6 ms·

> Whatever happened to them needing to represent the interests of the people? As a Canadian, where Americans often come here in droves to buy cheap insulin i'v

> Whatever happened to them needing to represent the interests of the people? As a Canadian, where Americans often come here in droves to buy cheap insulin i've often wondered the same thing. https://www.ctvnews.ca/health/caravan-of-americans-cross-into-canada-just-to-get-affordable-insulin-1.4415683 https://www.ctvnews.ca/health/caravan-of-americans-cross-int... Americans drive 1,000 KM just to get affordable insulin which in many cases is a life or death drug?

rufus_foreman 4y ago
Human insulin is available without a prescription for around $25 a vial at Walmart. That is what most diabetics would have used 20 years ago before the drug companies developed analog insulin versions that are easier to use. Analog insulin is available with a prescription for around $75 a vial at Walmart. About 1 in 7 Walmart shoppers have diabetes.
- swores 4y ago
  That's still ridiculously expensive, no? edit: yes, seems it is indeed - https://news.ycombinator.com/item?id=33572721 https://news.ycombinator.com/item?id=33572721
  - harimau777 4y ago
    I don't know if it's accurate, but this suggests that on average, diabetics use 2-3 vials per month. So that would be $50 to $75 a month. However, it also mentions that some people need 50-60 units per meal and a vial contains 1000 units. Assuming three meals per day, someone using 50 vials per meal would spend $666.66 per month. $666.66 per month would be prohibitively expensive for many people and even $50 to $75 could be a significant expense for people making minimum wage (depending on local minimum wage it could be equivalent to 7-8 hours of work before taxes). https://4allfamily.com/blogs/diabetes/how-long-does-a-vial-of-insulin-last https://4allfamily.com/blogs/diabetes/how-long-does-a-vial-o...
    - chewbacha 4y ago
      50 units per dose would be 20 doses per vial. 3 meals a day * 30 days would be 90 meals. 90 meals / 20 doses / 1 vial = 4.5 vials / month 4.5 * 25 = 112.5 I’m not seeing how we get to $666
      - clnq 4y ago
        More context: the insulin dose diabetics take with meals is called a bolus dose. However, cells in the human body need glucose uptake constantly, 24 hours a day. So T1 diabetics also have to take a basal insulin dose either once daily as an injection or continuously on a pump. In addition to that, diabetics need to take correction bolus doses to lower their blood glucose when it's high not as a result of a meal, and sometimes they have snack or meals other than just the 3 meals a day. The basal and bolus ratio is around 50% : 50% for some people, although it depends on their doctor and a lot of different factors. So, to recap - there are food boluses, correction boluses, and basal doses. Here's how I would do the math: 50 units per dose x 3.5 meals on average x 2 for basal = 350 units a day. Or 0.35 vial per day, and 10.7 vials per month. Assuming synthetic human insulin and not insulin analogue is used, that means about $270 per month. However, some caveats: - synthetic human insulin is not fast enough for most carbohydrates in meals, and it results in higher blood glucose spikes immediately after a meal than using an insulin analogue. The higher the blood glucose, the more insulin it takes to lower it the same amount. Moreover, we only have so many hours in the day, and slower acting synthetic human insulin needs time to work. So people using it are more likely to "overcompensate" and then eat a bit later to offset their dose. This is a very long-winded way of saying that a person might need slightly more synthetic human insulin than analogues, plus synthetic human insulin in general is less effective. - In my calculations, I did not include correction bolus doses, insulin used to prime needles, and pump infusion sets (although probably very few people use human synthetic insulin in pumps anyways). I also did not include insulin that is spoiled in some way (refrigerator breakdowns, reserve insulin taken on trips that's not refrigerated, heatwaves, and so on). - Most people use between 70 and 110 units of insulin per day, whether that's a combination of an insulin analogue and basal insulin injections, or using insulin analogue in a pump. I don't know how much synthetic human insulin is used per day on average, probably a bit more. So I would say in practice, for someone who uses that much synthetic human insulin, the cost can be even $400 per month. For analogues, it would be much, much higher. I think it makes sense for me to provide a source for all this - I care for someone with T1 diabetes and am somewhat connected with the broader T1 community.
- clnq 4y ago
  Analogues are not only easier to use, but also allow for regimens and therapies (such as insulin pump therapy) that somewhat improve life expectancy and significantly improve quality of life. The relatively inelastic demand of insulin analogues when synthetic human insulin is available shows how important analogues are to T1 diabetics. Sometimes pharma companies try to allude to analogues being a luxury good compared to synthetic human insulin. But to T1 diabetics this notion is generally ridiculous. Analogue insulins allow them to regain a little bit more quality of life lost to the disease, and that should be a human right when insulin manufacturing costs are so low.
tomohawk 4y ago
- notwedtm 4y ago
  What a weird take. Are you saying that if these for-profit corporations didn't charge absurd amounts to US citizens, then the drug would be unattainable for Canadians?
- likecarter 4y ago
  No, it's because our government negotiates on behalf of all Canadians. And we are a very big healthcare market (even with a small population) since we all participate in the health care system – since it's public.
  - dboreham 4y ago
    Is that meaningfully different from price controls? US government also represents a huge proportion of the demand but is banned through corruption from exercising similar price pressure.
    - harimau777 4y ago
      Doesn't that go both ways? Eli Lilly is a huge organization negotiating in favor of higher prices, so it makes sense that a huge organization (i.e. the government or insurance companies) would be needed to negotiate against them. Even if there is a power imbalance between Eli Lilly and the Canadian Government, there would also be a power imbalance if it was instead Eli Lilly vs. individual consumers.
      - bart_spoon 4y ago
        Eli Lilly actually doesn’t negotiate for higher prices. I’ve had somewhat more insight than the average person into how the dynamics of the insulin pricing work, and it’s a total abomination, largely born out of a lack of a universal public insurance option in the US. Despite the skyrocketing costs of insulin over the decades, Eli Lilly’s profits per unit are mostly in line with inflation. This is because in the US system, there is a pervasive system of rebates that exists between pharmaceutical companies and insurers. Insurers often may only pay 10% of what the sticker price is for insulin. But the way these rebates get negotiated through third party firms known as PBMs create a system that incentivizes insulin that is marked up an incredible amount and then discounted to X, than simply pricing it at X in the first place. But this obviously screws over anyone without access to the rebate, i.e. those without insurance. And this system largely exists because the privatized nature of insurance in the US. If there was some kind of universal medicare in the US, undermines those incentives and the market would normalize immediately.
Naga 4y ago
On the other hand, now Canadians drive to the United States to buy children's pain medicine because it is largely unavailable here.
- moistly 4y ago
  A temporary supply chain issue, versus a systemic healthcare issue. Really not comparable.

rufus_foreman 4y ago

Human insulin is available without a prescription for around $25 a vial at Walmart. That is what most diabetics would have used 20 years ago before the drug companies developed analog insulin versions that are easier to use. Analog insulin is available with a prescription for around $75 a vial at Walmart. About 1 in 7 Walmart shoppers have diabetes.

swores 4y ago
That's still ridiculously expensive, no? edit: yes, seems it is indeed - https://news.ycombinator.com/item?id=33572721 https://news.ycombinator.com/item?id=33572721
- harimau777 4y ago
  I don't know if it's accurate, but this suggests that on average, diabetics use 2-3 vials per month. So that would be $50 to $75 a month. However, it also mentions that some people need 50-60 units per meal and a vial contains 1000 units. Assuming three meals per day, someone using 50 vials per meal would spend $666.66 per month. $666.66 per month would be prohibitively expensive for many people and even $50 to $75 could be a significant expense for people making minimum wage (depending on local minimum wage it could be equivalent to 7-8 hours of work before taxes). https://4allfamily.com/blogs/diabetes/how-long-does-a-vial-of-insulin-last https://4allfamily.com/blogs/diabetes/how-long-does-a-vial-o...
  - chewbacha 4y ago
    50 units per dose would be 20 doses per vial. 3 meals a day * 30 days would be 90 meals. 90 meals / 20 doses / 1 vial = 4.5 vials / month 4.5 * 25 = 112.5 I’m not seeing how we get to $666
    - clnq 4y ago
      More context: the insulin dose diabetics take with meals is called a bolus dose. However, cells in the human body need glucose uptake constantly, 24 hours a day. So T1 diabetics also have to take a basal insulin dose either once daily as an injection or continuously on a pump. In addition to that, diabetics need to take correction bolus doses to lower their blood glucose when it's high not as a result of a meal, and sometimes they have snack or meals other than just the 3 meals a day. The basal and bolus ratio is around 50% : 50% for some people, although it depends on their doctor and a lot of different factors. So, to recap - there are food boluses, correction boluses, and basal doses. Here's how I would do the math: 50 units per dose x 3.5 meals on average x 2 for basal = 350 units a day. Or 0.35 vial per day, and 10.7 vials per month. Assuming synthetic human insulin and not insulin analogue is used, that means about $270 per month. However, some caveats: - synthetic human insulin is not fast enough for most carbohydrates in meals, and it results in higher blood glucose spikes immediately after a meal than using an insulin analogue. The higher the blood glucose, the more insulin it takes to lower it the same amount. Moreover, we only have so many hours in the day, and slower acting synthetic human insulin needs time to work. So people using it are more likely to "overcompensate" and then eat a bit later to offset their dose. This is a very long-winded way of saying that a person might need slightly more synthetic human insulin than analogues, plus synthetic human insulin in general is less effective. - In my calculations, I did not include correction bolus doses, insulin used to prime needles, and pump infusion sets (although probably very few people use human synthetic insulin in pumps anyways). I also did not include insulin that is spoiled in some way (refrigerator breakdowns, reserve insulin taken on trips that's not refrigerated, heatwaves, and so on). - Most people use between 70 and 110 units of insulin per day, whether that's a combination of an insulin analogue and basal insulin injections, or using insulin analogue in a pump. I don't know how much synthetic human insulin is used per day on average, probably a bit more. So I would say in practice, for someone who uses that much synthetic human insulin, the cost can be even $400 per month. For analogues, it would be much, much higher. I think it makes sense for me to provide a source for all this - I care for someone with T1 diabetes and am somewhat connected with the broader T1 community.
clnq 4y ago
Analogues are not only easier to use, but also allow for regimens and therapies (such as insulin pump therapy) that somewhat improve life expectancy and significantly improve quality of life. The relatively inelastic demand of insulin analogues when synthetic human insulin is available shows how important analogues are to T1 diabetics. Sometimes pharma companies try to allude to analogues being a luxury good compared to synthetic human insulin. But to T1 diabetics this notion is generally ridiculous. Analogue insulins allow them to regain a little bit more quality of life lost to the disease, and that should be a human right when insulin manufacturing costs are so low.

tomohawk 4y ago

notwedtm 4y ago
What a weird take. Are you saying that if these for-profit corporations didn't charge absurd amounts to US citizens, then the drug would be unattainable for Canadians?
likecarter 4y ago
No, it's because our government negotiates on behalf of all Canadians. And we are a very big healthcare market (even with a small population) since we all participate in the health care system – since it's public.
- dboreham 4y ago
  Is that meaningfully different from price controls? US government also represents a huge proportion of the demand but is banned through corruption from exercising similar price pressure.
  - harimau777 4y ago
    Doesn't that go both ways? Eli Lilly is a huge organization negotiating in favor of higher prices, so it makes sense that a huge organization (i.e. the government or insurance companies) would be needed to negotiate against them. Even if there is a power imbalance between Eli Lilly and the Canadian Government, there would also be a power imbalance if it was instead Eli Lilly vs. individual consumers.
    - bart_spoon 4y ago
      Eli Lilly actually doesn’t negotiate for higher prices. I’ve had somewhat more insight than the average person into how the dynamics of the insulin pricing work, and it’s a total abomination, largely born out of a lack of a universal public insurance option in the US. Despite the skyrocketing costs of insulin over the decades, Eli Lilly’s profits per unit are mostly in line with inflation. This is because in the US system, there is a pervasive system of rebates that exists between pharmaceutical companies and insurers. Insurers often may only pay 10% of what the sticker price is for insulin. But the way these rebates get negotiated through third party firms known as PBMs create a system that incentivizes insulin that is marked up an incredible amount and then discounted to X, than simply pricing it at X in the first place. But this obviously screws over anyone without access to the rebate, i.e. those without insurance. And this system largely exists because the privatized nature of insurance in the US. If there was some kind of universal medicare in the US, undermines those incentives and the market would normalize immediately.

Naga 4y ago

On the other hand, now Canadians drive to the United States to buy children's pain medicine because it is largely unavailable here.

moistly 4y ago
A temporary supply chain issue, versus a systemic healthcare issue. Really not comparable.