer products and not the generics. But of cause patients also want the newer products at the same price as the generics which will never happen, even if the government fixes the drug pricing market.
  - lostmymind66 7y ago
    If the generics are $25, then I don't see a problem. It's cheaply available and this article is wrong.
    - erinaceousjones 7y ago
      Not all insulin is created equal, as the Vox article posted in this thread shows - https://www.vox.com/science-and-health/2019/4/10/18302238/insulin-walmart-relion https://www.vox.com/science-and-health/2019/4/10/18302238/in... - different formulations vary in their effectiveness person-to-person regarding regulating blood sugar levels. For one person, the cheap ReliOn insulin from Walmart might allow them to manage their T1 diabetes, but for another person it might cause more incidences of hypo/hypergylcaemia. The expensive, newer, patent-covered formulations like Lantus are what are prescribed over here in the UK - lucky that the NHS shields us from the ridiculous prices!
      - tomatotomato37 7y ago
        I don't get it. If the generic unimproved versions... unimprovedness is riskier, and an improved version is researched and created that removes that risk, than why should the new formula of the new version not be under patent?
        dunstad 7y ago
        If you think about the rules of our current system, your conclusion makes perfect sense. I and others don't think the rules of the current system are very good if they're preventing us from giving people better quality of life.
        deleted 7y ago
        [deleted]
        themaninthedark 7y ago
        I purchased an OS 8 years ago, if I want to buy the same modern OS from the maker it now cost more money. I purchased a car from a manufacturer, the base price was 20,000. Now the same model car has the base price 25,000. Sure, they added side impact airbags, backup cameras and lane assist but why can't I buy it for 20,000? If you and others who think like you dislike the current system and want to improve everyone's quality of life, you are quite welcome to invest the time and capital to start a drug research lab, invent new and novel medicine, patent it, get it FDA approved then license it to anyone who wants to make and sell it. Volvo was committed to the idea of safety that when they developed a seatbelt system they did just that. The idea of taking someone's work with out paying them fair compensation is akin to slavery. The only difference it that slavery is forcing someone to do something and this is promising someone compensation then withholding it. Now, if we believe that this new formulation is so revolutionary and would be such a great benefit then why not just buy the patent from the maker? Put together a company, raise the funds. Anything can be bought and sold. The only question is price. Trying to force the government to use a version of eminent domain by lying about the situation to the public to spark outrage is scummy.
    - consp 7y ago
      Most people will not be healthy with the generic insulin. There are wide verieties of treatment methods for vastly different people and medicine has come a long way. This "generic" human insulin replacement is a 40 year setback in treatment and will likely cause more secondary costs due to bad treatment.
      - tschwimmer 7y ago
        Do you have some more information about this? It's interesting to me and I'd like to learn more.
        IG_Semmelweiss 7y ago
        http://www.econtalk.org/robin-feldman-on-drugs-money-and-secret-handshakes/ http://www.econtalk.org/robin-feldman-on-drugs-money-and-sec...
      - WalterBright 7y ago
        Since patents expire after 20 years, it would be max a 20 year setback.
    - jablongo2 7y ago
      The problem is that the generics are equivalent to insulin from the 70's, when complications of type-1 diabetes were considered almost unavoidable. You can be super diligent and figure out how to manage your diet to make it work with the cheaper stuff, but that takes years of practice and conditioning. If you have to switch from something like humalog and an insulin pump, to injections of Regular insulin a two times a day or so, you are gonna be screwed.
    - wishinghand 7y ago
      The generic insulin is very low quality. Yes it could save my life, but it would incredibly hard to manage a healthy one.
  - deleted 7y ago
    [deleted]
  - ng12 7y ago
    > If you ask the patients there’s a world of difference between the cheap genetics and the main brand products The main problem is the $25 insulin is R and not fast-acting. It's not the difference between generic and name-brand, it's about using an insulin that takes over twice as long to be absorbed by your body.
    - hjk05 7y ago
      It really boggles my mind that every article on insulin goes through this cycle: “the producers are scammers it the same product put out a hundred years ago but they have new patents!!!” “It’s cheaply available in the old form” “but that’s not the same product!!” You can’t have it both ways. Cheap alternatives are available. But yes newer main brand products are better in tons of ways, which is not surprising as they are culmination of decades of research. You can’t both claim there are no differences and than want those differences in the cheaper generics.
      - ng12 7y ago
        I agree that the reporting is sub-par but that's not really what's going on. Insulin R and rapid-acting insulin are two separate medications. All insulin manufacturers produce both types and a generic is only available for NPH, despite the fact that the overwhelming majority of Type 1 diabetics are prescribed fast-acting. Additionally most diabetics are prescribed to take a long-lasting insulin as well since the body needs insulin 24-hours a day, there is no generic for this variant either.
      - rland 7y ago
        The patent is expired on the “new version,” Humalog. It expired sometime in the early 2010s. However, because it is produced biologically (altering RNA in bacteria) instead of chemically, additional regulations prevent a genetics from entering the market. It is this additional regulation that should be subject to scrutiny, since the price of humalog has continued to rise, even after its patent expired. A vial of humalog costs~$5-10 to manufacture, while its list price is nearly $300 and rising quickly. I’m guessing because pharmas want to milk their golden cow while these regulations are still in place. We could drop the price of Humalog 90% within a matter of days by simply cutting regulation against import, as it is already being manufactured safely abroad. By the way, when Humalog was under patent, on day one, the list price was something like $30 per vial. Using cheaper alternatives is also strongly correlated with worse outcomes, including amputations and death. In a word, yes, it literally is exactly as unconscionable and greedy as it looks on the tin.
deogeo 7y ago
> Even though insulin treatment itself can’t be patented, improvements in delivery mechanisms can be. These incremental improvements, no matter how small, can be used to extend the 20-year patent on a drug, a process called “patent evergreening.” I'm confused - wouldn't the new patent only cover the improved method, and the patent on the original, un-improved version would still expire?
- DarkStar851 7y ago
  Yes, the old drug patent will expire, and when this happens the company typically pulls an "oh our old version is now magically unsafe!" to wrestle away competition. Plus developing a product from the old patent still requires extensive FDA approval. Very expensive stuff.
  - hjk05 7y ago
    Do you have references for that claim? If a company goes out with a claim their old product is unsafe it’s not like it’s rocket science to test the claim. And if their lying and you could literally corner a billion dollar industry by testing the claim I’d expect every producer of generics to do so. On the other hand if the product is actually unsafe that opens up liability claims from costumers.
    - Scoundreller 7y ago
      I've seen companies create "extended release" formulations of their old formulation 1 year before the patent expires to get everyone to switch over to the patented version before the generic comes out. I've even seen it done when the previous version and the new version were still both once daily (tamsulosin, I'm looking at you!) Yes, some insurers will hesitate to cover the new formulation when it comes out, but not all. Sometimes the insurer will make a deal with the manufacturer so that the manufacturer is only getting paid the generic-equivalent price. But who knows what happens behind closed doors.
      - hjk05 7y ago
henvic 7y ago
By the way, you can do business without IP... I recommend the following book: Against Intellectual Property by Stephan Kinsella. https://mises.org/library/against-intellectual-property-0 https://mises.org/library/against-intellectual-property-0
jablongo2 7y ago
As a type-1 diabetic and user of Lilly and Novo Nordisk insulins, this article is spot on. People are literally dying in some cases due to this dysfunction. One thing that is not mentioned is that the dynamics of prescription-writing in the first place is anti-competitive in terms of price. Fiasp and Humalog are equivalent fast acting insulins from Novo-Nordisk and Lilly - competition will only happen when patients can decide which one to take instead of their doctors, who are not sensitive to small price differences (and in most cases are not themselves taking the drug).
- rayiner 7y ago
  > s a type-1 diabetic and user of Lilly and Novo Nordisk insulins, this article is spot on. People are literally dying in some cases due to this dysfunction How many people would be dying if there wasn’t the same level of incentives to research these drugs in the first place? Diabetes is a common health problem around the world. Nothing stopped say a non-profit or government from beating Lilly and Novo Nordisk to the punch developing these drugs. But profit seeking corporations are simply better at innovation than governments and non-profits.
  - markbnj 7y ago
    The whole point of the article is that the manufacturers aren't developing new drugs. The drugs haven't changed in decades. They're making small changes to delivery systems and other ancillary aspects and then patenting these new variations, as well as engaging in the usual quid pro quo wink wink old boy network anti-competitive manipulation of regulatory regimes.
    - rayiner 7y ago
      Insulin has changed quite dramatically over the decades. Earlier iterations of insulin are available as generics. But newer versions act faster and have fewer side effects.
      - markbnj 7y ago
BurningFrog 7y ago
Obligatory link to essay explaining the issues in pedagogical detail. Section II is on insulin: https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-healthcaristan-ssr/ https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-...
TomMckenny 7y ago
If campaign contributions are called free speech and legislators are happy making laws blatantly favoring contributors, you're going to have a pretty tight loop.
IG_Semmelweiss 7y ago
Most of thw misunderstanding on this topic has to do on people from outside the patent field trying to figure out what is going on in it, and specifically, how drug companies are gaming it. Here is a great podcast on the matter. If you want to know about drug patents and how they are gamed, this is your bible. http://www.econtalk.org/robin-feldman-on-drugs-money-and-secret-handshakes/ http://www.econtalk.org/robin-feldman-on-drugs-money-and-sec...
mnm1 7y ago
How big is the insulin market? It sounds fairly big considering how many people have diabetes. So where are the Mexican cartels or similar black market organizations when you need them? If we're going to wait for the government, or worse, the industry itself to fix this problem it'll never be fixed. What we need is a proper black market. Is insulin available on the dark web drug markets? If not someone should make it available and cash in while still providing massive savings. That's how you solve a problem like this when your fucking government has stopped working like the US government has.
- henvic 7y ago
  Proper black market is exactly a part of the industry that the state fights. One of the things I always wanted was to create a black market for electronics in my home country (Brazil) because taxation here is really high. You should also know that the government with its patents system is the root cause of this price spike. I wish black market organizations doing legit and good stuff (like selling medicine that is pricey due to state granted monopolies) was the norm and I hope someday it will be. However, we are not there yet.

130 points by henvic 7y ago

It's unaffordable because there is a monopoly on Insulin. Why is there a monopoly? Because it takes decades of work and close to a billion dollars to get a new drug through FDA approval. We need to work on bringing these costs down, so more companies can actually compete. Government regulation schemes will only reduce the amount of companies willing to go through the process and give us less choice in the end.

hjk05 7y ago
There isn’t a monopoly. It doesn’t take decades to get a generic on the market. Insulin is available in wallmart for 25$ per vial. There is a definite problem in the US with drug pricing, and middlemen gauging the market, but it’s a straw man to claim new insulin products don’t bring any change. If you ask the patients there’s a world of difference between the cheap genetics and the main brand products, which is why they want the newer products and not the generics. But of cause patients also want the newer products at the same price as the generics which will never happen, even if the government fixes the drug pricing market.
- lostmymind66 7y ago
  If the generics are $25, then I don't see a problem. It's cheaply available and this article is wrong.
  - erinaceousjones 7y ago
    Not all insulin is created equal, as the Vox article posted in this thread shows - https://www.vox.com/science-and-health/2019/4/10/18302238/insulin-walmart-relion https://www.vox.com/science-and-health/2019/4/10/18302238/in... - different formulations vary in their effectiveness person-to-person regarding regulating blood sugar levels. For one person, the cheap ReliOn insulin from Walmart might allow them to manage their T1 diabetes, but for another person it might cause more incidences of hypo/hypergylcaemia. The expensive, newer, patent-covered formulations like Lantus are what are prescribed over here in the UK - lucky that the NHS shields us from the ridiculous prices!
    - tomatotomato37 7y ago
      I don't get it. If the generic unimproved versions... unimprovedness is riskier, and an improved version is researched and created that removes that risk, than why should the new formula of the new version not be under patent?
      - dunstad 7y ago
        If you think about the rules of our current system, your conclusion makes perfect sense. I and others don't think the rules of the current system are very good if they're preventing us from giving people better quality of life.
        deleted 7y ago
        [deleted]
        themaninthedark 7y ago
        I purchased an OS 8 years ago, if I want to buy the same modern OS from the maker it now cost more money. I purchased a car from a manufacturer, the base price was 20,000. Now the same model car has the base price 25,000. Sure, they added side impact airbags, backup cameras and lane assist but why can't I buy it for 20,000? If you and others who think like you dislike the current system and want to improve everyone's quality of life, you are quite welcome to invest the time and capital to start a drug research lab, invent new and novel medicine, patent it, get it FDA approved then license it to anyone who wants to make and sell it. Volvo was committed to the idea of safety that when they developed a seatbelt system they did just that. The idea of taking someone's work with out paying them fair compensation is akin to slavery. The only difference it that slavery is forcing someone to do something and this is promising someone compensation then withholding it. Now, if we believe that this new formulation is so revolutionary and would be such a great benefit then why not just buy the patent from the maker? Put together a company, raise the funds. Anything can be bought and sold. The only question is price. Trying to force the government to use a version of eminent domain by lying about the situation to the public to spark outrage is scummy.
  - consp 7y ago
    Most people will not be healthy with the generic insulin. There are wide verieties of treatment methods for vastly different people and medicine has come a long way. This "generic" human insulin replacement is a 40 year setback in treatment and will likely cause more secondary costs due to bad treatment.
    - tschwimmer 7y ago
      Do you have some more information about this? It's interesting to me and I'd like to learn more.
      - IG_Semmelweiss 7y ago
        http://www.econtalk.org/robin-feldman-on-drugs-money-and-secret-handshakes/ http://www.econtalk.org/robin-feldman-on-drugs-money-and-sec...
    - WalterBright 7y ago
      Since patents expire after 20 years, it would be max a 20 year setback.
  - jablongo2 7y ago
    The problem is that the generics are equivalent to insulin from the 70's, when complications of type-1 diabetes were considered almost unavoidable. You can be super diligent and figure out how to manage your diet to make it work with the cheaper stuff, but that takes years of practice and conditioning. If you have to switch from something like humalog and an insulin pump, to injections of Regular insulin a two times a day or so, you are gonna be screwed.
  - wishinghand 7y ago
    The generic insulin is very low quality. Yes it could save my life, but it would incredibly hard to manage a healthy one.
- deleted 7y ago
  [deleted]
- ng12 7y ago
  > If you ask the patients there’s a world of difference between the cheap genetics and the main brand products The main problem is the $25 insulin is R and not fast-acting. It's not the difference between generic and name-brand, it's about using an insulin that takes over twice as long to be absorbed by your body.
  - hjk05 7y ago
    It really boggles my mind that every article on insulin goes through this cycle: “the producers are scammers it the same product put out a hundred years ago but they have new patents!!!” “It’s cheaply available in the old form” “but that’s not the same product!!” You can’t have it both ways. Cheap alternatives are available. But yes newer main brand products are better in tons of ways, which is not surprising as they are culmination of decades of research. You can’t both claim there are no differences and than want those differences in the cheaper generics.
    - ng12 7y ago
      I agree that the reporting is sub-par but that's not really what's going on. Insulin R and rapid-acting insulin are two separate medications. All insulin manufacturers produce both types and a generic is only available for NPH, despite the fact that the overwhelming majority of Type 1 diabetics are prescribed fast-acting. Additionally most diabetics are prescribed to take a long-lasting insulin as well since the body needs insulin 24-hours a day, there is no generic for this variant either.
    - rland 7y ago
      The patent is expired on the “new version,” Humalog. It expired sometime in the early 2010s. However, because it is produced biologically (altering RNA in bacteria) instead of chemically, additional regulations prevent a genetics from entering the market. It is this additional regulation that should be subject to scrutiny, since the price of humalog has continued to rise, even after its patent expired. A vial of humalog costs~$5-10 to manufacture, while its list price is nearly $300 and rising quickly. I’m guessing because pharmas want to milk their golden cow while these regulations are still in place. We could drop the price of Humalog 90% within a matter of days by simply cutting regulation against import, as it is already being manufactured safely abroad. By the way, when Humalog was under patent, on day one, the list price was something like $30 per vial. Using cheaper alternatives is also strongly correlated with worse outcomes, including amputations and death. In a word, yes, it literally is exactly as unconscionable and greedy as it looks on the tin.

deogeo 7y ago

> Even though insulin treatment itself can’t be patented, improvements in delivery mechanisms can be. These incremental improvements, no matter how small, can be used to extend the 20-year patent on a drug, a process called “patent evergreening.” I'm confused - wouldn't the new patent only cover the improved method, and the patent on the original, un-improved version would still expire?

DarkStar851 7y ago
Yes, the old drug patent will expire, and when this happens the company typically pulls an "oh our old version is now magically unsafe!" to wrestle away competition. Plus developing a product from the old patent still requires extensive FDA approval. Very expensive stuff.
- hjk05 7y ago
  Do you have references for that claim? If a company goes out with a claim their old product is unsafe it’s not like it’s rocket science to test the claim. And if their lying and you could literally corner a billion dollar industry by testing the claim I’d expect every producer of generics to do so. On the other hand if the product is actually unsafe that opens up liability claims from costumers.
  - Scoundreller 7y ago
    I've seen companies create "extended release" formulations of their old formulation 1 year before the patent expires to get everyone to switch over to the patented version before the generic comes out. I've even seen it done when the previous version and the new version were still both once daily (tamsulosin, I'm looking at you!) Yes, some insurers will hesitate to cover the new formulation when it comes out, but not all. Sometimes the insurer will make a deal with the manufacturer so that the manufacturer is only getting paid the generic-equivalent price. But who knows what happens behind closed doors.
    - hjk05 7y ago

henvic 7y ago

By the way, you can do business without IP... I recommend the following book: Against Intellectual Property by Stephan Kinsella. https://mises.org/library/against-intellectual-property-0 https://mises.org/library/against-intellectual-property-0

jablongo2 7y ago

As a type-1 diabetic and user of Lilly and Novo Nordisk insulins, this article is spot on. People are literally dying in some cases due to this dysfunction. One thing that is not mentioned is that the dynamics of prescription-writing in the first place is anti-competitive in terms of price. Fiasp and Humalog are equivalent fast acting insulins from Novo-Nordisk and Lilly - competition will only happen when patients can decide which one to take instead of their doctors, who are not sensitive to small price differences (and in most cases are not themselves taking the drug).

rayiner 7y ago
> s a type-1 diabetic and user of Lilly and Novo Nordisk insulins, this article is spot on. People are literally dying in some cases due to this dysfunction How many people would be dying if there wasn’t the same level of incentives to research these drugs in the first place? Diabetes is a common health problem around the world. Nothing stopped say a non-profit or government from beating Lilly and Novo Nordisk to the punch developing these drugs. But profit seeking corporations are simply better at innovation than governments and non-profits.
- markbnj 7y ago
  The whole point of the article is that the manufacturers aren't developing new drugs. The drugs haven't changed in decades. They're making small changes to delivery systems and other ancillary aspects and then patenting these new variations, as well as engaging in the usual quid pro quo wink wink old boy network anti-competitive manipulation of regulatory regimes.
  - rayiner 7y ago
    Insulin has changed quite dramatically over the decades. Earlier iterations of insulin are available as generics. But newer versions act faster and have fewer side effects.
    - markbnj 7y ago

BurningFrog 7y ago

Obligatory link to essay explaining the issues in pedagogical detail. Section II is on insulin: https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-healthcaristan-ssr/ https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-...

TomMckenny 7y ago

If campaign contributions are called free speech and legislators are happy making laws blatantly favoring contributors, you're going to have a pretty tight loop.

IG_Semmelweiss 7y ago

Most of thw misunderstanding on this topic has to do on people from outside the patent field trying to figure out what is going on in it, and specifically, how drug companies are gaming it. Here is a great podcast on the matter. If you want to know about drug patents and how they are gamed, this is your bible. http://www.econtalk.org/robin-feldman-on-drugs-money-and-secret-handshakes/ http://www.econtalk.org/robin-feldman-on-drugs-money-and-sec...

mnm1 7y ago

How big is the insulin market? It sounds fairly big considering how many people have diabetes. So where are the Mexican cartels or similar black market organizations when you need them? If we're going to wait for the government, or worse, the industry itself to fix this problem it'll never be fixed. What we need is a proper black market. Is insulin available on the dark web drug markets? If not someone should make it available and cash in while still providing massive savings. That's how you solve a problem like this when your fucking government has stopped working like the US government has.

henvic 7y ago
Proper black market is exactly a part of the industry that the state fights. One of the things I always wanted was to create a black market for electronics in my home country (Brazil) because taxation here is really high. You should also know that the government with its patents system is the root cause of this price spike. I wish black market organizations doing legit and good stuff (like selling medicine that is pricey due to state granted monopolies) was the norm and I hope someday it will be. However, we are not there yet.