6 ms·

There’s different kinds. IIRC the cheap stuff and Walmart is just that, cheap. It’s fast acting, and varies in how it reacts in the body. Our real issue here i

There’s different kinds. IIRC the cheap stuff and Walmart is just that, cheap. It’s fast acting, and varies in how it reacts in the body. Our real issue here is that there is absolutely no incentives to control costs. You’d think our ins companies would do it, but I’m practice, they end up negotiating sweet deals with the drug manufacturers. say med X @ $1000/mo msrp, but the ins companies negotiate it down to $400/mo. The drug company makes out like a bandit, and the ins people get kick backs for buying from the drug co, and passes on the costs to the insurance buyers.

RHSeeger 5y ago
> It’s fast acting, and varies in how it reacts in the body. I believe they offer R (short acting / 2-5h), N (medium), and L (long acting / 24h). The problem with the older insulins isn't so much that they're faster, it's that they're less "specific" (from my experience). A newer short acting insulin (Apidpra, etc) has a spike in the 15-30 minute range and the spike is steep and the tail (while up to 5 hours) is low. Whereas R peaks in the 30m-1h range and the peak is low and the tail is much higher. As such, you need to plan ahead much better for your eating. It's frustrating, but not horrible. The N and L have similar problems (L is the reverse, where you want a tail equal to the spike, but it isn't). The newer insulins a just much more convenient and require a lot less planning of what you eat and when... and not as close an eye on your blood.
- HideousKojima 5y ago
  If that's actually the case that puts all the "You're literally killing us with expensive insulin prices" people in a very negative light. At best they're ill-informed, at worst they're being intentionally deceptive to achieve political aims.
  - RHSeeger 5y ago
    What you've said is true. Refusing to use the older insulins is what is killing people. Having to use the older insulins is shitty, and it shouldn't be happening, but it's not the thing that's killing people. However, actually _saying_ that tends to get people up in arms, harassing you about how it how it shouldn't be necessary for people to use the older insulins, and how the newer insulins shouldn't cost what they do. Even though everyone actually agrees with them and they're arguing against a point that nobody it actually trying to make. It is... frustrating trying to get people to understand that you agree with them, but you're talking about something different. I had this exact discussion with one such person yesterday, and I was trying to explain that they are sabotaging their own goals by misrepresenting the issues. And that I WANT them to succeed in changing things, but they're making it harder to do so. Edit: You're already being downvoted for stating something that is obviously and undeniably true, because people are not bothering to understand what you're saying. I'm sorry for that.
    - HarryHirsch 5y ago
      Having to use the older insulins is shitty, and it shouldn't be happening, but it's not the thing that's killing people. In a way it is killing people, blood sugar control is much easier with a mix of the newer insulins, and patience compliance is much higher. This directly translates into better quality of life and lower disease burden from diabetes complications. No one can argue that pharmcos shouldn't be paid for R & D that increases quality of life, in civilized countries the taxpayer should and will pay for your medication if it's an improvement over what's already at market. But here people seem to be arguing that if you can't afford anything else there's still Walmart short-acting Humalog, and you get to bear all the risk, and that's just fine.
  - pimeys 5y ago
    I have to ask, are you suffering from a Type 1 diabetes? If not, at least for me, this answer kind of misses the point completely. Type 1 is a hell to manage. It is REALLY hard. Like I actually use an open source pancreas to control my glucose levels so now I can sleep every night without having to worry about dying. This is in Europe where the insurance covers everything and prices are cheaper than in US. Using the Walmart insulin makes everything much much more complex, and even for the smartest of us, even with the best possible insulins, managing T1 is a HUGE pain and can kill you quite fast. I hope I misread your comment...
    - RHSeeger 5y ago
      I do have type 1 diabetes, and I lived on R/L for over a decade. The point being made here is > The high price of tier 1 insulins is killing people Is (more or less) a lie. While > The high price of tier 1 insulins is making people's lives considerably worse and their diabetes harder to manage. Is (more or less) true. When you try to push for change and use, as part of your argument, a lie, you sabotage yourself. People can point at what you're saying and, ignoring the validity of what you're trying to achieve, say "you're lying". That's bad. The truth is that there are good reasons why tier 1 insulins should not cost as much as they do, not by a long shot. And destroying your own progress towards changing things is counter productive. Just don't do it.
      - burkaman 5y ago
        It is not a lie if you think about real human behavior, rather than a theoretical rational automaton. There are real, documented cases of people who were prescribed insulin they could not afford, tried to ration it, and died as a direct result. Maybe their doctor told them not to use it, or they didn't live near a Walmart, or they didn't know it existed. Maybe they tried the Walmart stuff and almost died because it's so difficult to manage, so their doctor told them to switch back to the best treatment available. I promise they did not die to make a political point. One in four patients in the US have rationed insulin because of the cost: https://news.yale.edu/2018/12/03/one-four-patients-say-theyve-skimped-insulin-because-high-cost https://news.yale.edu/2018/12/03/one-four-patients-say-theyv... It is simply untrue to say the high cost only forces people to use the cheaper Walmart generic. That isn't what happens. They ration it, and sometimes they die. Finally, it doesn't make sense to say that the high price is making diabetes harder to manage, but isn't killing people. That's like saying speeding doesn't kill, it just makes the car harder to manage.
  - icelancer 5y ago
    It's the same with basically every other campaign that wants to grab headlines. It literally makes no sense that insulin prices are killing people and it's unavailable, and a basic amount of research shows that yeah indeed, it's clickbait intended to hook you into a more complex discussion. I pay zero attention to people and news sources that repeat that behavior more than once. Lead with the truth.
    - RHSeeger 5y ago
      You are a prime example of WHY that lie is bad. The discussion they are trying to drag you into is an important one, and well worth having. However, by starting out with a lie, they are driving you away before they can even start the conversation with you about it. A conversation where you might agree with them.
  - ska 5y ago
    How cheap is the cheap option? I found some references for "old" versions that claim price increase from $17 in 1997 to $138 today, another from $21 to $255. Going by inflation only those would be around $30-40. I don't know how much a typical diabetic needs per month (I imagine it varies) but I could see that being a problem for a lot of people if that is, say a monthly supply.
    - RHSeeger 5y ago
      > How cheap is the cheap option About $25, that last I checked. The ones you're talking about, I believe, are the "newer" ones (which are not very new). The prices of those have shot up over the years (in the US) for no good reason. It's shameful.
      - ska 5y ago
        I guess my mistake was thinking 20 plus years was old enough, that would be out of patent.
        RHSeeger 5y ago
        My understanding it that they are out of patent, but regulations make it hard for new players to enter the market. Since the number of companies making them are so limited, even the generics cost a lot. For example, Basaglar is a "generic" of Lantus, but it's still expensive. Here’s How to Save on Basaglar, the Expensive Lantus “Generic” https://www.goodrx.com/blog/basaglar-expensive-lantus-generic-how-to-save/ https://www.goodrx.com/blog/basaglar-expensive-lantus-generi... > Basaglar contains the same kind of insulin as Lantus (insulin glargine), and while it is cheaper—Basaglar costs about 15% less than Lantus—it is still expensive, with a cash price of around $450 for a 30-day supply. Unlike normal generics, the bio-similars need to go through their own clinical trials and prove they work the same as the original. They can't just "use the same ingredients" and release it. Mind you, that doesn't explain the extreme price markup, but it does explain why these "generics" don't follow the same "85% cost reduction" of normal generics. They still have, effectively, a costly R&D phase. At least, that's my understanding.
  - KittenInABox 5y ago
    It's extremely hard to manage your health with old insulins because they're so much less precise. Imagine if you were programming but your keyboard works such that any key you type might be +3/-3 key presses actually. Except in the case of diabetes, this results in the loss of body parts and blindness.
  - dv_dt 5y ago
    The people who can least afford healthcare also have the most external constraints on their work and life, making it the most difficult to make good, non-harmful use of older insulin in the long term. There are plenty of cases of people literally dying because of difficulty managing insulin due to cost. It’s nice to say other low cost forms are available while handwaving away actual deaths as well as accumulative long term damage from difficult insulin management. https://khn.org/news/insulins-high-cost-leads-to-deadly-rationing/ https://khn.org/news/insulins-high-cost-leads-to-deadly-rati... Many of the “newer” forms are 20+ years old, and are also extremely low cost to produce.
- arwineap 5y ago
  That's context I've never gotten before. Obviously there's a nice convenience benefit built into this product that a company has created, they should get to charge some markup for that. I wonder how different the production costs are though, my understanding is the costs to consumer are greater than 10x
  - deleted 5y ago
    [deleted]
  - pimeys 5y ago
    The difference with the old insulin vs. the analogs is that with the old ones it's really easy to lose a toe, leg, kidney or get blind. With the new analogs it's possible to control your glucose levels so that you can stay healthy and get old. Source: a T1 diabetic, used all possible insulins in my life. Very happy in Europe.
- UnpossibleJim 5y ago
  They also tend to have a more reliable absorption curve. I take both Novolog (short acting) and Lantus (long acting), which are the newer insulins. Lantus has a more predictable long acting curve than the older L did, even though I take it in a 12 hour cycle. It rises not so much like a bell, but more like a plateau, I guess it a better analogy. At least for me. The L really was a pain for planning, especially when physical activity was involved, as it would shorten the bell curve.
- RHSeeger 5y ago
  On a related note... if you can afford a CGM (continuous glucode monitor), especially one with alerts (like the Dexcom G6), I wholeheartedly recommend one. They are life altering for a type 1 diabetic. Being able to check your blood sugar by just looking at your phone (or separate receiver) is very convenient. I check my blood sugar 100 times a day, instead of poking a hole in myself 10 times a day. And I can (mostly) rely on it alerting me if my blood sugar gets low (or is going to get low soon). I cannot stress enough how much it changed my control of my diabetes. Admittedly, they're not cheap w/o insurance, which sucks. But if you can get one, so do. You won't be disappointed.
  - mgarfias 5y ago
    I keep on trying to get one, but being well controlled, the ins cos won't approve it. And its pretty spendy out of pocket. My biggest use case would be an alert that my glucose levels are tanking while exercising so I can do something about it before I drop out. I find myself not doing things like long bike rides that I'd really like to do because of it.
    - mikeproctor 5y ago
      You should be able to get the Libre 14 day sensors for about $120/per month (2 sensors) without insurance. I've been using it for about a year and it has been a huge game changer for me. I've been on insulin for about 23 years. The Libre doesn't have alerts but being able to tap your phone to your arm to test your glucose makes a big difference in how you test/monitor even without alerts.
      - RHSeeger 5y ago
        The alerts (of the G6) are certainly desirable (amazing). But, as mike notes, even just being able to check your glucose with 0 effort... just changes everything. You wind up checking it so often that it's more than just checking it, you get more of a feel for how your body is reacting to your food/activity/etc. I can't say enough positive things about it.
HPsquared 5y ago
I guess the question is, do countries with socialized healthcare provide the cheap version or the expensive one?
- ravitation 5y ago
  Not actually the question since countries with modern healthcare systems provide all types of insulin at an average cost per unit that is roughly 1/10th to 1/20th the cost in the United States (cheap vs. expensive is an over simplification).
  - refurb 5y ago
    No, it is the question because countries with public health systems often don’t pay for the latest generation of drugs, since they don’t feel the extra cost is worth the benefit.
    - jjmarinho 5y ago
      It's still the wrong question to ask. We should ask what are the outcomes that these systems produce, not how new the drugs are. A cutting-edge healthcare system plagued by inequality and extreme costs can produce worse results than a more efficient healthcare system which is not as high-tech.
      - refurb 5y ago
        Well all the diabetics in this discussion are claiming they can’t do without the latest generation insulin. But yes, I agree. Sometimes the juice isn’t worth the squeeze.
    - ravitation 5y ago
      My comment answered that "countries with public health systems" actually do "pay" for the "latest generation insulin" (i.e. the price for the "latest generation insulin" is still a tiny fraction the cost in the United States). Just repeating the question, when I gave you the answer, isn't very productive.

RHSeeger 5y ago

> It’s fast acting, and varies in how it reacts in the body. I believe they offer R (short acting / 2-5h), N (medium), and L (long acting / 24h). The problem with the older insulins isn't so much that they're faster, it's that they're less "specific" (from my experience). A newer short acting insulin (Apidpra, etc) has a spike in the 15-30 minute range and the spike is steep and the tail (while up to 5 hours) is low. Whereas R peaks in the 30m-1h range and the peak is low and the tail is much higher. As such, you need to plan ahead much better for your eating. It's frustrating, but not horrible. The N and L have similar problems (L is the reverse, where you want a tail equal to the spike, but it isn't). The newer insulins a just much more convenient and require a lot less planning of what you eat and when... and not as close an eye on your blood.

HideousKojima 5y ago
If that's actually the case that puts all the "You're literally killing us with expensive insulin prices" people in a very negative light. At best they're ill-informed, at worst they're being intentionally deceptive to achieve political aims.
- RHSeeger 5y ago
  What you've said is true. Refusing to use the older insulins is what is killing people. Having to use the older insulins is shitty, and it shouldn't be happening, but it's not the thing that's killing people. However, actually _saying_ that tends to get people up in arms, harassing you about how it how it shouldn't be necessary for people to use the older insulins, and how the newer insulins shouldn't cost what they do. Even though everyone actually agrees with them and they're arguing against a point that nobody it actually trying to make. It is... frustrating trying to get people to understand that you agree with them, but you're talking about something different. I had this exact discussion with one such person yesterday, and I was trying to explain that they are sabotaging their own goals by misrepresenting the issues. And that I WANT them to succeed in changing things, but they're making it harder to do so. Edit: You're already being downvoted for stating something that is obviously and undeniably true, because people are not bothering to understand what you're saying. I'm sorry for that.
  - HarryHirsch 5y ago
    Having to use the older insulins is shitty, and it shouldn't be happening, but it's not the thing that's killing people. In a way it is killing people, blood sugar control is much easier with a mix of the newer insulins, and patience compliance is much higher. This directly translates into better quality of life and lower disease burden from diabetes complications. No one can argue that pharmcos shouldn't be paid for R & D that increases quality of life, in civilized countries the taxpayer should and will pay for your medication if it's an improvement over what's already at market. But here people seem to be arguing that if you can't afford anything else there's still Walmart short-acting Humalog, and you get to bear all the risk, and that's just fine.
- pimeys 5y ago
  I have to ask, are you suffering from a Type 1 diabetes? If not, at least for me, this answer kind of misses the point completely. Type 1 is a hell to manage. It is REALLY hard. Like I actually use an open source pancreas to control my glucose levels so now I can sleep every night without having to worry about dying. This is in Europe where the insurance covers everything and prices are cheaper than in US. Using the Walmart insulin makes everything much much more complex, and even for the smartest of us, even with the best possible insulins, managing T1 is a HUGE pain and can kill you quite fast. I hope I misread your comment...
  - RHSeeger 5y ago
    I do have type 1 diabetes, and I lived on R/L for over a decade. The point being made here is > The high price of tier 1 insulins is killing people Is (more or less) a lie. While > The high price of tier 1 insulins is making people's lives considerably worse and their diabetes harder to manage. Is (more or less) true. When you try to push for change and use, as part of your argument, a lie, you sabotage yourself. People can point at what you're saying and, ignoring the validity of what you're trying to achieve, say "you're lying". That's bad. The truth is that there are good reasons why tier 1 insulins should not cost as much as they do, not by a long shot. And destroying your own progress towards changing things is counter productive. Just don't do it.
    - burkaman 5y ago
      It is not a lie if you think about real human behavior, rather than a theoretical rational automaton. There are real, documented cases of people who were prescribed insulin they could not afford, tried to ration it, and died as a direct result. Maybe their doctor told them not to use it, or they didn't live near a Walmart, or they didn't know it existed. Maybe they tried the Walmart stuff and almost died because it's so difficult to manage, so their doctor told them to switch back to the best treatment available. I promise they did not die to make a political point. One in four patients in the US have rationed insulin because of the cost: https://news.yale.edu/2018/12/03/one-four-patients-say-theyve-skimped-insulin-because-high-cost https://news.yale.edu/2018/12/03/one-four-patients-say-theyv... It is simply untrue to say the high cost only forces people to use the cheaper Walmart generic. That isn't what happens. They ration it, and sometimes they die. Finally, it doesn't make sense to say that the high price is making diabetes harder to manage, but isn't killing people. That's like saying speeding doesn't kill, it just makes the car harder to manage.
- icelancer 5y ago
  It's the same with basically every other campaign that wants to grab headlines. It literally makes no sense that insulin prices are killing people and it's unavailable, and a basic amount of research shows that yeah indeed, it's clickbait intended to hook you into a more complex discussion. I pay zero attention to people and news sources that repeat that behavior more than once. Lead with the truth.
  - RHSeeger 5y ago
    You are a prime example of WHY that lie is bad. The discussion they are trying to drag you into is an important one, and well worth having. However, by starting out with a lie, they are driving you away before they can even start the conversation with you about it. A conversation where you might agree with them.
- ska 5y ago
  How cheap is the cheap option? I found some references for "old" versions that claim price increase from $17 in 1997 to $138 today, another from $21 to $255. Going by inflation only those would be around $30-40. I don't know how much a typical diabetic needs per month (I imagine it varies) but I could see that being a problem for a lot of people if that is, say a monthly supply.
  - RHSeeger 5y ago
    > How cheap is the cheap option About $25, that last I checked. The ones you're talking about, I believe, are the "newer" ones (which are not very new). The prices of those have shot up over the years (in the US) for no good reason. It's shameful.
    - ska 5y ago
      I guess my mistake was thinking 20 plus years was old enough, that would be out of patent.
      - RHSeeger 5y ago
        My understanding it that they are out of patent, but regulations make it hard for new players to enter the market. Since the number of companies making them are so limited, even the generics cost a lot. For example, Basaglar is a "generic" of Lantus, but it's still expensive. Here’s How to Save on Basaglar, the Expensive Lantus “Generic” https://www.goodrx.com/blog/basaglar-expensive-lantus-generic-how-to-save/ https://www.goodrx.com/blog/basaglar-expensive-lantus-generi... > Basaglar contains the same kind of insulin as Lantus (insulin glargine), and while it is cheaper—Basaglar costs about 15% less than Lantus—it is still expensive, with a cash price of around $450 for a 30-day supply. Unlike normal generics, the bio-similars need to go through their own clinical trials and prove they work the same as the original. They can't just "use the same ingredients" and release it. Mind you, that doesn't explain the extreme price markup, but it does explain why these "generics" don't follow the same "85% cost reduction" of normal generics. They still have, effectively, a costly R&D phase. At least, that's my understanding.
- KittenInABox 5y ago
  It's extremely hard to manage your health with old insulins because they're so much less precise. Imagine if you were programming but your keyboard works such that any key you type might be +3/-3 key presses actually. Except in the case of diabetes, this results in the loss of body parts and blindness.
- dv_dt 5y ago
  The people who can least afford healthcare also have the most external constraints on their work and life, making it the most difficult to make good, non-harmful use of older insulin in the long term. There are plenty of cases of people literally dying because of difficulty managing insulin due to cost. It’s nice to say other low cost forms are available while handwaving away actual deaths as well as accumulative long term damage from difficult insulin management. https://khn.org/news/insulins-high-cost-leads-to-deadly-rationing/ https://khn.org/news/insulins-high-cost-leads-to-deadly-rati... Many of the “newer” forms are 20+ years old, and are also extremely low cost to produce.
arwineap 5y ago
That's context I've never gotten before. Obviously there's a nice convenience benefit built into this product that a company has created, they should get to charge some markup for that. I wonder how different the production costs are though, my understanding is the costs to consumer are greater than 10x
- deleted 5y ago
  [deleted]
- pimeys 5y ago
  The difference with the old insulin vs. the analogs is that with the old ones it's really easy to lose a toe, leg, kidney or get blind. With the new analogs it's possible to control your glucose levels so that you can stay healthy and get old. Source: a T1 diabetic, used all possible insulins in my life. Very happy in Europe.
UnpossibleJim 5y ago
They also tend to have a more reliable absorption curve. I take both Novolog (short acting) and Lantus (long acting), which are the newer insulins. Lantus has a more predictable long acting curve than the older L did, even though I take it in a 12 hour cycle. It rises not so much like a bell, but more like a plateau, I guess it a better analogy. At least for me. The L really was a pain for planning, especially when physical activity was involved, as it would shorten the bell curve.
RHSeeger 5y ago
On a related note... if you can afford a CGM (continuous glucode monitor), especially one with alerts (like the Dexcom G6), I wholeheartedly recommend one. They are life altering for a type 1 diabetic. Being able to check your blood sugar by just looking at your phone (or separate receiver) is very convenient. I check my blood sugar 100 times a day, instead of poking a hole in myself 10 times a day. And I can (mostly) rely on it alerting me if my blood sugar gets low (or is going to get low soon). I cannot stress enough how much it changed my control of my diabetes. Admittedly, they're not cheap w/o insurance, which sucks. But if you can get one, so do. You won't be disappointed.
- mgarfias 5y ago
  I keep on trying to get one, but being well controlled, the ins cos won't approve it. And its pretty spendy out of pocket. My biggest use case would be an alert that my glucose levels are tanking while exercising so I can do something about it before I drop out. I find myself not doing things like long bike rides that I'd really like to do because of it.
  - mikeproctor 5y ago
    You should be able to get the Libre 14 day sensors for about $120/per month (2 sensors) without insurance. I've been using it for about a year and it has been a huge game changer for me. I've been on insulin for about 23 years. The Libre doesn't have alerts but being able to tap your phone to your arm to test your glucose makes a big difference in how you test/monitor even without alerts.
    - RHSeeger 5y ago
      The alerts (of the G6) are certainly desirable (amazing). But, as mike notes, even just being able to check your glucose with 0 effort... just changes everything. You wind up checking it so often that it's more than just checking it, you get more of a feel for how your body is reacting to your food/activity/etc. I can't say enough positive things about it.

HPsquared 5y ago

I guess the question is, do countries with socialized healthcare provide the cheap version or the expensive one?

ravitation 5y ago
Not actually the question since countries with modern healthcare systems provide all types of insulin at an average cost per unit that is roughly 1/10th to 1/20th the cost in the United States (cheap vs. expensive is an over simplification).
- refurb 5y ago
  No, it is the question because countries with public health systems often don’t pay for the latest generation of drugs, since they don’t feel the extra cost is worth the benefit.
  - jjmarinho 5y ago
    It's still the wrong question to ask. We should ask what are the outcomes that these systems produce, not how new the drugs are. A cutting-edge healthcare system plagued by inequality and extreme costs can produce worse results than a more efficient healthcare system which is not as high-tech.
    - refurb 5y ago
      Well all the diabetics in this discussion are claiming they can’t do without the latest generation insulin. But yes, I agree. Sometimes the juice isn’t worth the squeeze.
  - ravitation 5y ago
    My comment answered that "countries with public health systems" actually do "pay" for the "latest generation insulin" (i.e. the price for the "latest generation insulin" is still a tiny fraction the cost in the United States). Just repeating the question, when I gave you the answer, isn't very productive.