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Insulin is way too expensive. California has a solution: Make its own

241 points by victormours 4y ago

monsterofcookie 4y ago
What about banning sales of food with artificially added sugar? Lol... Nevermind
junofan 4y ago
> because of the Senate’s arcane rules, they could not establish the same cap for private insurance It looks like one party tried to get this done in reconciliation. If so, blaming “arcane rules” is slanted and makes me wonder what other information the author is twisting.
- tonetheman 4y ago
  To be clear about it hnews does not like politics but it was blocked by Republicans. https://www.axios.com/2022/08/07/insulin-price-cap-reconciliation https://www.axios.com/2022/08/07/insulin-price-cap-reconcili... There was little reason to block it and it is hard to imagine why they blocked it given how many people it could help. I tried to understand the logic but most everything I read were just out right lies. I have knowledge of this first hand because my wife takes insulin.
  - jrussino 4y ago
    I saw this commend as [dead] and vouched for it, but you should realize that the gripe about "hnews does not like politics" is counter-productive. I do agree that it's on-topic in this particular thread to have a discussion about the merits of policies like this and that can include highlighting the factions that support or oppose them (and the reasons and/or incentives that might be driving that support/opposition).
- HWR_14 4y ago
  The rules of reconciliation are indeed arcane. There is a Senate Parliamentarian who makes calls on interpretations because the details are so convoluted. Sure, at a high level it's simple. But so is "crawl the internet, make a database and match keywords from requests to a ranked list of results."
  - ceejayoz 4y ago
    > There is a Senate Parliamentarian who makes calls on interpretations Sorta. They can be fired at will (https://www.washingtonpost.com/archive/politics/2001/05/08/key-senate-official-loses-job-in-dispute-with-gop/e2310021-0f14-4667-a261-54e6c033207c/ https://www.washingtonpost.com/archive/politics/2001/05/08/k...) and they're making advisories, which the Senate can just... overrule.
    - Kon-Peki 4y ago
      If the parliamentarian is "overruled" for political reasons, the likely outcome is that the Senate grinds to a halt, not that the majority party gets to pass desired legislation that otherwise wouldn't pass. The job of the parliamentarian is to interpret the rules and give advice about what is allowed and what is not. Sure, they can be wrong. But if you don't like the rules, change them. Because any self-governing body that isn't following its own rules isn't actually operating. Any legislation the Senate "passes" in violation of its own rules doesn't actually exist. It's an exercise in futility. Both Democrats and Republicans understand this and both parties value an impartial parliamentarian as an asset. It's a job created out of need: > Charles Watkins had arrived in the Senate in 1904 from Arkansas to work as a stenographer. Blessed with a photographic memory, and a curiosity about Senate procedures, he eventually transferred to the Senate floor as journal clerk. In 1919 he started what became a 45-year search of the Congressional Record, back to the 1880s, for Senate decisions that interpreted the body’s individual standing rules to the legislative needs of the moment. > In 1923 Watkins replaced the ailing assistant secretary of the Senate as unofficial advisor on floor procedure to the presiding officer. From that time, he became the body’s parliamentarian, in fact if not in title. Finally, in 1935, at a time when an increased volume of New Deal-era legislation expanded opportunities for procedural confusion and mischief, he gained the actual title. https://www.senate.gov/about/officers-staff/secretary-of-the-senate/first-official-parliamentarian.htm https://www.senate.gov/about/officers-staff/secretary-of-the...
- advisedwang 4y ago
  The reason private insurance was excluded from the bill was because of the "Byrd Rule". The senate parliamentarian gets to rule on and decides it unilaterally. The only reason to do it in reconciliation in the first place is because of the filibuster. I would say that whole combination is pretty arcane.
  - frgtpsswrdlame 4y ago
    To be clear, the parliamentarian is only an advisory role, they don't get to rule or decide anything, only offer guidance which senators then choose to listen to. But they could ignore it (and have done so in the past) or can fire the parliamentarian and pick a new one which is more likely to advise in the way that they want (and have done so in the past.)
    - advisedwang 4y ago
      It's not the senate generally that is taking the parlimentarian's advice in this case, but the presiding officer, who does get to unilaterally decide (although the have some options). See 2 USC 641(d) for it being out of order and Senate rule XX for how those are decided (which is surprisingly flexible, as you hit). Or for a more readable source: https://www.cbpp.org/research/federal-budget/introduction-to-budget-reconciliation https://www.cbpp.org/research/federal-budget/introduction-to... But the fact that we're even discussing this shows that the article is pretty reasonable in calling this arcane.
skybrian 4y ago
> The state is taking a two-phase approach. In the short term, California has put out a request for proposals from existing enterprises that could produce generic insulin for the state as a subcontractor in the next few years in order to try to deliver relief as soon as possible. [...] > But in the long term, the plan is for a government factory operated by government workers producing government-owned medication. The state would have its own public production facilities, staffed by civil workers, which would sell generic insulin for the same cost needed to produce it, plus perhaps a small percentage to cover auxiliary costs for the program. > The $100 million in funding is split evenly between the short and long term. But that long-term vision will take time. Even if the state were to retrofit an existing factory for insulin production, that construction work could take years, as would hiring a workforce to oversee it. Once production is up and running, California would need to hit more targets — most importantly producing a product that the FDA says is interchangeable with existing insulin medications. That second phase is certainly ambitious. Putting it out for bid would be the more normal government process. It will be interesting to see what happens.
- iibarea 4y ago
  Newsom structures things like this a lot, and the more ambitious part almost never happens. I think this is mostly about running for president and creating a talking point, call me cynical but I don't think anyone expects Ca to directly run drug manufacturing.
pastacacioepepe 4y ago
[flagged]
- msla 4y ago
  This isn't Socialism, it's the Welfare State, which was created to deflate Socialism: https://en.wikipedia.org/wiki/Otto_von_Bismarck https://en.wikipedia.org/wiki/Otto_von_Bismarck > A master of complex politics at home, Bismarck created the first welfare state in the modern world, with the goal of gaining working class support that might otherwise go to his socialist opponents.
- unethical_ban 4y ago
  This tone is not useful, I say this as someone who supports this move. The best time to do the right thing is yesterday, the second best is today.
- MisterBastahrd 4y ago
  [flagged]
  - skyyler 4y ago
    Could someone against the idea of providing food for children at school explain their position? I'm interested to hear why you think children should go hungry if their parents don't give them cash to bring to school.
    - HarryHirsch 4y ago
      The keyword is "immanent justice" and its twin sister "unconditional grace". Bad things happen to those who deserve them, and also, since bad things do not happen to you you are counted amongst the good guys and are visibly favoured by the Lord God who looks out for his own. If that sounds sick in the head, that's because it is.
    - XMPPwocky 4y ago
      I think I can do a decent job of steel-manning this- I might be a bit unfair because I think it's rather morally reprehensible and deeply harmful (and also suspect these are only the stated motives of folks pushing this idea), but I can try. Everybody generally agrees children going hungry is bad. What we're really arguing about is whether the government should be spending taxpayer funds on feeding them. In fact, because the overwhelming majority of people see child hunger as bad, private charity would step in to feed those kids who aren't fed by the state. This is better in two ways: first, it's more voluntary (instead of "donations" being compelled by force), and second, private (market-driven) charity can be more efficient than a state monopoly. So it's not that kids should go hungry, and I (n.b. this is me in-character!) am a bit surprised that you think I seriously believe that. Rather, kids necessarily go hungry if nobody feeds them, and the debate (OOC: note i'm deliberately reframing the harm here as a natural thing!) is really over who should step in if the parents, the natural caretakers, aren't able to support their child. Should the government use taxpayer funds to do so, or is voluntary charity a better option for everybody? Additionally, there's a moral hazard here where the state effectively subsidizes having kids that a parent might not be able to take care of on their own.
kwhitefoot 4y ago
Perhaps the drug cartels should get involved.
- deleted 4y ago
  [deleted]
ErikVandeWater 4y ago
> States have become more ambitious in their policies for tackling the insulin affordability crisis because the scale of the problem continues to grow and the federal government seems capable of taking only limited action to address it. As if the federal government isn't the one causing the shortage in the first place.
- genderwhy 4y ago
  [Citation very much needed]
  - bhawks 4y ago
    The article directly explains this. # 1 competition works > When a company develops a new drug, it gets a period of exclusivity, 10 years or more, in which it is the only one able to make or sell that drug. But after that exclusivity period has passed, other companies can make a carbon copy and sell it at a lower price. Studies find that once several generic competitors come on the market, prices drop significantly. # 2 big pharma has hacked regulations for prescription drugs, medical devices and generic replacement to prevent losing federal government granted monopolies. > But pharma companies are savvy about finding ways to extend their monopolies, with insulin and other drugs, by making minor tweaks to the chemical compound and asking for a patent extension. In the case of insulin, the companies can also modify the delivery device to protect their market share. Each product is meant to be used with specific, company-designed injectors. This is a government created problem.
    - genderwhy 4y ago
      Thanks. That's the opposite (the government is protecting corporate interests too much) of what the usual "It's the feds fault" usually implies.
      - ChadNauseam 4y ago
        What does it usually imply?
yonran 4y ago
I listened to the Vox The Weeds podcast interviewing the same author and was frustrated that his many explanations seemed disconnected. Since old insulin patents have expired, is it that you are allowed to buy generic insulin but there are no manufacturers, or that you not allowed to buy generic insulin because recent advancements are so good that doctors won’t prescribe the old stuff anymore? And no one will make generic insulin because the brand-name companies will undercut them and there are so many kinds you need to make, but basically a $100 million donation to the world by California will fix all that?
- rayiner 4y ago
  > Since old insulin patents have expired, is it that you are allowed to buy generic insulin but there are no manufacturers, or that you not allowed to buy generic insulin because recent advancements are so good that doctors won’t prescribe the old stuff anymore? Walmart sells human insulin (the previous gen stuff) for $25/vial. It’s manufactured by Novo Nordisk. It’s what was regularly prescribed in the 1990s. It has downsides, such as requiring a strict eating schedule: https://diabetesstrong.com/walmart-insulin/ https://diabetesstrong.com/walmart-insulin/ Most doctors today prescribe human analog insulin. They do this because it is better at controlling blood sugar without requiring strict eating schedules.
- dmreedy 4y ago
  You are allowed to buy generic/affordable "older" varieties of insulin. It can be got at Walmart for $25 per vial. It is a "regular insulin" as opposed to the more modern insulin analogs; a functional but inferior technology that requires a very restrictive and rigid diet, as opposed to modern combinations of fast and slow acting analogs that allow for something closer to a "normal", albeit carb-cautious diet. It will, to quote my endocrinologist, "keep you alive". It is not part of a modern regimen for a Type 1 Diabetic. My understanding is that it is manufactured by Novo Nordisk, the makers of more modern, name-brand insulins, as well (they make the fast-acting insulin aspart called Novolog that I take as part of my own regimen). For further reference: https://diabetesstrong.com/walmart-insulin/ https://diabetesstrong.com/walmart-insulin/
  - 4y ago
ZeroGravitas 4y ago
Seems to be a weirdly US specific problem: https://worldpopulationreview.com/country-rankings/cost-of-insulin-by-country https://worldpopulationreview.com/country-rankings/cost-of-i...
- aidenn0 4y ago
  Good thing California is in the US, or this might be a waste of time.
- outworlder 4y ago
  Drug costs in general are jacked up in the US. Insurance will "negotiate" but ends up paying anyway. No insurance, you pay the full price. Insulin is cheap. My brother gets his from the Brazilian government, no charge and no proof of income(it is a life-saving medication and you already pay your taxes). If you want more "convenience" (receive at home, not wait in line, etc), you can go to a pharmacy and pay. Costs maybe $20 for a month's supply of brand name long acting insulin (less if you are low income, even less if you have some forms of private insurance). The Brazilian government also highly incentivizes generics vs brand names, doctors will often prescribe by the active ingredient unless there's a very specific reason to go to a particular brand. It has threatened to break patents (and done so on occasion) of companies that overcharge for essential medication (https://www.reuters.com/article/us-merck-brazil/brazil-bypasses-patent-on-merck-aids-drug-idUSN0435172120070504 https://www.reuters.com/article/us-merck-brazil/brazil-bypas...) There is absolutely no way insulin costs should be as high as they are. Walmart survives with a 3% profit margin but somehow we allow pharmaceutical companies to charge about whatever they want. It's not 'high tech' anymore, despite minor improvements by Lilly and friends to keep the patents alive. Related: US health care costs (global is following) are also higher than they should because of the food industry. They will push their sugar heavy processed crap worldwide, but in the US they use high fructose corn syrup. For decades fructose was erroneously pushed to diabetics because fructose doesn't raise insulin levels. What it does do it cause metabolic syndrome, ultimately leading to obesity, type-2 diabetes, and there are links to cancer and even a growing number of publication linking to Alzheimer's and dementia in general. 88% of Americans have some sort of metabolic dysfunction(https://www.ksl.com/article/50332891/88-of-americans-are-metabolically-unhealthy-says-utah-scientist-heres-what-to-do-about-it https://www.ksl.com/article/50332891/88-of-americans-are-met...). We tend to shame people and say that they are pre-diabetic, obese or what have you because they are lazy and over eat. That's untrue. You can't outrun a bad diet. People will try to "eat healthy" and eat a bowl of cereal because companies say it's good for you. It is not. They will cut fat (and end up eating more carbs) because they have been told (by the food industry) that fat is bad. It is not, sugar and highly processed foods are. They feed people bad information(a calorie is a calorie) and then shame people for not "taking care of themselves", all the while polluting geniune research that contradicts them. It's terrible.
bhawks 4y ago
Big pharma has totally pwnd the regulations the government enforces on the prescription drug market ensuring they have monopoly pricing power. Why wait for CA to spin up it's own insulin manufacturing industry - just do not prosecute the import/manufacturing and resale of insulin - like it did for medical marijuana in the 90s?
- smt88 4y ago
  Manufacturing in the US is better for the US economy and looks much better if you're someone trying to get re-elected.
  - vkou 4y ago
    That's second fiddle to the real reason for why we're in the current state of affairs - fleecing the public is much better for the vendors, and it's much better for a politician trying to get re-elected to go along with it. "Domestic manufacturing" is just a talking point to fig-leaf the real goal.
mgarfias 4y ago
Ok. What KIND of insulin? The old school stuff sux
- LarryMullins 4y ago
  AFAIK the old school stuff (e.g. synthetic human insulin) is cheap, so I assume that's not the sort they're talking about. Probably they're talking about analogue insulin, which is very expensive.
Gene5ive 4y ago
How do people live with themselves charging 20 times the production cost of an essential medicine?
- bhawks 4y ago
  They make pills for that :)
- yumraj 4y ago
  Same way people live with themselves working for an Ad companies that tracks people, and social media companies, and every other kind of business that is considered unethical by vast majority of people - by looking at their bank balance and being in denial about the harm they are causing. One should look at their own employers and see if everything they are doing is ethical. NOTE: just making a point, I don’t condone what these companies are doing
- favaq 4y ago
  Let's not pretend almost all diabetics didn't get in that situation themselves.
  - bhawks 4y ago
    1.4 million people in the us alone would disagree with you. Type 1 diabetes has nothing to do with diet it is an autoimmune disease with genetic and possible environmental antecedents. If you're interested in learning more about type 1 diabetes please check out: https://www.jdrf.org/t1d-resources/about/facts https://www.jdrf.org/t1d-resources/about/facts
    - mhb 4y ago
      "More than 37 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them have type 2 diabetes." https://www.cdc.gov/diabetes/basics/type2.html https://www.cdc.gov/diabetes/basics/type2.html
      - 4y ago
rayiner 4y ago
Reflecting a common theme in our healthcare system, the problem of insulin costs is very unevenly distributed: https://www.healthsystemtracker.org/brief/out-of-pocket-spending-on-insulin-among-people-with-private-insurance https://www.healthsystemtracker.org/brief/out-of-pocket-spen.... About 3 in 4 enrollees in ACA plans that use insulin pay $35/month or less out of pocket. For people with private insurance, 4 in 5 pay $35/month or less. The biggest problem seems to be too many plans, too many choices, and too many ways to fall through the cracks.
- aqme28 4y ago
  Is the $35 the amount the patient pays, or is it the total amount paid for the insulin? It's still a despicable racket if the patient only pays $35, but the insurance company is paying $500.
  - jjk166 4y ago
    Yeah, it's important to note that all the money the insurance company pays for medicine is still coming from you and other policy holders, it's just in the form of a predictable monthly policy plan instead of a possibly very large unexpected bill. If the drugs were cheaper, you could get a cheaper insurance plan that offered the same quality of coverage. So extremely high insulin prices hurt you even if you personally don't take insulin.
- dmreedy 4y ago
  I think a part of the trick here too is that this report does not appear to discriminate between Type 1 (where insulin is required, and the amount required varies significantly and often increases with age) and Type 2 (where insulin, if it is required at all, is often required less). Folks in the Type 1 boat are in a much rougher place without insurance than the far larger, and growing, population of Type 2s. And I imagine, skew any reporting that does not make the discrimination between the two. (This all intended as a supplement to your very good point)
- legitster 4y ago
  Also, no one is paying sticker price. When I was uninsured I often payed less out of pocket costs for care and medicine because so many automatic discounts kicked in.
toomanyrichies 4y ago
Reading these comments, I learned about human analog insulin and how it's considered more modern than older, off-patent versions. I was wondering about human analog insulin's patent status, and from here [1] I learned about the practice of patent ever-greening.[2] TL;DR: "Evergreening is any of various legal, business, and technological strategies by which producers (often pharmaceutical companies) extend the lifetime of their patents that are about to expire in order to retain revenues from them. Often the practice includes taking out new patents (for example over associated delivery systems or new pharmaceutical mixtures), or by buying out or frustrating competitors, for longer periods of time than would normally be permissible under the law." A relevant quote from the Wikipedia article: "In one study of the prescription drug market, Feldman found that 78% of new patents associated with prescription drugs were for existing drugs." Depressing AF... 1. https://www.t1international.com/blog/2019/01/20/why-insulin-so-expensive https://www.t1international.com/blog/2019/01/20/why-insulin-... 2. https://en.wikipedia.org/wiki/Evergreening https://en.wikipedia.org/wiki/Evergreening
thesausageking 4y ago
Walmart now sells Novo Nordisk produced insulin for $17 per pen[0]. I have a hard time believing California will do it cheaper than that. [0] https://www.walmart.com/cp/relion-diabetic-care/3769564 https://www.walmart.com/cp/relion-diabetic-care/3769564
- j_walter 4y ago
  I thought that insulin was the rapid one and not the long lasting one. I think a lot of people had put themselves into diabetic shock by using that one instead of the one they needed...because it was cheap. https://theconversation.com/why-telling-people-with-diabetes-to-use-walmart-insulin-can-be-dangerous-advice-125528 https://theconversation.com/why-telling-people-with-diabetes...
  - dmreedy 4y ago
    This is the more modern insulin analog, insulin aspart (sold branded as "Novolog"). It is fast acting, and has a different treatment approach than traditional human "regular" insulin. Using it incorrectly or recklessly definitely risks a hypoglycemic incident, which can be fatal. Selling this under the ReliOn brand is new, and it is relatively affordable compared to the sticker prices for the branded versions (upwards of $300 for a box of 5 pens, vs. the $73 walmart is offering) Walmart also sells, and has for a while, "regular" human insulin under their "ReliOn" brand, which is $25/vial. This is an older style of insulin, less flexible and reactive, and requires a more restrictive lifestyle to make it work . Not following this restrictive diet schedule and rules can put you at risk of a hypoglycemic incident, which can be fatal. There are other kinds of insulin analogs, including a "slow acting" variety called insulin glargine (sold under the brand names Basaglar, Lantus, etc). It serves to smooth the overall curve of blood sugar on a given day. My own treatment regime includes both insulin aspart and insulin glargine. I do not believe Walmart sells any insulin glargine (yet?) For what it's worth, as an additional piece of information, a Continuous Glucose Monitor (CGM) is another modern tool in the treatment arsenal. They are also incredibly expensive, especially without insurance, but have saved my life several times when I made mistakes or just had bad luck with a dose of insulin aspart, and went very low. Being able to see myself starting to go low, rather than simply reacting when it is too late and I am already affected, is a significant aid.
ggreer 4y ago
Insulin is expensive for the same reasons that epi pens are expensive[1] and why Martin Shkreli could increase the price of Daraprim by 50x without worrying about losing market share[2]. The FDA restricts the manufacture and importation of these drugs. Often there is only one manufacturer who has managed to jump through all the bureaucratic hoops, giving them a monopoly on the drug. 1. https://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/ https://slatestarcodex.com/2016/08/29/reverse-voxsplaining-d... 2. https://slatestarcodex.com/2015/09/24/the-problems-with-generic-medications-go-deeper-than-one-company/ https://slatestarcodex.com/2015/09/24/the-problems-with-gene...
jerlam 4y ago
California governor Newsom announced this plan seven months ago: https://news.ycombinator.com/item?id=32021868 https://news.ycombinator.com/item?id=32021868 (216 comments) I clicked on the Vox link, hoping to see an update. There wasn't one, although I'm guessing that the 2022 announcement was about the budget being approved and now in 2023, they just started writing an RFP.
asow92 4y ago
If we are making our own insulin, can we also take steps to prevent insulin resistance, pre-diabetes, and diabetes while we're at it?
genderwhy 4y ago
This is great news. Honestly, I hope to see more nationalization of widely used services (or whatever the equivalent word for nationalization is at state or municipal levels.) Municipal broadband, power, roads, schools, post, housing, and healthcare? It's long overdue, and with an appropriate amount of funding has been shown to be effective at controlling costs and delivering moderately good quality in most cases. A lot of things get so warped by profit motive. And there are places I want a profit motive, but insulin (and healthcare generally) isn't one.
- AnEro 4y ago
  Honestly though some industry's products/services verifiably don't improve end user/customer experiences from maximizing profits. It's hard not to see it at this point
  - SuoDuanDao 4y ago
    It makes sense that to improve end user experience you need competition. Works great in restaurants. Anywhere with network effects (utilities) or legal barriers to entry (healthcare) doesn't tend to compete away poor results.
- rayiner 4y ago
  > Municipal broadband, power, roads, schools, post, housing, and healthcare? It's long overdue, and with an appropriate amount of funding has been shown to be effective at controlling costs and delivering moderately good quality in most cases. Where? The US has among the highest percentage of kids going to government owned and operated schools. We have plenty of government housing as well (projects). Nearly all of our roads and transit systems are publicly owned and operated too. Almost uniformly, those government operated systems aren’t very good—in America. And it doesn’t have to do with “funding.” If you compare with Europe, we spend more money per student, per transit rider, and per public housing resident, etc.
  - miguelazo 4y ago
    There are many causes of lackluster public education, and funding is definitely one of them. Another huge one is the ability of parents who have the time and resources to divert their children (likely already at a huge advantage) to private and charter schools, thereby skewing the public school below the median in a vicious circle. I’ve seen this exact dynamic play out in many of the cities I have lived. It’s also why newer suburbs (avoiding legacy costs and filled with upwardly mobile, resourced families) have excellent public schools.
debacle 4y ago
America's reluctance to "socialize" things has created a nightmare with our infrastructure + social utility system. I hope this is done well.
r3trohack3r 4y ago
> Though insulin generally costs less than $10 per dose to produce, some versions of the drug have a list price above $200. This is in part because, in the US, a warped market has allowed three companies to dominate the insulin business. > With California leading the way, a handful of states are considering trying to disrupt the market for essential medications, starting with insulin. The plan would be to manufacture and sell insulin themselves for a price that is roughly equivalent to the cost of production. I feel like I'm missing something here. My understanding of why insulin is so expensive: laws are created and enforced by the government preventing people from competing in the space. If you try to make your own insulin, and you take it to market with 3rd party analysis and certification of it being medical grade (and safe) insulin, you'll start seeing an escalation of the state against you. First angry letters from lawyers and eventually, if you continue head strong and ignore everyone telling you to stop, government officials (possibly with guns) will come and forcibly shut you down. Is California just going to ignore these laws? How will the state not be liable for damages when individuals are? I'm all in favor of revoking the legal structures that pick the winners in this market. It seems like there are plenty of people passionate in this space that would/could make insulin at near-cost if permitted to. It's just that, by my understanding, it's the government that doesn't permit them to. It's weird that people in the government (at the state level) are stepping in to do what people in the government (at the federal, but possibly also the state level?) won't let people in the market do. Edit: substituting “intellectual property laws” with “laws” as it seems there’s more to it than just IP.
- rayiner 4y ago
  > I don't understand. My understanding of why insulin is so expensive: intellectual property laws are enforced by the government preventing businesses without that intellectual property to compete in the space. That’s not an accurate understanding of intellectual property specifically. Insulin isn’t like a pill, where once you have a chemical formula you can make millions of them very cheaply. It’s a biologic, an artificial hormone. Even leaving aside the patents, it’s very expensive to get approval for a generic biologic (called a biosimilar). That’s why there are few manufacturers of synthetic human insulin, even though that’s out of patent.
mig39 4y ago
This is a failure of the free market. When companies get too big, and no longer compete, they should be regulated. The free market only works when there's a ... free ... market.
- splitstud 4y ago
  [dead]
- BurningFrog 4y ago
  Insulin is hyper regulated in the US. There is no free market for insulin.
  - mig39 4y ago
    Is it significantly cheaper in other jurisdictions? Like Canada?
    - BurningFrog 4y ago
      That's what I've heard, though I don't any data to show. In general all medications are the most expensive in the US, often by a lot. For two main reasons: 1. All other countries are to some extent "free riding" on the US market, and refusing to pay full price. 2. The FDA is doesn't approve a lot of things. So many cheap foreign medications are illegal to import. I heard that many forms of insulin are in this group.
- refurb 4y ago
  You mean the same free market that produces most of the new, innovative drugs we have today? The same free market entities that produced covid vaccines in record time? That free market?
andy_ppp 4y ago
There’s a better solution; regulate, fine and breakup unscrupulous drug companies. Hang on, isn’t insulin pricing the exact sort of thing anti-cartel/anti-competitive laws are meant to prevent?
- refurb 4y ago
  Yes, fining and breaking up companies that spend billions on R&D is a great way to encourage innovation.
  - andy_ppp 4y ago
    This is the same argument that giving money to rich people makes the poor wealthier. There’s no evidence of more innovation in larger companies and in fact very often rent seeking causes these big bloated companies to not take risks or generate new opportunities.
    - refurb 4y ago
      There is a very good reason it was Pfizer who brought the covid vaccine to market first. Decades of experience, thousands of employees who are experts in their own area and the capital to move fast.
jjk166 4y ago
Alternative title: regulatory capture has gotten so bad that we'd rather just start our own big pharma with blackjack and hookers.
- r3trohack3r 4y ago
  I hope this is a DEFCON reference!
fallingfrog 4y ago
For context: the patent on insulin was sold in 1923 to the university of Toronto for one dollar because the inventor felt it was unethical to use this invention to make egregious profits off people who had no alternative. This is 100 year old technology. It's not a manufacturing, regulatory, or technological issue. It's just monopoly pricing and greed.
- coredog64 4y ago
  See comments above for more details on how the expensive insulin being discussed here isn’t the animal-derived insulin isolated 100 years ago
worik 4y ago
Why can California not import Indian I nsulin? I thought thr Indian pharmaceutical industry was well able to make it, why not just buy it?
- basch 4y ago
  So we make a law that says a product's intellectual property is protected and cant be copied. Someone in another country copies it, without paying. Then it's legal to import it? Seems like a very roundabout way when we could just ignore intellectual property laws directly, at home. The same applies to "importing things from Canada." Why the ruse?
  - worik 4y ago
    > So we make a law that says a product's intellectual property is protected and cant be copied It is out of patent.
    - basch 4y ago
      What is? All the modern expensive insulins have some patent protecting them or have no biosimilar, san one. It's all in the article.
m2f2 4y ago
Finally!!!!!
TEP_Kim_Il_Sung 4y ago
Or just abolish the FDA? They're the ones keeping competitively priced insulin out of the market. https://mises.org/wire/patents-legal-monopolies-and-high-prices-drugs https://mises.org/wire/patents-legal-monopolies-and-high-pri...
- civilized 4y ago
  Yeah, I mean I'm sure there's a complicated story here... but when the market isn't producing some consumer good, I think it's a good idea to check whether there's some root cause we can fix. Not just throw yet another hack on top of the chaos.
  - TEP_Kim_Il_Sung 4y ago
    Make pharmaceutical companies work against each other: Have them check their competition and advertise their competitors' malpractice. Having some faceless government bureaucracy delay that process for decades, just hides the truth from the people who need it most.
- taftster 4y ago
  That's a bit like saying we should defund the police. It's thought provoking and grabs headlines. It even has some merit, but it's ultimately not the solution. Reform the FDA, sure I can support that. The FDA, from my perspective, plays such a huge and important role in our society and showcases the exact things we need from our government. They are an example of a government entity that mostly gets the job done right, an essential part of our livelihood today.
  - hwillis 4y ago
    In 1938, the FDA started reviewing and approving drugs. In 1960, Richardson-Merrell applied for approval for a drug called Thalidomide, a cancer treatment. They had clinical trials that included pregnant women. They were rejected six times. In the UK, The Distillers Company (Biochemicals) Ltd, a subsidiary of Distillers Co. Ltd marketed thalidomide as Distaval, a remedy for morning sickness. Their advertisement claimed that "Distaval can be given with complete safety to pregnant women and nursing mothers without adverse effect on mother or child ... Outstandingly safe Distaval has been prescribed for nearly three years in this country." By 1962, over 10,000 children (most in west germany) were born with crippling disabilities caused by thalidomide. Over 2,000 died. Frances Oldham Kelsey was awarded the medal for Distinguished Federal Civilian Service by President John F. Kennedy for rejecting the drug.
BonoboIO 4y ago
„Alec Smith, died in 2017 because he could not afford the $1,300 out-of-pocket price for his prescription once he was dropped from his parents’ health insurance when he turned 26“ What a reality. I‘m glad that I don’t have a life threatening diseases, but I would do everything that is possible to survive. Steal, rob, fraud to come at least up with the money to survive. I‘m shocked that simply surviving a manageable sickness in a first world country is not a human right.
GrumpyNl 4y ago
Why not just import it from Europe, its around 18 dollars here.
- TheLoafOfBread 4y ago
  That would be competition. Nobody wants that in USA. Ironic huh?
stefantalpalaru 4y ago
[dead]
SecurityMinded 4y ago
Don't believe in Gavin Newsom's new bullshit. Last I heard about this, a Vial of generic insulin was going to be $35. Walmart sells the same insulin (regular or suspended varieties) for $25 It is just a publicity ploy. Even at $25/vial, Walmart insulin has a very nice mark-up. Why buy it from state of CA for a more expensive price tag? To boot all of this, if you do not have health insurance, Walmart sells the insulin to you without prescription. CA? Not so much. I am sick and tired of this quasi-populist sounding stories from California nad other liberal inundated locations.
- everybodyknows 4y ago
  You're doubting the competence of the same government that's bringing Californians a bullet train, some day real soon now? Jeez, what a cynic.
  - daniel-cussen 4y ago
    [dead]
AnthonBerg 4y ago
My fiancée was close to death from a missed diagnosis of Type 1 diabetes. We were extremely lucky that she actually got a diagnosis; A nurse at the oncology ward had a hunch. (Overburdened medical personnel miss diagnoses.) Her HbA1c long-term blood sugar measurement was literally off the charts. Off the chart on the wall on the hospital, right through the red “DANGER” section. She had lost 17% of her bodyweight and half of her hair. We have learned the following: You want a continuous glucose monitor (CGM), and an insulin pump, with rapid-acting insulin. You do not want long-acting insulin. Especially not insulin glargine. It is a dangerous form of insulin: It is injected as a blob of insulin (“bolus”) under the skin. It’s supposed to stay in the place and slowly fritter and diffuse into the bloodstream. This effect is due to crystallization of the modified insulin amino acid chain in the pH level inside the body. It’s clever. However, if insulin glargine happens to go into a blood vessel, it works pretty much instantly. Then it is not long-acting at all. The subcutaneous environment is… living tissue. There are capillaries. It can and will go into directly into the bloodstream at some point. For some reason. At injection time, or due to bumps and jostles and physical pressure. Then there are no brakes on it. 24 hours’ worth of active insulin can go into the bloodstream. Then every cell in the body is signaled hard to pull glucose from the blood – all the flesh in the body rips the sugar out of your blood, leaving too little for the brain. People start losing consciousness in minutes, csn pass out, and may die. Insulin degludec is another long-acting insulin, one which is acceptable in this regard. The bolus stays glommed together due to polymerization of the insulin so it’s more robust. It also has molecular brakes on it kind of – if it does go into the bloodstream, it attaches to albumin in blood plasma and doesn’t become active all at once. However, using rapid-acting insulin in a pump is strictly better because this replicates the insulin oscillation of the pancreas. “[The pancreas’] basal insulin level is not stable. It oscillates with a regular period of 3-6 min. After a meal the amplitude of these oscillations increases but the periodicity remains constant. The oscillations are believed to be important for insulin sensitivity by preventing downregulation of insulin receptors in target cells. Such downregulation underlies insulin resistance, which is common in type 2 diabetes.”—https://en.wikipedia.org/wiki/Insulin_oscillation https://en.wikipedia.org/wiki/Insulin_oscillation The insulin pumps work this way. They pump the insulin with a rhythm. It’s easier to control the blood sugar and you need less insulin. It’s crucially different and much better for long-term health and quality of life. The most important things are a good blood sugar sensor (continuous glucose meter or CGM), and a good pump with a good user interface. We haven’t tried one of the closed-loop automatically controlled pumps that reads from the sensor and autoadjusts, but it’s clear from the problems people have with badly designed pump that a good “semiautomatic” pump is better than a poor and unpredictable sensor-feedback-controlled automatic one. These have issues like sometimes cutting out without giving clear warning if blood sugar is high, and the blood sugar target range can’t be adjusted low enough (liability issues afaik) so people tend to stay at too high blood sugar levels which do long-term harm. I do assume that a good automatic pump is magic. Also, glucose metabolism and inflammation are intimately related, which ties into the vascular system. There is a lot more actionable science out on this than most doctors are aware of. (Overburdened medical personnel are unable to keep abreast of scientific developments.)
black_13 4y ago
[dead]
diebeforei485 4y ago
What exactly is California planning to make? The generic version is already available for $25-$30. Why does the state need to get into the manufacturing business?

241 points by victormours 4y ago

What about banning sales of food with artificially added sugar? Lol... Nevermind

> because of the Senate’s arcane rules, they could not establish the same cap for private insurance It looks like one party tried to get this done in reconciliation. If so, blaming “arcane rules” is slanted and makes me wonder what other information the author is twisting.

tonetheman 4y ago
To be clear about it hnews does not like politics but it was blocked by Republicans. https://www.axios.com/2022/08/07/insulin-price-cap-reconciliation https://www.axios.com/2022/08/07/insulin-price-cap-reconcili... There was little reason to block it and it is hard to imagine why they blocked it given how many people it could help. I tried to understand the logic but most everything I read were just out right lies. I have knowledge of this first hand because my wife takes insulin.
- jrussino 4y ago
  I saw this commend as [dead] and vouched for it, but you should realize that the gripe about "hnews does not like politics" is counter-productive. I do agree that it's on-topic in this particular thread to have a discussion about the merits of policies like this and that can include highlighting the factions that support or oppose them (and the reasons and/or incentives that might be driving that support/opposition).
HWR_14 4y ago
The rules of reconciliation are indeed arcane. There is a Senate Parliamentarian who makes calls on interpretations because the details are so convoluted. Sure, at a high level it's simple. But so is "crawl the internet, make a database and match keywords from requests to a ranked list of results."
- ceejayoz 4y ago
  > There is a Senate Parliamentarian who makes calls on interpretations Sorta. They can be fired at will (https://www.washingtonpost.com/archive/politics/2001/05/08/key-senate-official-loses-job-in-dispute-with-gop/e2310021-0f14-4667-a261-54e6c033207c/ https://www.washingtonpost.com/archive/politics/2001/05/08/k...) and they're making advisories, which the Senate can just... overrule.
  - Kon-Peki 4y ago
    If the parliamentarian is "overruled" for political reasons, the likely outcome is that the Senate grinds to a halt, not that the majority party gets to pass desired legislation that otherwise wouldn't pass. The job of the parliamentarian is to interpret the rules and give advice about what is allowed and what is not. Sure, they can be wrong. But if you don't like the rules, change them. Because any self-governing body that isn't following its own rules isn't actually operating. Any legislation the Senate "passes" in violation of its own rules doesn't actually exist. It's an exercise in futility. Both Democrats and Republicans understand this and both parties value an impartial parliamentarian as an asset. It's a job created out of need: > Charles Watkins had arrived in the Senate in 1904 from Arkansas to work as a stenographer. Blessed with a photographic memory, and a curiosity about Senate procedures, he eventually transferred to the Senate floor as journal clerk. In 1919 he started what became a 45-year search of the Congressional Record, back to the 1880s, for Senate decisions that interpreted the body’s individual standing rules to the legislative needs of the moment. > In 1923 Watkins replaced the ailing assistant secretary of the Senate as unofficial advisor on floor procedure to the presiding officer. From that time, he became the body’s parliamentarian, in fact if not in title. Finally, in 1935, at a time when an increased volume of New Deal-era legislation expanded opportunities for procedural confusion and mischief, he gained the actual title. https://www.senate.gov/about/officers-staff/secretary-of-the-senate/first-official-parliamentarian.htm https://www.senate.gov/about/officers-staff/secretary-of-the...
advisedwang 4y ago
The reason private insurance was excluded from the bill was because of the "Byrd Rule". The senate parliamentarian gets to rule on and decides it unilaterally. The only reason to do it in reconciliation in the first place is because of the filibuster. I would say that whole combination is pretty arcane.
- frgtpsswrdlame 4y ago
  To be clear, the parliamentarian is only an advisory role, they don't get to rule or decide anything, only offer guidance which senators then choose to listen to. But they could ignore it (and have done so in the past) or can fire the parliamentarian and pick a new one which is more likely to advise in the way that they want (and have done so in the past.)
  - advisedwang 4y ago
    It's not the senate generally that is taking the parlimentarian's advice in this case, but the presiding officer, who does get to unilaterally decide (although the have some options). See 2 USC 641(d) for it being out of order and Senate rule XX for how those are decided (which is surprisingly flexible, as you hit). Or for a more readable source: https://www.cbpp.org/research/federal-budget/introduction-to-budget-reconciliation https://www.cbpp.org/research/federal-budget/introduction-to... But the fact that we're even discussing this shows that the article is pretty reasonable in calling this arcane.

skybrian 4y ago

> The state is taking a two-phase approach. In the short term, California has put out a request for proposals from existing enterprises that could produce generic insulin for the state as a subcontractor in the next few years in order to try to deliver relief as soon as possible. [...] > But in the long term, the plan is for a government factory operated by government workers producing government-owned medication. The state would have its own public production facilities, staffed by civil workers, which would sell generic insulin for the same cost needed to produce it, plus perhaps a small percentage to cover auxiliary costs for the program. > The $100 million in funding is split evenly between the short and long term. But that long-term vision will take time. Even if the state were to retrofit an existing factory for insulin production, that construction work could take years, as would hiring a workforce to oversee it. Once production is up and running, California would need to hit more targets — most importantly producing a product that the FDA says is interchangeable with existing insulin medications. That second phase is certainly ambitious. Putting it out for bid would be the more normal government process. It will be interesting to see what happens.

iibarea 4y ago
Newsom structures things like this a lot, and the more ambitious part almost never happens. I think this is mostly about running for president and creating a talking point, call me cynical but I don't think anyone expects Ca to directly run drug manufacturing.

pastacacioepepe 4y ago

[flagged]

msla 4y ago
This isn't Socialism, it's the Welfare State, which was created to deflate Socialism: https://en.wikipedia.org/wiki/Otto_von_Bismarck https://en.wikipedia.org/wiki/Otto_von_Bismarck > A master of complex politics at home, Bismarck created the first welfare state in the modern world, with the goal of gaining working class support that might otherwise go to his socialist opponents.
unethical_ban 4y ago
This tone is not useful, I say this as someone who supports this move. The best time to do the right thing is yesterday, the second best is today.
MisterBastahrd 4y ago
[flagged]
- skyyler 4y ago
  Could someone against the idea of providing food for children at school explain their position? I'm interested to hear why you think children should go hungry if their parents don't give them cash to bring to school.
  - HarryHirsch 4y ago
    The keyword is "immanent justice" and its twin sister "unconditional grace". Bad things happen to those who deserve them, and also, since bad things do not happen to you you are counted amongst the good guys and are visibly favoured by the Lord God who looks out for his own. If that sounds sick in the head, that's because it is.
  - XMPPwocky 4y ago
    I think I can do a decent job of steel-manning this- I might be a bit unfair because I think it's rather morally reprehensible and deeply harmful (and also suspect these are only the stated motives of folks pushing this idea), but I can try. Everybody generally agrees children going hungry is bad. What we're really arguing about is whether the government should be spending taxpayer funds on feeding them. In fact, because the overwhelming majority of people see child hunger as bad, private charity would step in to feed those kids who aren't fed by the state. This is better in two ways: first, it's more voluntary (instead of "donations" being compelled by force), and second, private (market-driven) charity can be more efficient than a state monopoly. So it's not that kids should go hungry, and I (n.b. this is me in-character!) am a bit surprised that you think I seriously believe that. Rather, kids necessarily go hungry if nobody feeds them, and the debate (OOC: note i'm deliberately reframing the harm here as a natural thing!) is really over who should step in if the parents, the natural caretakers, aren't able to support their child. Should the government use taxpayer funds to do so, or is voluntary charity a better option for everybody? Additionally, there's a moral hazard here where the state effectively subsidizes having kids that a parent might not be able to take care of on their own.

kwhitefoot 4y ago

Perhaps the drug cartels should get involved.

deleted 4y ago
[deleted]

ErikVandeWater 4y ago

> States have become more ambitious in their policies for tackling the insulin affordability crisis because the scale of the problem continues to grow and the federal government seems capable of taking only limited action to address it. As if the federal government isn't the one causing the shortage in the first place.

genderwhy 4y ago
[Citation very much needed]
- bhawks 4y ago
  The article directly explains this. # 1 competition works > When a company develops a new drug, it gets a period of exclusivity, 10 years or more, in which it is the only one able to make or sell that drug. But after that exclusivity period has passed, other companies can make a carbon copy and sell it at a lower price. Studies find that once several generic competitors come on the market, prices drop significantly. # 2 big pharma has hacked regulations for prescription drugs, medical devices and generic replacement to prevent losing federal government granted monopolies. > But pharma companies are savvy about finding ways to extend their monopolies, with insulin and other drugs, by making minor tweaks to the chemical compound and asking for a patent extension. In the case of insulin, the companies can also modify the delivery device to protect their market share. Each product is meant to be used with specific, company-designed injectors. This is a government created problem.
  - genderwhy 4y ago
    Thanks. That's the opposite (the government is protecting corporate interests too much) of what the usual "It's the feds fault" usually implies.
    - ChadNauseam 4y ago
      What does it usually imply?

yonran 4y ago

I listened to the Vox The Weeds podcast interviewing the same author and was frustrated that his many explanations seemed disconnected. Since old insulin patents have expired, is it that you are allowed to buy generic insulin but there are no manufacturers, or that you not allowed to buy generic insulin because recent advancements are so good that doctors won’t prescribe the old stuff anymore? And no one will make generic insulin because the brand-name companies will undercut them and there are so many kinds you need to make, but basically a $100 million donation to the world by California will fix all that?

rayiner 4y ago
> Since old insulin patents have expired, is it that you are allowed to buy generic insulin but there are no manufacturers, or that you not allowed to buy generic insulin because recent advancements are so good that doctors won’t prescribe the old stuff anymore? Walmart sells human insulin (the previous gen stuff) for $25/vial. It’s manufactured by Novo Nordisk. It’s what was regularly prescribed in the 1990s. It has downsides, such as requiring a strict eating schedule: https://diabetesstrong.com/walmart-insulin/ https://diabetesstrong.com/walmart-insulin/ Most doctors today prescribe human analog insulin. They do this because it is better at controlling blood sugar without requiring strict eating schedules.
dmreedy 4y ago
You are allowed to buy generic/affordable "older" varieties of insulin. It can be got at Walmart for $25 per vial. It is a "regular insulin" as opposed to the more modern insulin analogs; a functional but inferior technology that requires a very restrictive and rigid diet, as opposed to modern combinations of fast and slow acting analogs that allow for something closer to a "normal", albeit carb-cautious diet. It will, to quote my endocrinologist, "keep you alive". It is not part of a modern regimen for a Type 1 Diabetic. My understanding is that it is manufactured by Novo Nordisk, the makers of more modern, name-brand insulins, as well (they make the fast-acting insulin aspart called Novolog that I take as part of my own regimen). For further reference: https://diabetesstrong.com/walmart-insulin/ https://diabetesstrong.com/walmart-insulin/
- 4y ago

ZeroGravitas 4y ago

Seems to be a weirdly US specific problem: https://worldpopulationreview.com/country-rankings/cost-of-insulin-by-country https://worldpopulationreview.com/country-rankings/cost-of-i...

aidenn0 4y ago
Good thing California is in the US, or this might be a waste of time.
outworlder 4y ago
Drug costs in general are jacked up in the US. Insurance will "negotiate" but ends up paying anyway. No insurance, you pay the full price. Insulin is cheap. My brother gets his from the Brazilian government, no charge and no proof of income(it is a life-saving medication and you already pay your taxes). If you want more "convenience" (receive at home, not wait in line, etc), you can go to a pharmacy and pay. Costs maybe $20 for a month's supply of brand name long acting insulin (less if you are low income, even less if you have some forms of private insurance). The Brazilian government also highly incentivizes generics vs brand names, doctors will often prescribe by the active ingredient unless there's a very specific reason to go to a particular brand. It has threatened to break patents (and done so on occasion) of companies that overcharge for essential medication (https://www.reuters.com/article/us-merck-brazil/brazil-bypasses-patent-on-merck-aids-drug-idUSN0435172120070504 https://www.reuters.com/article/us-merck-brazil/brazil-bypas...) There is absolutely no way insulin costs should be as high as they are. Walmart survives with a 3% profit margin but somehow we allow pharmaceutical companies to charge about whatever they want. It's not 'high tech' anymore, despite minor improvements by Lilly and friends to keep the patents alive. Related: US health care costs (global is following) are also higher than they should because of the food industry. They will push their sugar heavy processed crap worldwide, but in the US they use high fructose corn syrup. For decades fructose was erroneously pushed to diabetics because fructose doesn't raise insulin levels. What it does do it cause metabolic syndrome, ultimately leading to obesity, type-2 diabetes, and there are links to cancer and even a growing number of publication linking to Alzheimer's and dementia in general. 88% of Americans have some sort of metabolic dysfunction(https://www.ksl.com/article/50332891/88-of-americans-are-metabolically-unhealthy-says-utah-scientist-heres-what-to-do-about-it https://www.ksl.com/article/50332891/88-of-americans-are-met...). We tend to shame people and say that they are pre-diabetic, obese or what have you because they are lazy and over eat. That's untrue. You can't outrun a bad diet. People will try to "eat healthy" and eat a bowl of cereal because companies say it's good for you. It is not. They will cut fat (and end up eating more carbs) because they have been told (by the food industry) that fat is bad. It is not, sugar and highly processed foods are. They feed people bad information(a calorie is a calorie) and then shame people for not "taking care of themselves", all the while polluting geniune research that contradicts them. It's terrible.

bhawks 4y ago

Big pharma has totally pwnd the regulations the government enforces on the prescription drug market ensuring they have monopoly pricing power. Why wait for CA to spin up it's own insulin manufacturing industry - just do not prosecute the import/manufacturing and resale of insulin - like it did for medical marijuana in the 90s?

smt88 4y ago
Manufacturing in the US is better for the US economy and looks much better if you're someone trying to get re-elected.
- vkou 4y ago
  That's second fiddle to the real reason for why we're in the current state of affairs - fleecing the public is much better for the vendors, and it's much better for a politician trying to get re-elected to go along with it. "Domestic manufacturing" is just a talking point to fig-leaf the real goal.

mgarfias 4y ago

Ok. What KIND of insulin? The old school stuff sux

LarryMullins 4y ago
AFAIK the old school stuff (e.g. synthetic human insulin) is cheap, so I assume that's not the sort they're talking about. Probably they're talking about analogue insulin, which is very expensive.

Gene5ive 4y ago

How do people live with themselves charging 20 times the production cost of an essential medicine?

bhawks 4y ago
They make pills for that :)
yumraj 4y ago
Same way people live with themselves working for an Ad companies that tracks people, and social media companies, and every other kind of business that is considered unethical by vast majority of people - by looking at their bank balance and being in denial about the harm they are causing. One should look at their own employers and see if everything they are doing is ethical. NOTE: just making a point, I don’t condone what these companies are doing
favaq 4y ago
Let's not pretend almost all diabetics didn't get in that situation themselves.
- bhawks 4y ago
  1.4 million people in the us alone would disagree with you. Type 1 diabetes has nothing to do with diet it is an autoimmune disease with genetic and possible environmental antecedents. If you're interested in learning more about type 1 diabetes please check out: https://www.jdrf.org/t1d-resources/about/facts https://www.jdrf.org/t1d-resources/about/facts
  - mhb 4y ago
    "More than 37 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them have type 2 diabetes." https://www.cdc.gov/diabetes/basics/type2.html https://www.cdc.gov/diabetes/basics/type2.html
    - 4y ago

rayiner 4y ago

Reflecting a common theme in our healthcare system, the problem of insulin costs is very unevenly distributed: https://www.healthsystemtracker.org/brief/out-of-pocket-spending-on-insulin-among-people-with-private-insurance https://www.healthsystemtracker.org/brief/out-of-pocket-spen.... About 3 in 4 enrollees in ACA plans that use insulin pay $35/month or less out of pocket. For people with private insurance, 4 in 5 pay $35/month or less. The biggest problem seems to be too many plans, too many choices, and too many ways to fall through the cracks.

aqme28 4y ago
Is the $35 the amount the patient pays, or is it the total amount paid for the insulin? It's still a despicable racket if the patient only pays $35, but the insurance company is paying $500.
- jjk166 4y ago
  Yeah, it's important to note that all the money the insurance company pays for medicine is still coming from you and other policy holders, it's just in the form of a predictable monthly policy plan instead of a possibly very large unexpected bill. If the drugs were cheaper, you could get a cheaper insurance plan that offered the same quality of coverage. So extremely high insulin prices hurt you even if you personally don't take insulin.
dmreedy 4y ago
I think a part of the trick here too is that this report does not appear to discriminate between Type 1 (where insulin is required, and the amount required varies significantly and often increases with age) and Type 2 (where insulin, if it is required at all, is often required less). Folks in the Type 1 boat are in a much rougher place without insurance than the far larger, and growing, population of Type 2s. And I imagine, skew any reporting that does not make the discrimination between the two. (This all intended as a supplement to your very good point)
legitster 4y ago
Also, no one is paying sticker price. When I was uninsured I often payed less out of pocket costs for care and medicine because so many automatic discounts kicked in.

toomanyrichies 4y ago

Reading these comments, I learned about human analog insulin and how it's considered more modern than older, off-patent versions. I was wondering about human analog insulin's patent status, and from here [1] I learned about the practice of patent ever-greening.[2] TL;DR: "Evergreening is any of various legal, business, and technological strategies by which producers (often pharmaceutical companies) extend the lifetime of their patents that are about to expire in order to retain revenues from them. Often the practice includes taking out new patents (for example over associated delivery systems or new pharmaceutical mixtures), or by buying out or frustrating competitors, for longer periods of time than would normally be permissible under the law." A relevant quote from the Wikipedia article: "In one study of the prescription drug market, Feldman found that 78% of new patents associated with prescription drugs were for existing drugs." Depressing AF... 1. https://www.t1international.com/blog/2019/01/20/why-insulin-so-expensive https://www.t1international.com/blog/2019/01/20/why-insulin-... 2. https://en.wikipedia.org/wiki/Evergreening https://en.wikipedia.org/wiki/Evergreening

thesausageking 4y ago

Walmart now sells Novo Nordisk produced insulin for $17 per pen[0]. I have a hard time believing California will do it cheaper than that. [0] https://www.walmart.com/cp/relion-diabetic-care/3769564 https://www.walmart.com/cp/relion-diabetic-care/3769564

j_walter 4y ago
I thought that insulin was the rapid one and not the long lasting one. I think a lot of people had put themselves into diabetic shock by using that one instead of the one they needed...because it was cheap. https://theconversation.com/why-telling-people-with-diabetes-to-use-walmart-insulin-can-be-dangerous-advice-125528 https://theconversation.com/why-telling-people-with-diabetes...
- dmreedy 4y ago
  This is the more modern insulin analog, insulin aspart (sold branded as "Novolog"). It is fast acting, and has a different treatment approach than traditional human "regular" insulin. Using it incorrectly or recklessly definitely risks a hypoglycemic incident, which can be fatal. Selling this under the ReliOn brand is new, and it is relatively affordable compared to the sticker prices for the branded versions (upwards of $300 for a box of 5 pens, vs. the $73 walmart is offering) Walmart also sells, and has for a while, "regular" human insulin under their "ReliOn" brand, which is $25/vial. This is an older style of insulin, less flexible and reactive, and requires a more restrictive lifestyle to make it work . Not following this restrictive diet schedule and rules can put you at risk of a hypoglycemic incident, which can be fatal. There are other kinds of insulin analogs, including a "slow acting" variety called insulin glargine (sold under the brand names Basaglar, Lantus, etc). It serves to smooth the overall curve of blood sugar on a given day. My own treatment regime includes both insulin aspart and insulin glargine. I do not believe Walmart sells any insulin glargine (yet?) For what it's worth, as an additional piece of information, a Continuous Glucose Monitor (CGM) is another modern tool in the treatment arsenal. They are also incredibly expensive, especially without insurance, but have saved my life several times when I made mistakes or just had bad luck with a dose of insulin aspart, and went very low. Being able to see myself starting to go low, rather than simply reacting when it is too late and I am already affected, is a significant aid.

ggreer 4y ago

Insulin is expensive for the same reasons that epi pens are expensive[1] and why Martin Shkreli could increase the price of Daraprim by 50x without worrying about losing market share[2]. The FDA restricts the manufacture and importation of these drugs. Often there is only one manufacturer who has managed to jump through all the bureaucratic hoops, giving them a monopoly on the drug. 1. https://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/ https://slatestarcodex.com/2016/08/29/reverse-voxsplaining-d... 2. https://slatestarcodex.com/2015/09/24/the-problems-with-generic-medications-go-deeper-than-one-company/ https://slatestarcodex.com/2015/09/24/the-problems-with-gene...

jerlam 4y ago

California governor Newsom announced this plan seven months ago: https://news.ycombinator.com/item?id=32021868 https://news.ycombinator.com/item?id=32021868 (216 comments) I clicked on the Vox link, hoping to see an update. There wasn't one, although I'm guessing that the 2022 announcement was about the budget being approved and now in 2023, they just started writing an RFP.

asow92 4y ago

If we are making our own insulin, can we also take steps to prevent insulin resistance, pre-diabetes, and diabetes while we're at it?

genderwhy 4y ago

This is great news. Honestly, I hope to see more nationalization of widely used services (or whatever the equivalent word for nationalization is at state or municipal levels.) Municipal broadband, power, roads, schools, post, housing, and healthcare? It's long overdue, and with an appropriate amount of funding has been shown to be effective at controlling costs and delivering moderately good quality in most cases. A lot of things get so warped by profit motive. And there are places I want a profit motive, but insulin (and healthcare generally) isn't one.

AnEro 4y ago
Honestly though some industry's products/services verifiably don't improve end user/customer experiences from maximizing profits. It's hard not to see it at this point
- SuoDuanDao 4y ago
  It makes sense that to improve end user experience you need competition. Works great in restaurants. Anywhere with network effects (utilities) or legal barriers to entry (healthcare) doesn't tend to compete away poor results.
rayiner 4y ago
> Municipal broadband, power, roads, schools, post, housing, and healthcare? It's long overdue, and with an appropriate amount of funding has been shown to be effective at controlling costs and delivering moderately good quality in most cases. Where? The US has among the highest percentage of kids going to government owned and operated schools. We have plenty of government housing as well (projects). Nearly all of our roads and transit systems are publicly owned and operated too. Almost uniformly, those government operated systems aren’t very good—in America. And it doesn’t have to do with “funding.” If you compare with Europe, we spend more money per student, per transit rider, and per public housing resident, etc.
- miguelazo 4y ago
  There are many causes of lackluster public education, and funding is definitely one of them. Another huge one is the ability of parents who have the time and resources to divert their children (likely already at a huge advantage) to private and charter schools, thereby skewing the public school below the median in a vicious circle. I’ve seen this exact dynamic play out in many of the cities I have lived. It’s also why newer suburbs (avoiding legacy costs and filled with upwardly mobile, resourced families) have excellent public schools.

debacle 4y ago

America's reluctance to "socialize" things has created a nightmare with our infrastructure + social utility system. I hope this is done well.

r3trohack3r 4y ago

> Though insulin generally costs less than $10 per dose to produce, some versions of the drug have a list price above $200. This is in part because, in the US, a warped market has allowed three companies to dominate the insulin business. > With California leading the way, a handful of states are considering trying to disrupt the market for essential medications, starting with insulin. The plan would be to manufacture and sell insulin themselves for a price that is roughly equivalent to the cost of production. I feel like I'm missing something here. My understanding of why insulin is so expensive: laws are created and enforced by the government preventing people from competing in the space. If you try to make your own insulin, and you take it to market with 3rd party analysis and certification of it being medical grade (and safe) insulin, you'll start seeing an escalation of the state against you. First angry letters from lawyers and eventually, if you continue head strong and ignore everyone telling you to stop, government officials (possibly with guns) will come and forcibly shut you down. Is California just going to ignore these laws? How will the state not be liable for damages when individuals are? I'm all in favor of revoking the legal structures that pick the winners in this market. It seems like there are plenty of people passionate in this space that would/could make insulin at near-cost if permitted to. It's just that, by my understanding, it's the government that doesn't permit them to. It's weird that people in the government (at the state level) are stepping in to do what people in the government (at the federal, but possibly also the state level?) won't let people in the market do. Edit: substituting “intellectual property laws” with “laws” as it seems there’s more to it than just IP.

rayiner 4y ago
> I don't understand. My understanding of why insulin is so expensive: intellectual property laws are enforced by the government preventing businesses without that intellectual property to compete in the space. That’s not an accurate understanding of intellectual property specifically. Insulin isn’t like a pill, where once you have a chemical formula you can make millions of them very cheaply. It’s a biologic, an artificial hormone. Even leaving aside the patents, it’s very expensive to get approval for a generic biologic (called a biosimilar). That’s why there are few manufacturers of synthetic human insulin, even though that’s out of patent.

mig39 4y ago

This is a failure of the free market. When companies get too big, and no longer compete, they should be regulated. The free market only works when there's a ... free ... market.

splitstud 4y ago
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BurningFrog 4y ago
Insulin is hyper regulated in the US. There is no free market for insulin.
- mig39 4y ago
  Is it significantly cheaper in other jurisdictions? Like Canada?
  - BurningFrog 4y ago
    That's what I've heard, though I don't any data to show. In general all medications are the most expensive in the US, often by a lot. For two main reasons: 1. All other countries are to some extent "free riding" on the US market, and refusing to pay full price. 2. The FDA is doesn't approve a lot of things. So many cheap foreign medications are illegal to import. I heard that many forms of insulin are in this group.
refurb 4y ago
You mean the same free market that produces most of the new, innovative drugs we have today? The same free market entities that produced covid vaccines in record time? That free market?

andy_ppp 4y ago

There’s a better solution; regulate, fine and breakup unscrupulous drug companies. Hang on, isn’t insulin pricing the exact sort of thing anti-cartel/anti-competitive laws are meant to prevent?

refurb 4y ago
Yes, fining and breaking up companies that spend billions on R&D is a great way to encourage innovation.
- andy_ppp 4y ago
  This is the same argument that giving money to rich people makes the poor wealthier. There’s no evidence of more innovation in larger companies and in fact very often rent seeking causes these big bloated companies to not take risks or generate new opportunities.
  - refurb 4y ago
    There is a very good reason it was Pfizer who brought the covid vaccine to market first. Decades of experience, thousands of employees who are experts in their own area and the capital to move fast.

jjk166 4y ago

Alternative title: regulatory capture has gotten so bad that we'd rather just start our own big pharma with blackjack and hookers.

r3trohack3r 4y ago
I hope this is a DEFCON reference!

fallingfrog 4y ago

For context: the patent on insulin was sold in 1923 to the university of Toronto for one dollar because the inventor felt it was unethical to use this invention to make egregious profits off people who had no alternative. This is 100 year old technology. It's not a manufacturing, regulatory, or technological issue. It's just monopoly pricing and greed.

coredog64 4y ago
See comments above for more details on how the expensive insulin being discussed here isn’t the animal-derived insulin isolated 100 years ago

worik 4y ago

Why can California not import Indian I nsulin? I thought thr Indian pharmaceutical industry was well able to make it, why not just buy it?

basch 4y ago
So we make a law that says a product's intellectual property is protected and cant be copied. Someone in another country copies it, without paying. Then it's legal to import it? Seems like a very roundabout way when we could just ignore intellectual property laws directly, at home. The same applies to "importing things from Canada." Why the ruse?
- worik 4y ago
  > So we make a law that says a product's intellectual property is protected and cant be copied It is out of patent.
  - basch 4y ago
    What is? All the modern expensive insulins have some patent protecting them or have no biosimilar, san one. It's all in the article.

m2f2 4y ago

Finally!!!!!

TEP_Kim_Il_Sung 4y ago

Or just abolish the FDA? They're the ones keeping competitively priced insulin out of the market. https://mises.org/wire/patents-legal-monopolies-and-high-prices-drugs https://mises.org/wire/patents-legal-monopolies-and-high-pri...

civilized 4y ago
Yeah, I mean I'm sure there's a complicated story here... but when the market isn't producing some consumer good, I think it's a good idea to check whether there's some root cause we can fix. Not just throw yet another hack on top of the chaos.
- TEP_Kim_Il_Sung 4y ago
  Make pharmaceutical companies work against each other: Have them check their competition and advertise their competitors' malpractice. Having some faceless government bureaucracy delay that process for decades, just hides the truth from the people who need it most.
taftster 4y ago
That's a bit like saying we should defund the police. It's thought provoking and grabs headlines. It even has some merit, but it's ultimately not the solution. Reform the FDA, sure I can support that. The FDA, from my perspective, plays such a huge and important role in our society and showcases the exact things we need from our government. They are an example of a government entity that mostly gets the job done right, an essential part of our livelihood today.
- hwillis 4y ago
  In 1938, the FDA started reviewing and approving drugs. In 1960, Richardson-Merrell applied for approval for a drug called Thalidomide, a cancer treatment. They had clinical trials that included pregnant women. They were rejected six times. In the UK, The Distillers Company (Biochemicals) Ltd, a subsidiary of Distillers Co. Ltd marketed thalidomide as Distaval, a remedy for morning sickness. Their advertisement claimed that "Distaval can be given with complete safety to pregnant women and nursing mothers without adverse effect on mother or child ... Outstandingly safe Distaval has been prescribed for nearly three years in this country." By 1962, over 10,000 children (most in west germany) were born with crippling disabilities caused by thalidomide. Over 2,000 died. Frances Oldham Kelsey was awarded the medal for Distinguished Federal Civilian Service by President John F. Kennedy for rejecting the drug.

BonoboIO 4y ago

„Alec Smith, died in 2017 because he could not afford the $1,300 out-of-pocket price for his prescription once he was dropped from his parents’ health insurance when he turned 26“ What a reality. I‘m glad that I don’t have a life threatening diseases, but I would do everything that is possible to survive. Steal, rob, fraud to come at least up with the money to survive. I‘m shocked that simply surviving a manageable sickness in a first world country is not a human right.

GrumpyNl 4y ago

Why not just import it from Europe, its around 18 dollars here.

TheLoafOfBread 4y ago
That would be competition. Nobody wants that in USA. Ironic huh?

stefantalpalaru 4y ago

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SecurityMinded 4y ago

Don't believe in Gavin Newsom's new bullshit. Last I heard about this, a Vial of generic insulin was going to be $35. Walmart sells the same insulin (regular or suspended varieties) for $25 It is just a publicity ploy. Even at $25/vial, Walmart insulin has a very nice mark-up. Why buy it from state of CA for a more expensive price tag? To boot all of this, if you do not have health insurance, Walmart sells the insulin to you without prescription. CA? Not so much. I am sick and tired of this quasi-populist sounding stories from California nad other liberal inundated locations.

everybodyknows 4y ago
You're doubting the competence of the same government that's bringing Californians a bullet train, some day real soon now? Jeez, what a cynic.
- daniel-cussen 4y ago
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AnthonBerg 4y ago

My fiancée was close to death from a missed diagnosis of Type 1 diabetes. We were extremely lucky that she actually got a diagnosis; A nurse at the oncology ward had a hunch. (Overburdened medical personnel miss diagnoses.) Her HbA1c long-term blood sugar measurement was literally off the charts. Off the chart on the wall on the hospital, right through the red “DANGER” section. She had lost 17% of her bodyweight and half of her hair. We have learned the following: You want a continuous glucose monitor (CGM), and an insulin pump, with rapid-acting insulin. You do not want long-acting insulin. Especially not insulin glargine. It is a dangerous form of insulin: It is injected as a blob of insulin (“bolus”) under the skin. It’s supposed to stay in the place and slowly fritter and diffuse into the bloodstream. This effect is due to crystallization of the modified insulin amino acid chain in the pH level inside the body. It’s clever. However, if insulin glargine happens to go into a blood vessel, it works pretty much instantly. Then it is not long-acting at all. The subcutaneous environment is… living tissue. There are capillaries. It can and will go into directly into the bloodstream at some point. For some reason. At injection time, or due to bumps and jostles and physical pressure. Then there are no brakes on it. 24 hours’ worth of active insulin can go into the bloodstream. Then every cell in the body is signaled hard to pull glucose from the blood – all the flesh in the body rips the sugar out of your blood, leaving too little for the brain. People start losing consciousness in minutes, csn pass out, and may die. Insulin degludec is another long-acting insulin, one which is acceptable in this regard. The bolus stays glommed together due to polymerization of the insulin so it’s more robust. It also has molecular brakes on it kind of – if it does go into the bloodstream, it attaches to albumin in blood plasma and doesn’t become active all at once. However, using rapid-acting insulin in a pump is strictly better because this replicates the insulin oscillation of the pancreas. “[The pancreas’] basal insulin level is not stable. It oscillates with a regular period of 3-6 min. After a meal the amplitude of these oscillations increases but the periodicity remains constant. The oscillations are believed to be important for insulin sensitivity by preventing downregulation of insulin receptors in target cells. Such downregulation underlies insulin resistance, which is common in type 2 diabetes.”—https://en.wikipedia.org/wiki/Insulin_oscillation https://en.wikipedia.org/wiki/Insulin_oscillation The insulin pumps work this way. They pump the insulin with a rhythm. It’s easier to control the blood sugar and you need less insulin. It’s crucially different and much better for long-term health and quality of life. The most important things are a good blood sugar sensor (continuous glucose meter or CGM), and a good pump with a good user interface. We haven’t tried one of the closed-loop automatically controlled pumps that reads from the sensor and autoadjusts, but it’s clear from the problems people have with badly designed pump that a good “semiautomatic” pump is better than a poor and unpredictable sensor-feedback-controlled automatic one. These have issues like sometimes cutting out without giving clear warning if blood sugar is high, and the blood sugar target range can’t be adjusted low enough (liability issues afaik) so people tend to stay at too high blood sugar levels which do long-term harm. I do assume that a good automatic pump is magic. Also, glucose metabolism and inflammation are intimately related, which ties into the vascular system. There is a lot more actionable science out on this than most doctors are aware of. (Overburdened medical personnel are unable to keep abreast of scientific developments.)

black_13 4y ago

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diebeforei485 4y ago

What exactly is California planning to make? The generic version is already available for $25-$30. Why does the state need to get into the manufacturing business?