Taming Insulin's Rising Cost

Patient Expert
iStock

Insulin is essential for everyone who has type 1 diabetes, and about one-fourth of people with type 2 diabetes rely on it to control their blood sugar. But recently it has become much more costly.

Irl Hirsch, MD, professor of medicine at the University of Washington School of Medicine, is one of the world’s top experts about diabetes. He also treats patients and has type 1 diabetes himself. He spoke to a large assembly of diabetes professionals in the Grand Ballroom of the Boston Convention and Exhibition Center at the June convention of the American Diabetes Association.

For several years, readers of my articles have written me to complain about the rising cost of insulin. Because I know how expensive that insulin has become, I made sure to hear Dr. Hirsch’s presentation. I represented HealthCentral.com at the entire convention.

The Patent Problem

Dr. Hirsch reviewed the cost of insulin from 1921 when Drs. Frederick Banting and Charles Best discovered it. “In a generous gesture that unfortunately didn’t start a trend, they sold the patent for $1 so that cheap insulin would quickly become available. It worked like a charm: within two years Eli Lilly had sold 60 million units of its purified extract of pig and cow insulin.”

But after 1977 Genentech began to produce the first genetically-engineered, synthetic human insulin. This led to the first “dramatic increase” in the price of insulin. Since 1982 Eli Lilly has marketing it as Humulin.

In 1996 the development of the first insulin analog, lispro, led to another increase in the cost of insulin. Eli Lilly markets lispro as Humalog.

Citing My Article

Here, Dr. Hirsch cited an article that I wrote in 2001, “Is the Cost of Insulin Skyrocketing?” At the time I wrote, the net wholesale cost of a vial of Humalog was $35/vial, while a vial of Humulin was $20.

By 2005, people worldwide were spending more than $7.3 billion for insulin. “But no one could have predicted what would happen over the next decade,” Dr. Hirsch said. By 2013 we were spending $21 billion for it.

Between 2005 and 2015 the cost of a lispro vial went up 264 percent, while a vial of insulin glargine went up 348 percent, and a vial of NPH went up 364 percent. That’s a lot, but other insulins went up even more.

The cost of an aspart pen rose in this 10-year period by 389 percent. And the cost of a vial of U-500 regular insulin jumped a staggering 508 percent.

Price Fixing?

Dr. Hirsch noted that one year ago Sanofi increased the price insulin glargine 16.1 percent. “And literally the next day, Novo Nordisk increased the price of insulin detemir (Levemir) 16.1 percent. In fact, this pattern repeated six months later, and this has actually happened 13 times for these two products that have total U.S. sales of $11 billion.”

In the question and answer period following Dr. Hirsch’s presentation, a doctor who said that he is in private practice in Northern California commented that the prices of these two competing insulins going up in apparent lockstep “looks suspiciously like price fixing.” Dr. Hirsch refrained from replying.

Why is the price of insulin skyrocketing? “The actual cost of insulin manufacturing is extremely cheap,” Dr. Hirsch says. “My question is whether it ethical to charge such a price for a medication required for survival by some people with diabetes?” He left this question hanging.

What We Can Do

But meanwhile he suggests four things that we might do:

1. In general, Walmart and Costco are the cheapest when we pay in cash.

2. The cost of human insulin (NPH and Regular) is still quite cheap at Walmart.

3. All insulin companies have special programs for the very indigent.

4. We might consider online international pharmacies, although he is concerned about the problems of how to confirm factors like the potency and sterility — not to mention that it’s not legal.

Dr. Hirsch concluded his presentation by stating, “We have never had such challenges with insulin costs, as it has become unaffordable for many of us.” Biosimilar insulins, which are on the horizon, are unlikely to have much effect on the cost of insulin, and “we don’t know where the cost rise will end.”

One of his final comments is that the role of patient advocacy groups is unclear. It’s our job now to help clear up this travesty.

See more of my articles about how to manage diabetes:

Short-term Insulin: Long-term Results for Type 2 Diabetes

The Insulin Index

Allergic Reaction to Insulin: What to Do