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US Insulin prices 8 times higher than in other nations
- IanDrake 6y agoI wonder if this has anything to do with drug re-importation laws. I wish someone would do something about it. Like an executive order or something.
- addflip 6y agoCan't tell you're being sarcastic or not but there was an executive order[1] signed in July to address this. We'll see if this will bring down prices. 1.) https://www.whitehouse.gov/presidential-actions/executive-order-access-affordable-life-saving-medications/ https://www.whitehouse.gov/presidential-actions/executive-or...
- tigershark 6y agoYeah, it worked perfectly, now it’s cheaper than water.
- hn_throwaway_99 6y agoThat executive order shows the full-on insanity and dysfunction of our political system in the US: 1. Other countries achieve lower drug prices because their governments regulate those prices. 2. The US (especially a particular political party) is anti-government regulation, especially when it comes to price controls, so drug prices are MUCH higher in the US. 3. Thus, the US president has issued an executive order to allow reimportation of drugs so that the US can take advantage of other countries' lower drug prices. In other words, we won't pass our own regulations, so we are explicitly delegating our regulatory authority to other nations so that we can take advantage of the effects of their regulations. Honestly, whether or not you are pro or anti regulation, this current state is just f'ing insane. You certainly can't consistently state that you are anti-regulation and be for this policy.
- Consultant32452 6y agoIt's regulation that is stopping me from buying the cheapest price. I don't want the US to force a particular price in the US. And even if they did, I would still want to be able to buy from anywhere in the world, regardless of where the lowest price is.
- hn_throwaway_99 6y agoYeah, you want to take advantage of the regulation of those other countries, which you can't get in the US.
- Consultant32452 6y agoLet's not forget the need for patent reform in this area. The current state of patents around drugs in the US is crazy.
- dantheman 6y agoYou mean the regulations that limit competition in the US and restrict manufactures and grant monopoly rights? These are the regulations that are good right?
- hn_throwaway_99 6y agoWhat are you talking about when it comes to manufacturing insulin? I mean, yes, I definitely do want regulations around the safety of drug manufacturing, but beyond that what regulations specifically are you referring to that restrict the manufacturing of insulin?
- Consultant32452 6y agoOne example: >The second reason, the authors noted, is that there isn't significant competition in the U.S. insulin market. Price competition typically comes from the introduction of a generic drug that directly competes with a branded product. >But the authors said that current insulin makers have blocked the entry to such products by getting new patents based on things such as a new delivery device. https://www.usnews.com/news/health-news/articles/2019-11-07/why-are-insulin-prices-still-so-high-for-us-patients https://www.usnews.com/news/health-news/articles/2019-11-07/... Patent reform would help bring generics on the market and reduce prices.
- HarryHirsch 6y agoIt certainly fits in nicely with American Civil Religion. The government can't do anything, so you take personal responsibility for your own survival and make the drug run into Canada or Mexico every month.
- ghostbrainalpha 6y agoIs this a reference to the first Presidential debate? As a diabetic I was excited to hear when Trump said that he had made Insulin as cheap as water. However it still looks like it costs around $300 per vial at my pharmacy.
- Consultant32452 6y agohttps://www.forbes.com/sites/avikroy/2020/07/24/trumps-most-favored-nation-prescription-drug-executive-order-will-reduce-costs-for-seniors--taxpayers/#322fcecb1860 https://www.forbes.com/sites/avikroy/2020/07/24/trumps-most-... As one might expect, the pharma companies are fighting his executive order in the courts. Here's one article with some details.
- doomslice 6y agoThere's also no timeframe for implementation, lacks specific implementation details, and the only teeth it seems to have is that these Federally Qualified Health Centers (FQHCs) may potentially be excluded from grants.
- csa 6y agoYeah, my friend who has a daughter with Type 1 laughed her ass off at that comment.
- crocodiletears 6y agoI'll be the first to admit that I have very limited knowledge of the pharmaceutical industry, but from what I've gleaned, it's such a tangled, multi-tiered morass of different actors, contracts, and regulations, that it may be a few years before we see any movement on the market's pricing, if at all. I have a lot of hope for his ambitions to enact a favored nation's policy wrt Medicare's drug pricing, but since his administration's seemingly been lackluster on executing his order limiting insulin markups by federally funded clinics, I doubt his policies are anything other than paper tigers.
- mensetmanusman 6y agoTrump water has gold flakes, so it is still true for him.
- sxp 6y agoIt would be nice if the article directly linked to the report. The PDF can be downloaded from https://www.rand.org/pubs/research_reports/RRA788-1.html https://www.rand.org/pubs/research_reports/RRA788-1.html The price charts are on page 10.
- x87678r 6y agoI've heard this before and dont understand the reasons - is it really just an oligopoly ripping us off? I rarely trust newpaper articles because it is so politicized, but this looks like it really is. Also I understand there are newer Insulins which may have a patent, but the original is 100 years old and patent was not an issue. Why aren't there more manufacturers?
- coredog64 6y agoOff-patent insulin is $25/vial at Walmart. I’ll yield to any diabetics for additional nuance, but AIUI, this form of insulin is harder to correctly administer. The newer, patent protected versions are safer and more effective. Again, AIUI, patent protection for at least one form is expiring or expired recently.
- x87678r 6y agoOK $25 for every 1-3 weeks isn't cheap as I'd like but looks more like I'd expect. The Rand report has a table of different kids of insulin but doesn't list which ones have a patent. Would be good to know if the middle income countries listed like Turkey/Chile have the more modern variants or the original ones.
- tobyhinloopen 6y agoWhat’s off-patent insulin? Is it different somehow?
- willcipriano 6y agoMy understanding is the newer long acting insulins work so well for many it is like they no longer have diabetes, they can pretty much eat whatever they want and be fine. The older insulins require more careful management of diet and blood sugar levels than the long acting types and are less convenient for that reason.
- dmlittle 6y ago
- TeaDrunk 6y agoThis is a news release for a report, which can be found here: https://www.rand.org/pubs/research_reports/RRA788-1.html https://www.rand.org/pubs/research_reports/RRA788-1.html Additionally, the RAND Corporation appears to have a high factual reporting with a slight left political bias, according to mediabiasfactcheck.com. https://mediabiasfactcheck.com/rand-corporation/ https://mediabiasfactcheck.com/rand-corporation/
- bilekas 6y agoI was thinking this might be due to the lvles of diabetes in the US, but after checking, to my surprise the US is actually ranked 41st ? https://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/rankings https://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/r...
- notRobot 6y agoAlso, shouldn't higher levels = more demand = lower prices?
- lotsofpulp 6y agoIncreasing supply relative to demand results in lower prices.
- HarryHirsch 6y agoMedication for chronic disease is a highly inelastic market. The other such market is oil. Prices react to spikes and sudden drops in demand, otherwise they are stable. No one is going to bring a new plant onstream unless there are certain takers for the output.
- macinjosh 6y agoIn reality, other nations use the force of law to restrict the free market in their domain forcing countries that have more fair and free markets like the US to subsidize the other countries' artificially set prices. I am not saying the drug companies have no blame to shoulder, they have plenty. Just know that this isn't just a simple case of an evil capitalist trying to price gouge.
- adwww 6y agoI'm not convinced that's true. If the market really is free and fair, and the price is currently 8 times more than elsewhere, why are foreign pharmaceutical companies not flooding the US market? Why are there not dozens of silicon valley startups springing up to 'disrupt' this market - clearly there are large margins to be made given the price is so much higher at the moment. It sounds more like some regulatory capture has happened which is keeping prices artificially high, than that all other countries are artificially low.
- cplanas 6y ago> It sounds more like some regulatory capture has happened which is keeping prices artificially high This. Not sure if it's a system bug, or a feature: the system may have been designed for this to happen.
- warkdarrior 6y agoOne cannot import drugs into US unless they get FDA approval for that particular drug from that particular manufacturer from that particular country.
- adwww 6y agoWhich somewhat undermines the original claim that the US market is more free and fair than any other...
- i_haz_rabies 6y agoWait, you mean the low international price of a medicine that was developed and given to humanity for free is now somehow a burden on US drug companies? I doubt it.
- hinkley 6y agoGiven the varying level of regulations in different countries "up to" means nothing where medical care is concerned. What matters most is what are the prices in countries with equally strict quality controls, which would be, unless I'm mistaken, the EU, the British Commonwealth, Japan, and a few other places. And the answer to that question seems to be >6x which is bad enough. One of the things I've learned about persuasion is that I'm never, ever, going to persuade some people. What I can do is persuade people who can do it for me. In many cases, then, my time and effort is best spent on recruiting the folks who are good at explaining to others. In my experience most of these people can smell bullshit coming a mile away, and so if the first 'fact' out of my mouth is reproachable, I've already put them on the defensive. I often hear, "we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism - we can't let 'those people' beat us. It's ugly, and if you have to stoop to that, is it really worth winning? It's no good living forever if you can't live with yourself.
- chrisseaton 6y ago> I often hear, "we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism - we can't let 'those people' beat us. It's ugly, and if you have to stoop to that, is it really worth winning? It's no good living forever if you can't live with yourself. I don’t think anyone’s complaining about the price due to nationalism or racism... they just want to be able to afford insulin to keep themselves alive like they’d be able to in other countries.
- hinkley 6y agoNot certain I succeeded, but I was trying to word it as a general comment rather than an indictment of this particular article, which does a reasonably decent job in that regard. This class of article suffers from that problem often, and something about that has always bugged me but I couldn't clearly express why. There's a fine line between "France did X and the sky did not fall," and evoking Us-vs-Them emotions. Some people will bring that energy no matter how you state it, but let's try not to invite it in.
- Consultant32452 6y agoI wonder how long it will take the "favored nations" policy to get through the courts. And if it gets nixed by the courts, will Congress pick up the ball. https://www.forbes.com/sites/avikroy/2020/07/24/trumps-most-favored-nation-prescription-drug-executive-order-will-reduce-costs-for-seniors--taxpayers/#322fcecb1860 https://www.forbes.com/sites/avikroy/2020/07/24/trumps-most-...
- sithlord 6y agoAs someone who is type 1 diabetic, and someone who has had insurance that required me to pay up front, and then get reimbursed after the fact - insulin was charged at ~200 dollars a vial, I can't speak for everyone, as everyone is different - but i would hazard to guess that most use 2-3+ vials a month (of rapid acting, on a pump).
- grep_name 6y agoI had a 40 day insurance lapse when I started my new job and it was $350 for a vial for me :( luckily I only needed to buy one, and it was enough to last me until the end of the period. For a full year and a half before that, I had to go to the pharmacy every 20 days to pick up more insulin because my insurance didn't want to risk paying for medicine that I could still use after leaving my job / insurance.
- adwww 6y ago> 40 day insurance lapse How does that sort of thing affect you? I can't imagine the pressure of knowing you 'can't' get ill for a period of time! Do you stop biking to work, avoid DIY projects, skip the 5-a-side sessions that month...?!
- grep_name 6y agoI was very upset about not being warned during the interview process and even had a conversation with HR about it > Do you stop biking to work, avoid DIY projects, skip the 5-a-side sessions that month On the contrary, at the time I had to drive a two hour round trip daily on 285* where I was often graphically reminded of the dangers of traffic. I mentioned this point specifically when talking to HR, but ultimately I didn't really have any recourse *(edited to remove reference to spaghetti junction, didn't realize there were multiple spaghetti junctions out there)
- renewiltord 6y agoMissed signing up for COBRA? I did too, but I had the backing knowledge that my family of medical professionals could probably wrangle something for me in an emergency.
- flowerlad 6y agoIn 2001, Acthar sold for about $40 a vial. Today: more than $40,000. An increase of 100,000 percent. "Medicare is not allowed to negotiate the price of drugs because of a law passed by Congress." [1] 26-year-old recently removed from his parent’s insurance plan, was found dead in his home because he couldn't afford $1,300 per month for insulin. [2] This is basically white-collar looting. It is sad that this allowed to happen in USA. [1] https://www.cbsnews.com/news/the-problem-with-prescription-drug-prices/ https://www.cbsnews.com/news/the-problem-with-prescription-d... [2] https://www.nytimes.com/2018/06/22/well/diabetes-patients-at-risk-from-rising-insulin-prices.html https://www.nytimes.com/2018/06/22/well/diabetes-patients-at...
- offtop5 6y agoAt a point wouldn't it be cheaper to hop on a flight to London , and check yourself into a hospital ? I know if I wasn't upper middle class I'd likely be skipping medicine right now. NHS style healthcare should be a human right
- paxys 6y agoIt is, and tons of people do it. Although they go to Mexico/India/SE Asia. There are entire medical tourism packages offered by hospitals in these countries - including airfare, surgeries/consultations, drugs, hospital stays, recovery at fancy resorts - all still working out to a fraction of the cost of treatment in the US.
- thayne 6y agoYep. But what do you do if you can't afford to do that? And even if you can, if you have a chronic condition, you would need to find a job in London (or whereever else you go).
- offtop5 6y agoI'm being a bit tongue in cheek , you can get round trip flights to London for 400$ or so. No one should die due to an inability to pay. Even if you have a great job , you can still lose it
- thayne 6y ago> The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S. I suspect this gives a hint to one contributing factor. Suppliers probably list much higher prices so that they can negotiate lower prices with insurance companies without losing profit. But then the consumer needs to use an "in-network" supplier to get those reduced prices, which removes competition and drives prices up even further.
- pnutjam 6y agobingo, the kick backs work in a similar feedback loop. My insurance only covers long term rx from CVS. If I go somewhere else, they stop covering it after about 3 fills. CVS is more expensive then my warehouse club price.
- vonmoltke 6y agoThe only thing almost as obscene as medical sticker prices in the US is the amount that just disappears after insurance settles. I have actually had a bill with a 94% "insurance discount" applied.
- cashsterling 6y agobut, but... Trump said he's getting Insulin as cheap as water. Could he be... lying?!?
- MuffinFlavored 6y agoWhy is anybody a modern day conservative/Republican if Democrats want to fix health care and everything that is broken with it can be attributed to Republicans? At least that's the vibe I get from reading here + Reddit on politics. Seriously asking.
- chmln 6y agoPerhaps it's worth educating yourself on possible reasons. r/politics and HN are not the best places to do that, to put it mildly.
- MuffinFlavored 6y agoHow would I go about doing that? I feel like every time I find a source, there's something wrong with it. All of the Republican "pundits" like Ben Shapiro + Candace Owens seem to have been "cancelled" for spreading racism and hate and misinformation. Can't trust CNN or Fox News, where am I supposed to become educated on politics?
- vondur 6y agoThis is from Sept. 20th: "Even though insulin is not included among the drugs covered by the rule, the Trump administration Thursday issued a request for proposals seeking plans from private companies on how insulin could be safely brought in from other countries and made available to consumers at a lower cost than products here." This is in regards to a law that allows states to import drugs from Canada at lower prices than they are sold here. So it looks like the administration is working on it.
- snazz 6y agoI'll only talk about healthcare here, because this could degenerate into a flamewar otherwise, and I want to avoid that. Also, I'm no expert on politics, economics, or healthcare, so I'm open to any corrections. I'll try to remain as neutral as possible. People have different thoughts about economic policy with regards to healthcare. Additionally, there are some cultural concerns. For one, conservatives feel that liberals are too idealistic and don't have a good plan for actually paying for socialized healthcare. This is most commonly used against Bernie Sanders. Liberals argue that "competition drives down cost" is equally, if not more, idealistic. Second, in places with "socialized" healthcare, health is thought of as society's responsibility, not the individual's responsibility. This conflicts with the American notion of individuality. Conservatives argue that the US's culture makes socialized healthcare infeasible without costs ballooning out of control, because people are selfish and don't care to protect their health. There is plenty of debate on this matter. I'm guessing that healthcare is not the most important reason that conservatives vote Republican. Although it seems like a huge issue, there are other issues that might make someone choose one side over the other, even if they disagree with their side's healthcare policy.
- mindfulplay 6y agoThis seems on par or worse than what the Sacklers did. But because this is a multiheaded beast with no clear villain to blame, nothing really happens. Congress are to blame.
- 54794836 6y agoTo put this in perspective: I am from Slovakia (Europe). I am type 1 diabetic. NovoRapid (10 x 3ml) costs 73€. My insurance (which is required in Slovakia and costs me about 70€/month) covers 64€. That means I pay only 9€. I usually get one package every three months. That means insulin costs me 3€ per month. Average salary in Slovakia is currently 13100€/year.
- x87678r 6y agoOK good data point. Is NovoRapid about the same as Novolog 70/30? 73 euro is about $86 which is about the same price as Wallgreens/RiteAid. CVS is more expensive. https://www.goodrx.com/novolog-70-30 https://www.goodrx.com/novolog-70-30
- entitydc 6y agoIt's the same as Novolog, not 70/30 though. Novolog 70/30 is a mix is a mix of two insulins - an intermediate acting & a faster acting insulin.
- ssanan 6y agoPrivate healthcare system is always expensive for the public.
- tasubotadas 6y agoPlease tell that to the Swiss
- deleted 6y ago[deleted]
- throwaway13337 6y agoIt's not just insulin. If you have an autoimmune disease, Enbrel or other biological agents cost all the about same in America. Over 5k per month. All other countries price the drug at around 1 to 1.5k per month. I'd been getting it from other countries over the years but, due to covid, it's not an option really. The medical industry and its regulatory support by the government are doing a lot to destroy this country.
- heavyset_go 6y agoThe only medications on the market that can prevent the transmission of HIV in people who don't have HIV costs about $2000 a month in the US. In the UK, they cost $40 a month. That's a 50x markup. HIV transmission could be virtually eradicated within the US if at-risk populations had access to the medications at the same price as people in the UK do.
- hikerclimber 6y agonot suprising more people die in the U.S. than any other developed nation.
- nytgop77 6y agoGenerates 8 times more gdp. Good for stats :-)
- apta 6y agoThe argument I heard is that it is the US-based companies that are incurring all the R&D and subsequent safety approval costs. Once the drug is researched and determined to be safe, you'll have generic providers then make their own copies of it, for a fraction of the cost. Is there any merit in this argument?
- pessimizer 6y agoAbuterol/Ventolin rescue inhalers are $70 here, but like $5 everywhere else. They managed to get them repatented by claiming that the old versions were a major contributor to global warming. I guarantee you that thousands have died because of this price change.
- anoraca 6y agoWhat company did that?
- pessimizer 6y agohttps://www.motherjones.com/environment/2011/07/cost-increase-asthma-inhalers-expensive/ https://www.motherjones.com/environment/2011/07/cost-increas... All of them. edit: https://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html https://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-...
- magnetowasright 6y agoI can't begin to imagine the burden of asthmatic Americans when the inhalers cost so much. Yes, they're about $5 in Australia, and I've even gotten them for free on occasion when I was unemployed. Some quick stats about the medication from wikipedia [0] - The medication was generally available in the UK 1969 (1982 for USA), and in 2017 was the tenth most prescribed medication in the USA. When I saw news popping up over the last year or so about how exciting it was for a generic inhaler to be approved and available I was surprised and appalled by the whole ordeal, to be honest. It's an essential medicine. Generics have been available for ages here. How on earth can companies and the government be allowed to do this to people? I mean, the literal answer is probably the oligarchy. I would have thought that people who can manage their chronic health conditions and avoid becoming disabled (or dead) would be infinitely more exploitable than those who can't, but I guess the numbers have been crunched and that mustn't be the case. It's unspeakably awful. [0] https://en.wikipedia.org/wiki/Salbutamol https://en.wikipedia.org/wiki/Salbutamol
- Animats 6y agoThere's been a steady, and huge, increase of the prices of most pharmacy products. Not just prescription drugs. Look at vitamins. Some vitamins used to be extremely cheap. The manufacturing cost of Vitamin C is very low. It's useful to compare prices between CVS in the US and Boots in the UK. They're the same company.
- pvaldes 6y agoFor a moment I have a mental image of narcos stop cooking anfetamine and start making insulin instead... Or chemist diabetics making their own insulin at home.
- abeppu 6y agoSeveral people in this thread are saying regulatory issues are a major cause. Can anyone elaborate on what those regulations look like? I've been led to believe that a large fraction of pharmaceuticals consumed in the US are produced either entirely overseas, or else active ingredients are (and this causes challenges for the FDA to actively regulate those overseas producers). Is it the case that in some Sanofi site in Frankfurt, the same insulin meeting the same standards is put into vials, some intended for the US market, some intended for other markets around the world ... and regulations prevent someone from buying vials in the EU and selling them in the US? Like, the regulation is not only about the production methods or quality control?
- pas 6y agoAnyone trying to sell FDA controlled substances in the US needs FDA approval. In case of insulin the problem is that currently it's a mess, supply is low, demand is high, so price is high too. https://care.diabetesjournals.org/content/41/6/1299 https://care.diabetesjournals.org/content/41/6/1299
- helsinki 6y agoDoes anyone know what is necessary for someone to manufacture their own fast-acting insulin? I’m a T1 diabetic and would really like to buy the necessary infra to create my own insulin in preparation for the end times.
- lolc 6y agoYour best bet is to become a pig farmer.
- stevespang 6y agoThen are diabetics smuggling insulin over the Canadian border ?
- deleted 6y ago[deleted]
- mkevac 6y ago24$ for 5x3 ml in Russia [1] > The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S. Here in Russia price can only go up from manufacturer’s price. Simpler world. [1] https://redapteka.ru/catalog/lekarstva/endokrinologiya/sakharnyy_diabet/novorapid_flekspen/ https://redapteka.ru/catalog/lekarstva/endokrinologiya/sakha...
- rigrassm 6y agoFor those who may find themselves unable to afford their prescription insulin, you should know that Walmart Pharmacies (in most states IIRC) offers both long-acting and short acting formulas (even have a 70/30 formula) under the Novalin brand name over the counter(no prescription needed) for $25/per 10ml vial of u-100. Product Names: Novalin N - XR for basal Novalin R - fast acting for bolus Novalin 70/30 - just a premix of the two shown 70% N 30% R. It may not be the best formulation out there but so long as you pay close attention to how your body responds to it (ie. Typical bolus duration, Blood Glucose mg/dl lowered per unit of insulin etc) when you first start using it, it can be just as effective as the name brand anologues. Sure, it has a longer duration and takes a bit longer before it takes effect, but those shortcomings can be addressed by simply making adjustments to when you are dosing. I typically need to bolus about 1unit/12g of carbs 20-25 minutes prior to eating with Novalin vs 1unit/15g 10-15 minutes before using an analogue. I've actually used Novalin R in lieu of analogues in my insulin pump now for about a year with no issues. I realize getting these devices may be financially out of reach for many since they are expensive, even with insurance. If you're interested in using one but are not able to afford the cost of initial cost, Medtronic used to offer a payment plan that did not require good credit at all (mine was a complete dumpster fire) back when I got mine 6 years ago so people who are interested and could possibly afford to make monthly payments it's worth taking to your doctor and the manufacturers reps about the options they have available. Sorry in advance for any grammatical/spelling errors, on mobile topping in a text box ~6 lines tall and 32 characters wide.