17 ms·

California aims to slash insulin prices

148 points by lxm 4y ago

mhb 4y ago
The state has had discussions with other companies, including celebrity investor Mark Cuban’s for-profit drug company, the Mark Cuban Cost Plus Drug Co. It is building its own manufacturing plant, like Civica, but for now sells drugs online to anyone at wholesale cost plus a 15% markup. Founder Dr. Alex Oshmyansky said that the company’s talks with California fizzled out early on but that he’d be open to future discussions. Cuban is the chief investor in the company, Oshmyansky said. Would be interesting to know why these discussions fizzled.
- ceeplusplus 4y ago
  - wumpus 4y ago
    Thank you for illustrating how toxic many political discussions are.
- wahern 4y ago
  It seems there's some sort of medium-term mandate to build manufacturing facilities in California.[1] Presumably these preexisting ventures aren't interested in building a facility in California (instead of elsewhere), nor keen on working with a state that may eventually compete directly with them. [1] It's unclear how strict is this mandate. The 2020 legislation only requires investigating the feasibility of directly manufacturing drugs in-state. See the summary at https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB852 https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml... as well as section 127694 specifically. I'm guessing Newsom is trying to find a way to justify building an in-state manufacturing facility. It fits into the state's broader policy to develop the biotechnology sector, which is already significant--depending on metric, first in the nation or second to Massachusetts. Not sure it's worth delaying these deals over, but perhaps Civica and others are demanding long-term contracts in an attempt to preempt California building a competitor. (It's understandable why they wouldn't appreciate more competition. Even for a charitable venture, more capacity would impact their financial viability, especially considering that preexisting, for-profit suppliers will aggressively use their pricing and market powers to try to suffocate these new ventures. OTOH, that's exactly why one might want a state-backed facility, so they're not beholden to investors--even beneficent investors--and the ruthless economics of the market. And theoretically a state-owned facility might be more resilient, either legally or politically, to Federal government suppression, which is one of the primary tools the pharmaceutical industry has used to rig the market in the U.S.)
HillBates 4y ago
- avs733 4y ago
  People are literally dying because of the cost of insulin, but sure let’s find a “one day maybe” R&D project instead.
  - RHSeeger 4y ago
    Every example I'd seen publicized of someone who "can't afford insulin because it costs $300/bottle, so they died" has been a blatant lie. Every single one of them, without exception, could have switched to L/R/N, which are on the order of $25 per bottle. Are they as good? No, certainly not. But they do work, and they are certainly better than dying. Heck, you don't even need a prescription for them. Don't get me wrong; insulin prices are out of control, and something should be done. But these stories about people dying because they couldn't afford $300 for a vial of insulin are misinformation; and propagating them weakens the argument to get insulin prices reduced; because it gives people a factually correct way to push back against it (what with it being factually incorrect and all). Please don't spread those stories. Side note: People will comment about how awful R/N/L are, and say you'll always feel sick, etc. I was on R/L for on the order of a decade. It's annoying because it's effectiveness curve (of the R) means you need to take it 20 minutes (give or take; it's been a while) in advance of eating.. and if you wind up not being hungry, you have to eat anyways. But they are plenty effective for controlling blood sugar.
- fatboy93 4y ago
  It's not easy to do gene therapy? All the editing systems, have off targets that are yet to be studied. Even then, let's say that they work, what about cases like gestational diabetes? Are you going to do gene therapy on a pregnant person to resolve diabetes that tends to normally vanish off once the baby is born? What about the impact on the baby?
  - HillBates 4y ago
newyankee 4y ago
I will never understand US healthcare. If Mark Cuban's idea was so straightforward, i really wonder what took it so long. Perhaps, all that was needed was an interested billionare who did not want unlimited profits ?
- ptero 4y ago
  Too many vested interests and rigid regulation that cannot be changed because of those vested interests. To be honest, the same is true of many countries with socialized medicine, but the snag is not with cost but with availability and speed of care. And some medically solvable problems cannot be solved because changing anything is almost impossible.
  - iancmceachern 4y ago
    "Vested interests" = the insurance company / large corporate caregiver (kaiser, dignity, etc.) industrial complex. It's just like it sounds, it's the military industrial complex but with insurance companies and large corporate hospital systems, etc.
    - ehsankia 4y ago
      Nearly all of US problems can be traced back to the insanely powerful lobbying (citizen united, etc). The gun lobby, the private prison lobby, the healthcare lobby, the tax filing lobby, etc. Corporations not only buying politicians for dirt cheap to keep their own profits high, but also spreading lies and propaganda brainwashing part of the population into believing the bullshit they're peddling. Just look at the story of Wendell Potter [1], an ex US health exec who basically came out and detailed all the lies he spread about Canadian healthcare. So many people in the US believe those lies still to this day. [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
      - zarzavat 4y ago
        The first step is for Americans to stop using the word “lobbying” and call it like it is: corruption. When a politician receives benefits for passing certain laws (often hard cash to their campaign!) they are a corrupt politician. The term “lobbying” is the same kind of linguistic exceptionalism involved in the word “expat” vs “immigrant”.
jimrandomh 4y ago
I'm a T1 diabetic, so I've been through this. There's a simple way to buy insulin for 10x cheaper: Drive over the border. Any border will do. The extremely high prices are unique to the United States. Other countries have the same insulin brands, from the same companies, at literally 10x lower prices. That should make the solution clear: Undo the laws that prevent retailers from driving over the border themselves. If US drug stores could import insulin from Europe, Canada, and Mexico, then it would be impossible to maintain such a large price difference, and the US price would come down.
- iancmceachern 4y ago
  I'm curious what the legality would be on a communal trip of some sort. A lot like thr early days of medicinal Marijuana where individual patients would sign over their allotted plants to a caregiver. I wonder if there could be a coyote to use a perhaps not so great but applicable term for it. This coyote would collect a bunch or orders from folks, get the goods (insulin), bring it back. Now that I've written this I realize that this person has a name, it's not coyote, it's drug trafficker. I'm leaving it because: How shameful we are. A person whom would drive hundreds of miles to a foreign land to help people get basic medicine they need to survive is called a drug trafficker that is a felony. WTF America.
  - w-ll 4y ago
    I think it would be like this. "Dallas Buyers Club" https://www.imdb.com/title/tt0790636/ https://www.imdb.com/title/tt0790636/.
  - bolasanibk 4y ago
    http://www.banderasnews.com/0504/hb-cheapmeds.htm http://www.banderasnews.com/0504/hb-cheapmeds.htm https://en.m.wikipedia.org/wiki/Dallas_Buyers_Club https://en.m.wikipedia.org/wiki/Dallas_Buyers_Club
  - irrational 4y ago
    I live in a state where it is illegal to buy cold medicine with whatever the p-drug is called, without a prescription. But the next state over sells it over the counter. So when someone goes to the next state, people ask them to bring back the good stuff. I guess they are drug runners, though I never thought of it like that.
refurb 4y ago
produce its own brand of generic insulin and sell it at below-market prices to people with diabetes like Sabrina Caudillo But why? Diabetics don't want generic insulin, it's not as good as the newer insulins. And if they want cheap generic insulin, Walmart already sells generic insulin for cheap. Why not just buy it from Walmart and subsidize it? Why would you actually try and make it yourself and sell it for below market prices? That seems like a hard way to accomplish the same thing. What problem are they trying to solve? I mean, the LA Times reported on Walmart's cheap insulin not a year ago. https://www.latimes.com/business/story/2021-06-30/column-walmart-insulin https://www.latimes.com/business/story/2021-06-30/column-wal...
- not2b 4y ago
  Diabetics don't want generic insulin because it is slow acting and difficult to control. It takes a long time to start working and then a long time to stop, making dangerous highs and lows more likely. Generic fast-acting insulin is now legal because patents have expired. But generic insulin is still quite expensive in the US.
  - refurb 4y ago
    Both short acting and long acting insulin is available as genetics. However the newer insulin’s allow for better control - that’s why diabetics want it. But regardless, how does that change my argument? Why is CA getting into generic insulin manufacturing when they could just have someone who knows what they are doing make it?
    - not2b 4y ago
      Evidently, according to the article, the plan is to contract with a drug manufacturer (so, "someone who knows what they are doing"). Since any new generic has to go through trials, I guess the state would put up the money for this.
      - refurb 4y ago
        By "make it" I mean all the way to finished product. There is a ton of expense and time to create a biosimilar insulin, not just clinical trials, but regulatory approvals and updates, safety monitoring. Why not just find an existing seller and negotiate some pricing deal and then subsidize it for people in CA?
x-shadowban 4y ago
A fun protest / boycott would be all americans stop using their hospitals and all go over the border.
- seibelj 4y ago
  For medicine, Americans go over the border. For healthcare, Canadians go over the border to America.
  - jpgvm 4y ago
    This is a much repeated but blatantly false trope. For life saving care you are strictly better off in Canada, Australia or Britain. For elective surgery you can probably get it done faster in the US if you have money but the standard of care isn't different. There are in-fact places that embrace even more medical capitalism than the US but with less middleman, lobbying and nonsense - take Thailand for instance, or South Korea. Both of which offer elective medical procedures for less than the US, no wait times, equivalent standard of care served with a side of luxury. So yeah, utter drivel as usual, the US system is inferior by all metrics and insurance lobbyists have duped conservative Americans into voting for something that is strictly against their interests. Conservative politicians the world over have perfected the art of getting turkeys to vote for Christmas.
    - seibelj 4y ago
      A bit confusing because the hospitals in Boston have wings for foreigners with luxury accommodations, and people all over the world fly in to get top-tier procedures done. My son was born with complications and my insurance paid for all of it at such a top-tier Boston hospital (I am a Boston resident and US citizen). So maybe things aren’t so simple. https://www.bostonmagazine.com/health/2015/11/24/boston-hospitals-luxury-rooms-amenities/ https://www.bostonmagazine.com/health/2015/11/24/boston-hosp...
      - jpgvm 4y ago
        The existence of very expensive private care in the US isn't counter to my point if anything it's an embodiment of it. Furthermore it's probably much more expensive than you realize. Premium contributions and deductibles totaled 11.6% of median income in 2020, compared to 2% Medicare levy in Australia across the income spectrum. The US system isn't defendable. You can say things like "Well I'm rich so it works for me" but you can't make assertions that it's good as a whole.
mjfl 4y ago
Most people have insurance right? So they won't be paying the $400 per vial?
- braingenious 4y ago
  People without insurance here often don’t have enough money to pay out of pocket either, so yes this is correct. They won’t pay the $400. They often just won’t get any insulin at all and drastically shorten their lives.
  - ars 4y ago
    WalMart sells insulin for $72.88. It's not the same stuff as the $400 product, but it works.
    - ThePowerOfFuet 4y ago
      That same one is half Walmart's price, or less, outside the US.
      - braingenious 4y ago
        It probably doesn’t matter to the GP. I bet that this person doesn’t know or care about any diabetics that are at risk of this problem.
    - perfectstorm 4y ago
      $72 is still expensive compared to other nations.
    - braingenious 4y ago
      That is super cool, have you put ReliOn into your insulin pump? Edit: Sometimes people that can’t afford $400 also can’t afford $72. How does your point matter for those real life humans?
  - deleted 4y ago
    [deleted]
ReignMaykr 4y ago
blenderdt 4y ago
Lately I am reading into the cause of the diabetic pandemic. It's kind of shocking to read that our food is to blame and food companies are blocking change. Somehow this 'fat is bad' lie came into the world. We have been eating fat for thousands of years. Fat is full of all kinds of stuff the body needs. The brain can tell us when we ate enough fat so we feel full. The body can handle fat very well so it doesn't get stored and we won't grow fat. But no, fat became wrong and was removed from our food making it tasteless. So sugars are added. This is good news for the food industry because the brain doesn't register when we have enough sugars. So we keep eating. And this item on HN continues the trend. There is no solution but it's about companies making huge profits over insulin.
- icehawk 4y ago
  For some people (Type I diabetics) changing food is not a solution. They don't have the β-cells that make insulin, so they're reliant on synthetic insulin. Even replacing the pancreas is only a stopgap measure, and their immune system enforces that. Yes, they're 5% to 10% of all diabetics but don't simply dismiss this as continuing the trend.
  - blenderdt 4y ago
    True, I should have added that to my comment.
- everforward 4y ago
  I don't know if you've seen it, but putting the blame on fat was an orchestrated effort by the sugar industry: https://www.npr.org/sections/thetwo-way/2016/09/13/493739074/50-years-ago-sugar-industry-quietly-paid-scientists-to-point-blame-at-fat https://www.npr.org/sections/thetwo-way/2016/09/13/493739074... The appeal to naturalism is kind of iffy, though. The kinds and amount of fat we eat might be substantially different than many of our ancestors. I'm not making an argument either way, just that I doubt modern food resembles ancient diets.
renewiltord 4y ago
To any users of diabetes treatment: why not the generic novolog sold as relion at Walmart?
argonaut 4y ago
A lot of people seem to be confused about insulin every time it comes up. There are many different forms of insulin. Regular human insulin has been around for decades and is fairly cheap without insurance but difficult/inconvenient to use because it requires planning out your eating schedule. The extremely expensive insulin that articles are talking about is usually a brand name like Humalog which is an altered form of insulin that is far more convenient to use. It is possible (but rather convoluted) to bring these eye-popping prices down to $99/month without insurance (https://www.admelog.com/savings https://www.admelog.com/savings), or $43-73/vial (https://www.goodrx.com/insulin-lispro https://www.goodrx.com/insulin-lispro or Walmart Novolog). Of course, this is all basically a way for pharma companies to price discriminate to extract as much $$$ from insurance.
- trasz 4y ago
  Yet this price goes down to eg 8£ if you’re living in UK, or nothing in many places in Europe. The exact same Humalog.
  - xnorswap 4y ago
    Source for UK pricing: https://bnf.nice.org.uk/drugs/insulin-lispro/medicinal-forms/ https://bnf.nice.org.uk/drugs/insulin-lispro/medicinal-forms... But also note that in the UK: > If you use insulin or medicine to manage your diabetes, you're entitled to free prescriptions I think (though not 100% sure) that covers all prescriptions too, not just those to manage diabetes.
    - Dma54rhs 4y ago
      But do they talk about that expensive form of brand insulin the article is taking about?
      - xnorswap 4y ago
        I don't understand your question.
      - 4y ago
deleted 4y ago
[deleted]
GrumpyNl 4y ago
Those prices are insane, here the official pricelist from the Netherlands https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/kostenoverzicht/modal/insuline__gewoon https://www.farmacotherapeutischkompas.nl/bladeren/preparaat...
viraptor 4y ago
> “Who is going to write the prescriptions for this magic insulin?” she asked. I don't get this, but I'm not in the US. Over here the prescriptions are for the active ingredient unless something specific is required and then you get both the name and the "no substitutions" box is ticked. The pharmacy will just ask "are you ok with a generic" otherwise. Is it much different? Why wouldn't people be prescribed "insulin" in this case? Even then the question seems weird - people will know about this happening, they will ask for it. How would it not be prescribed?
nickpp 4y ago
Let me guess: they are planning to use the amazing mechanism that proved to be so effective at reducing prices and improving availability for stuff like food, clothes, computing, communications and entertainment: the free market. Consequently all they have to do is remove the barriers for competition to enter said market and patiently watch as the problem solves itself, thanks to the amazing ingenuity and creativity of the entrepreneurial spirit. Of course, that would make it clear for everyone that the actual culprits are the politicians who erected said barriers and we'd all be better without their interferences in economy, so... there is a perverse incentive there... let's see what they want to do: > market failures that plague the pharmaceutical industry > disrupting monopolistic drug prices requires state intervention and that California can pull it off because the state “has market power.” Yup. So, any ways to bet on the outcome of this action? Favorite prediction markets?

148 points by lxm 4y ago

mhb 4y ago

The state has had discussions with other companies, including celebrity investor Mark Cuban’s for-profit drug company, the Mark Cuban Cost Plus Drug Co. It is building its own manufacturing plant, like Civica, but for now sells drugs online to anyone at wholesale cost plus a 15% markup. Founder Dr. Alex Oshmyansky said that the company’s talks with California fizzled out early on but that he’d be open to future discussions. Cuban is the chief investor in the company, Oshmyansky said. Would be interesting to know why these discussions fizzled.

ceeplusplus 4y ago
- wumpus 4y ago
  Thank you for illustrating how toxic many political discussions are.
wahern 4y ago
It seems there's some sort of medium-term mandate to build manufacturing facilities in California.[1] Presumably these preexisting ventures aren't interested in building a facility in California (instead of elsewhere), nor keen on working with a state that may eventually compete directly with them. [1] It's unclear how strict is this mandate. The 2020 legislation only requires investigating the feasibility of directly manufacturing drugs in-state. See the summary at https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB852 https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml... as well as section 127694 specifically. I'm guessing Newsom is trying to find a way to justify building an in-state manufacturing facility. It fits into the state's broader policy to develop the biotechnology sector, which is already significant--depending on metric, first in the nation or second to Massachusetts. Not sure it's worth delaying these deals over, but perhaps Civica and others are demanding long-term contracts in an attempt to preempt California building a competitor. (It's understandable why they wouldn't appreciate more competition. Even for a charitable venture, more capacity would impact their financial viability, especially considering that preexisting, for-profit suppliers will aggressively use their pricing and market powers to try to suffocate these new ventures. OTOH, that's exactly why one might want a state-backed facility, so they're not beholden to investors--even beneficent investors--and the ruthless economics of the market. And theoretically a state-owned facility might be more resilient, either legally or politically, to Federal government suppression, which is one of the primary tools the pharmaceutical industry has used to rig the market in the U.S.)

HillBates 4y ago

avs733 4y ago
People are literally dying because of the cost of insulin, but sure let’s find a “one day maybe” R&D project instead.
- RHSeeger 4y ago
  Every example I'd seen publicized of someone who "can't afford insulin because it costs $300/bottle, so they died" has been a blatant lie. Every single one of them, without exception, could have switched to L/R/N, which are on the order of $25 per bottle. Are they as good? No, certainly not. But they do work, and they are certainly better than dying. Heck, you don't even need a prescription for them. Don't get me wrong; insulin prices are out of control, and something should be done. But these stories about people dying because they couldn't afford $300 for a vial of insulin are misinformation; and propagating them weakens the argument to get insulin prices reduced; because it gives people a factually correct way to push back against it (what with it being factually incorrect and all). Please don't spread those stories. Side note: People will comment about how awful R/N/L are, and say you'll always feel sick, etc. I was on R/L for on the order of a decade. It's annoying because it's effectiveness curve (of the R) means you need to take it 20 minutes (give or take; it's been a while) in advance of eating.. and if you wind up not being hungry, you have to eat anyways. But they are plenty effective for controlling blood sugar.
fatboy93 4y ago
It's not easy to do gene therapy? All the editing systems, have off targets that are yet to be studied. Even then, let's say that they work, what about cases like gestational diabetes? Are you going to do gene therapy on a pregnant person to resolve diabetes that tends to normally vanish off once the baby is born? What about the impact on the baby?
- HillBates 4y ago

newyankee 4y ago

I will never understand US healthcare. If Mark Cuban's idea was so straightforward, i really wonder what took it so long. Perhaps, all that was needed was an interested billionare who did not want unlimited profits ?

ptero 4y ago
Too many vested interests and rigid regulation that cannot be changed because of those vested interests. To be honest, the same is true of many countries with socialized medicine, but the snag is not with cost but with availability and speed of care. And some medically solvable problems cannot be solved because changing anything is almost impossible.
- iancmceachern 4y ago
  "Vested interests" = the insurance company / large corporate caregiver (kaiser, dignity, etc.) industrial complex. It's just like it sounds, it's the military industrial complex but with insurance companies and large corporate hospital systems, etc.
  - ehsankia 4y ago
    Nearly all of US problems can be traced back to the insanely powerful lobbying (citizen united, etc). The gun lobby, the private prison lobby, the healthcare lobby, the tax filing lobby, etc. Corporations not only buying politicians for dirt cheap to keep their own profits high, but also spreading lies and propaganda brainwashing part of the population into believing the bullshit they're peddling. Just look at the story of Wendell Potter [1], an ex US health exec who basically came out and detailed all the lies he spread about Canadian healthcare. So many people in the US believe those lies still to this day. [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
    - zarzavat 4y ago
      The first step is for Americans to stop using the word “lobbying” and call it like it is: corruption. When a politician receives benefits for passing certain laws (often hard cash to their campaign!) they are a corrupt politician. The term “lobbying” is the same kind of linguistic exceptionalism involved in the word “expat” vs “immigrant”.

jimrandomh 4y ago

I'm a T1 diabetic, so I've been through this. There's a simple way to buy insulin for 10x cheaper: Drive over the border. Any border will do. The extremely high prices are unique to the United States. Other countries have the same insulin brands, from the same companies, at literally 10x lower prices. That should make the solution clear: Undo the laws that prevent retailers from driving over the border themselves. If US drug stores could import insulin from Europe, Canada, and Mexico, then it would be impossible to maintain such a large price difference, and the US price would come down.

iancmceachern 4y ago
I'm curious what the legality would be on a communal trip of some sort. A lot like thr early days of medicinal Marijuana where individual patients would sign over their allotted plants to a caregiver. I wonder if there could be a coyote to use a perhaps not so great but applicable term for it. This coyote would collect a bunch or orders from folks, get the goods (insulin), bring it back. Now that I've written this I realize that this person has a name, it's not coyote, it's drug trafficker. I'm leaving it because: How shameful we are. A person whom would drive hundreds of miles to a foreign land to help people get basic medicine they need to survive is called a drug trafficker that is a felony. WTF America.
- w-ll 4y ago
  I think it would be like this. "Dallas Buyers Club" https://www.imdb.com/title/tt0790636/ https://www.imdb.com/title/tt0790636/.
- bolasanibk 4y ago
  http://www.banderasnews.com/0504/hb-cheapmeds.htm http://www.banderasnews.com/0504/hb-cheapmeds.htm https://en.m.wikipedia.org/wiki/Dallas_Buyers_Club https://en.m.wikipedia.org/wiki/Dallas_Buyers_Club
- irrational 4y ago
  I live in a state where it is illegal to buy cold medicine with whatever the p-drug is called, without a prescription. But the next state over sells it over the counter. So when someone goes to the next state, people ask them to bring back the good stuff. I guess they are drug runners, though I never thought of it like that.

refurb 4y ago

produce its own brand of generic insulin and sell it at below-market prices to people with diabetes like Sabrina Caudillo But why? Diabetics don't want generic insulin, it's not as good as the newer insulins. And if they want cheap generic insulin, Walmart already sells generic insulin for cheap. Why not just buy it from Walmart and subsidize it? Why would you actually try and make it yourself and sell it for below market prices? That seems like a hard way to accomplish the same thing. What problem are they trying to solve? I mean, the LA Times reported on Walmart's cheap insulin not a year ago. https://www.latimes.com/business/story/2021-06-30/column-walmart-insulin https://www.latimes.com/business/story/2021-06-30/column-wal...

not2b 4y ago
Diabetics don't want generic insulin because it is slow acting and difficult to control. It takes a long time to start working and then a long time to stop, making dangerous highs and lows more likely. Generic fast-acting insulin is now legal because patents have expired. But generic insulin is still quite expensive in the US.
- refurb 4y ago
  Both short acting and long acting insulin is available as genetics. However the newer insulin’s allow for better control - that’s why diabetics want it. But regardless, how does that change my argument? Why is CA getting into generic insulin manufacturing when they could just have someone who knows what they are doing make it?
  - not2b 4y ago
    Evidently, according to the article, the plan is to contract with a drug manufacturer (so, "someone who knows what they are doing"). Since any new generic has to go through trials, I guess the state would put up the money for this.
    - refurb 4y ago
      By "make it" I mean all the way to finished product. There is a ton of expense and time to create a biosimilar insulin, not just clinical trials, but regulatory approvals and updates, safety monitoring. Why not just find an existing seller and negotiate some pricing deal and then subsidize it for people in CA?

x-shadowban 4y ago

A fun protest / boycott would be all americans stop using their hospitals and all go over the border.

seibelj 4y ago
For medicine, Americans go over the border. For healthcare, Canadians go over the border to America.
- jpgvm 4y ago
  This is a much repeated but blatantly false trope. For life saving care you are strictly better off in Canada, Australia or Britain. For elective surgery you can probably get it done faster in the US if you have money but the standard of care isn't different. There are in-fact places that embrace even more medical capitalism than the US but with less middleman, lobbying and nonsense - take Thailand for instance, or South Korea. Both of which offer elective medical procedures for less than the US, no wait times, equivalent standard of care served with a side of luxury. So yeah, utter drivel as usual, the US system is inferior by all metrics and insurance lobbyists have duped conservative Americans into voting for something that is strictly against their interests. Conservative politicians the world over have perfected the art of getting turkeys to vote for Christmas.
  - seibelj 4y ago
    A bit confusing because the hospitals in Boston have wings for foreigners with luxury accommodations, and people all over the world fly in to get top-tier procedures done. My son was born with complications and my insurance paid for all of it at such a top-tier Boston hospital (I am a Boston resident and US citizen). So maybe things aren’t so simple. https://www.bostonmagazine.com/health/2015/11/24/boston-hospitals-luxury-rooms-amenities/ https://www.bostonmagazine.com/health/2015/11/24/boston-hosp...
    - jpgvm 4y ago
      The existence of very expensive private care in the US isn't counter to my point if anything it's an embodiment of it. Furthermore it's probably much more expensive than you realize. Premium contributions and deductibles totaled 11.6% of median income in 2020, compared to 2% Medicare levy in Australia across the income spectrum. The US system isn't defendable. You can say things like "Well I'm rich so it works for me" but you can't make assertions that it's good as a whole.

mjfl 4y ago

Most people have insurance right? So they won't be paying the $400 per vial?

braingenious 4y ago
People without insurance here often don’t have enough money to pay out of pocket either, so yes this is correct. They won’t pay the $400. They often just won’t get any insulin at all and drastically shorten their lives.
- ars 4y ago
  WalMart sells insulin for $72.88. It's not the same stuff as the $400 product, but it works.
  - ThePowerOfFuet 4y ago
    That same one is half Walmart's price, or less, outside the US.
    - braingenious 4y ago
      It probably doesn’t matter to the GP. I bet that this person doesn’t know or care about any diabetics that are at risk of this problem.
  - perfectstorm 4y ago
    $72 is still expensive compared to other nations.
  - braingenious 4y ago
    That is super cool, have you put ReliOn into your insulin pump? Edit: Sometimes people that can’t afford $400 also can’t afford $72. How does your point matter for those real life humans?
- deleted 4y ago
  [deleted]

ReignMaykr 4y ago

blenderdt 4y ago

Lately I am reading into the cause of the diabetic pandemic. It's kind of shocking to read that our food is to blame and food companies are blocking change. Somehow this 'fat is bad' lie came into the world. We have been eating fat for thousands of years. Fat is full of all kinds of stuff the body needs. The brain can tell us when we ate enough fat so we feel full. The body can handle fat very well so it doesn't get stored and we won't grow fat. But no, fat became wrong and was removed from our food making it tasteless. So sugars are added. This is good news for the food industry because the brain doesn't register when we have enough sugars. So we keep eating. And this item on HN continues the trend. There is no solution but it's about companies making huge profits over insulin.

icehawk 4y ago
For some people (Type I diabetics) changing food is not a solution. They don't have the β-cells that make insulin, so they're reliant on synthetic insulin. Even replacing the pancreas is only a stopgap measure, and their immune system enforces that. Yes, they're 5% to 10% of all diabetics but don't simply dismiss this as continuing the trend.
- blenderdt 4y ago
  True, I should have added that to my comment.
everforward 4y ago
I don't know if you've seen it, but putting the blame on fat was an orchestrated effort by the sugar industry: https://www.npr.org/sections/thetwo-way/2016/09/13/493739074/50-years-ago-sugar-industry-quietly-paid-scientists-to-point-blame-at-fat https://www.npr.org/sections/thetwo-way/2016/09/13/493739074... The appeal to naturalism is kind of iffy, though. The kinds and amount of fat we eat might be substantially different than many of our ancestors. I'm not making an argument either way, just that I doubt modern food resembles ancient diets.

renewiltord 4y ago

To any users of diabetes treatment: why not the generic novolog sold as relion at Walmart?

argonaut 4y ago

A lot of people seem to be confused about insulin every time it comes up. There are many different forms of insulin. Regular human insulin has been around for decades and is fairly cheap without insurance but difficult/inconvenient to use because it requires planning out your eating schedule. The extremely expensive insulin that articles are talking about is usually a brand name like Humalog which is an altered form of insulin that is far more convenient to use. It is possible (but rather convoluted) to bring these eye-popping prices down to $99/month without insurance (https://www.admelog.com/savings https://www.admelog.com/savings), or $43-73/vial (https://www.goodrx.com/insulin-lispro https://www.goodrx.com/insulin-lispro or Walmart Novolog). Of course, this is all basically a way for pharma companies to price discriminate to extract as much $$$ from insurance.

trasz 4y ago
Yet this price goes down to eg 8£ if you’re living in UK, or nothing in many places in Europe. The exact same Humalog.
- xnorswap 4y ago
  Source for UK pricing: https://bnf.nice.org.uk/drugs/insulin-lispro/medicinal-forms/ https://bnf.nice.org.uk/drugs/insulin-lispro/medicinal-forms... But also note that in the UK: > If you use insulin or medicine to manage your diabetes, you're entitled to free prescriptions I think (though not 100% sure) that covers all prescriptions too, not just those to manage diabetes.
  - Dma54rhs 4y ago
    But do they talk about that expensive form of brand insulin the article is taking about?
    - xnorswap 4y ago
      I don't understand your question.
    - 4y ago

deleted 4y ago

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GrumpyNl 4y ago

Those prices are insane, here the official pricelist from the Netherlands https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/kostenoverzicht/modal/insuline__gewoon https://www.farmacotherapeutischkompas.nl/bladeren/preparaat...

viraptor 4y ago

> “Who is going to write the prescriptions for this magic insulin?” she asked. I don't get this, but I'm not in the US. Over here the prescriptions are for the active ingredient unless something specific is required and then you get both the name and the "no substitutions" box is ticked. The pharmacy will just ask "are you ok with a generic" otherwise. Is it much different? Why wouldn't people be prescribed "insulin" in this case? Even then the question seems weird - people will know about this happening, they will ask for it. How would it not be prescribed?

nickpp 4y ago

Let me guess: they are planning to use the amazing mechanism that proved to be so effective at reducing prices and improving availability for stuff like food, clothes, computing, communications and entertainment: the free market. Consequently all they have to do is remove the barriers for competition to enter said market and patiently watch as the problem solves itself, thanks to the amazing ingenuity and creativity of the entrepreneurial spirit. Of course, that would make it clear for everyone that the actual culprits are the politicians who erected said barriers and we'd all be better without their interferences in economy, so... there is a perverse incentive there... let's see what they want to do: > market failures that plague the pharmaceutical industry > disrupting monopolistic drug prices requires state intervention and that California can pull it off because the state “has market power.” Yup. So, any ways to bet on the outcome of this action? Favorite prediction markets?