5 ms·

Seriously: Isn't there a business case? Patents for the older Insulins have expired, the manufacture isn't that complicated for any halfway decent pharma or che

Seriously: Isn't there a business case? Patents for the older Insulins have expired, the manufacture isn't that complicated for any halfway decent pharma or chemical company. The current margins must be through the roof. How is Insulin in any way different from other generics which are a common business case? Why is there nobody offering competition?

antirez 5y ago
Apparently it's an US problem. Never heard of insulin as a costly drug in Europe. US health care system is totally broken with costs 10x for most procedures without any reason.
- ghosty141 5y ago
  I believe it gets payed for by insurance in basically any other country. I can only talk about germany: For type 1 diabetes insurance completely covers it. For type 2 it may get fully covered but it depends on some factors, but even then you don't pay the full price, only a part since the insurance will almost always at least partially cover it. (this is based on a quick google search)
  - antirez 5y ago
    In Italy no need for insurance, it's just the government that gives it you for free. But the problem is, I believe, different: it's the raw cost of the medication. Here in Europe even if the patient has to buy it, the cost is fraction.
    - mngnt 5y ago
      Do you have any source I could read to see how it works in Italy? I live in central Europe (Slovakia) and insulin is also "free" here (if you are diabetic and have a prescription), but it´s not "paid by the government", it´s paid by the compulsory insurance everyone is paying (for me, it´s about 5% off of my net salary). I 100% agree to your second point. I found some data to compare: Humalog from Eli Lilly Netherlands costs 19,42 € per 10 ml vial in Slovakia [1] and $296.29 in the US [2]. Yep, that´s ~13 times as much (I ignore exchange rates, but it´s in the same ballpark). This is not saying much though, due to salary difference. Average monthly salary in Slovakia is 1133 € , while in the US it is $4692.5. Thus, an average Slovak can pay for 580 ml of insulin monthly (I´ll note here, they doesn´t have to pay, it´s covered by insurance), while an American can only get 158 ml of the same brand, same product insulin. On top of that is the manufacture price is up to $6.16 per vial. [5] [1] https://translate.google.com/translate?sl=auto&tl=en&u=https://www.adc.sk/databazy/produkty/detail/humalog-100-u-ml-228842.html https://translate.google.com/translate?sl=auto&tl=en&u=https... [2] https://www.drugs.com/price-guide/humalog# https://www.drugs.com/price-guide/humalog# [3]https://translate.google.com/translate?hl=&sl=sk&tl=en&u=https%3A%2F%2Fwww.minimalnamzda.sk%2Fpriemerna-mzda.php https://translate.google.com/translate?hl=&sl=sk&tl=en&u=htt... [4]https://www.bls.gov/oes/current/oes_nat.htm#00-0000 https://www.bls.gov/oes/current/oes_nat.htm#00-0000 [5]https://www.singlecare.com/blog/insulin-prices/ https://www.singlecare.com/blog/insulin-prices/
      - maxerickson 5y ago
        The "cash" price in the US is $142: https://www.goodrx.com/humalog?dosage=10ml-of-100-units-ml&form=vial&label_override=Humalog&quantity=1&sort_type=popularity https://www.goodrx.com/humalog?dosage=10ml-of-100-units-ml&f... (GoodRx doesn't have any direct user fees, they make money by understanding the stupid prescription drug system in the US) There's a generic that is $50 at several pharmacies.
        mngnt 5y ago
        Thanks for pointing that out. GoodRx is not available from EU (Either due to GDPR or due to not being applicable to non-US readers, I guess). That invalidates my numbers a bit. However, it´s also pointing to another facet of this issue: the opaqueness of the pricing. In here, price of medication (including insulin) is regulated and it´s the same everywhere, for everyone and no seller-specific discount can be applied.
        maxerickson 5y ago
        Yeah, they make money by working the convoluted US system. It isn't good that the prices vary, but it's been long enough that people with substantial drug costs should be doing some basic checks, discussing the highest quoted US prices doesn't reflect what people are paying.
        steveklabnik 5y ago
        The "cash" price is $342. The $142 is from a $200 which has eligibility requirements, which don't allow you to get that discount in many cases.
        maxerickson 5y ago
        What requirements are attached to using the PBM replacements? My understanding is that you go to a pharmacy that accepts them and give them a number to put into the computer. Or does using them disqualify people from other programs?
- weezin 5y ago
  The US healthcare system is a mess in the US because the government pays for a lot incentivizing companies to raise prices.
- QuesnayJr 5y ago
  Total costs usually work out be 2x, it's just that the government pays a big chunk. (I'm sure it's not uniformly 2x, so insulin might cost more.)

antirez 5y ago

Apparently it's an US problem. Never heard of insulin as a costly drug in Europe. US health care system is totally broken with costs 10x for most procedures without any reason.

ghosty141 5y ago
I believe it gets payed for by insurance in basically any other country. I can only talk about germany: For type 1 diabetes insurance completely covers it. For type 2 it may get fully covered but it depends on some factors, but even then you don't pay the full price, only a part since the insurance will almost always at least partially cover it. (this is based on a quick google search)
- antirez 5y ago
  In Italy no need for insurance, it's just the government that gives it you for free. But the problem is, I believe, different: it's the raw cost of the medication. Here in Europe even if the patient has to buy it, the cost is fraction.
  - mngnt 5y ago
    Do you have any source I could read to see how it works in Italy? I live in central Europe (Slovakia) and insulin is also "free" here (if you are diabetic and have a prescription), but it´s not "paid by the government", it´s paid by the compulsory insurance everyone is paying (for me, it´s about 5% off of my net salary). I 100% agree to your second point. I found some data to compare: Humalog from Eli Lilly Netherlands costs 19,42 € per 10 ml vial in Slovakia [1] and $296.29 in the US [2]. Yep, that´s ~13 times as much (I ignore exchange rates, but it´s in the same ballpark). This is not saying much though, due to salary difference. Average monthly salary in Slovakia is 1133 € , while in the US it is $4692.5. Thus, an average Slovak can pay for 580 ml of insulin monthly (I´ll note here, they doesn´t have to pay, it´s covered by insurance), while an American can only get 158 ml of the same brand, same product insulin. On top of that is the manufacture price is up to $6.16 per vial. [5] [1] https://translate.google.com/translate?sl=auto&tl=en&u=https://www.adc.sk/databazy/produkty/detail/humalog-100-u-ml-228842.html https://translate.google.com/translate?sl=auto&tl=en&u=https... [2] https://www.drugs.com/price-guide/humalog# https://www.drugs.com/price-guide/humalog# [3]https://translate.google.com/translate?hl=&sl=sk&tl=en&u=https%3A%2F%2Fwww.minimalnamzda.sk%2Fpriemerna-mzda.php https://translate.google.com/translate?hl=&sl=sk&tl=en&u=htt... [4]https://www.bls.gov/oes/current/oes_nat.htm#00-0000 https://www.bls.gov/oes/current/oes_nat.htm#00-0000 [5]https://www.singlecare.com/blog/insulin-prices/ https://www.singlecare.com/blog/insulin-prices/
    - maxerickson 5y ago
      The "cash" price in the US is $142: https://www.goodrx.com/humalog?dosage=10ml-of-100-units-ml&form=vial&label_override=Humalog&quantity=1&sort_type=popularity https://www.goodrx.com/humalog?dosage=10ml-of-100-units-ml&f... (GoodRx doesn't have any direct user fees, they make money by understanding the stupid prescription drug system in the US) There's a generic that is $50 at several pharmacies.
      - mngnt 5y ago
        Thanks for pointing that out. GoodRx is not available from EU (Either due to GDPR or due to not being applicable to non-US readers, I guess). That invalidates my numbers a bit. However, it´s also pointing to another facet of this issue: the opaqueness of the pricing. In here, price of medication (including insulin) is regulated and it´s the same everywhere, for everyone and no seller-specific discount can be applied.
        maxerickson 5y ago
        Yeah, they make money by working the convoluted US system. It isn't good that the prices vary, but it's been long enough that people with substantial drug costs should be doing some basic checks, discussing the highest quoted US prices doesn't reflect what people are paying.
      - steveklabnik 5y ago
        The "cash" price is $342. The $142 is from a $200 which has eligibility requirements, which don't allow you to get that discount in many cases.
        maxerickson 5y ago
        What requirements are attached to using the PBM replacements? My understanding is that you go to a pharmacy that accepts them and give them a number to put into the computer. Or does using them disqualify people from other programs?
weezin 5y ago
The US healthcare system is a mess in the US because the government pays for a lot incentivizing companies to raise prices.
QuesnayJr 5y ago
Total costs usually work out be 2x, it's just that the government pays a big chunk. (I'm sure it's not uniformly 2x, so insulin might cost more.)