Insulin Has Become Unaffordable. Patients Are Dying In Their Efforts To Ration Doses

Published March 6, 2019 at 10:00 AM CST

Cardboard headstones line the sidewalk outside of pharmaceutical company Sanofi's Cambridge, Mass., offices. The Right Care Alliance held a protest against high insulin prices, which have led some to the dangerous practice of cutting doses to save. (Anna Bauman/On Point)

Find our buildout from this hour, featuring a partial transcription, here.

Six million Americans rely on insulin to survive. Many can no longer afford it. What happens when big pharma, big profits and strong patent laws lead to dying patients?

Guests

Dylan Scott, health care reporter at Vox. ( @dylanlscott)

Vikas Saini, cardiologist and president of the Lown Institute, a nonpartisan think tank dedicated to promoting health care equity. Co-chair of The Right Care Alliance. ( @DrVikasSaini)

Dr. Kasia Lipska, endocrinologist and diabetes outcomes research at Yale School of Medicine. ( @klipskaMD)

In The News: The Right Care Alliance Protests At Sanofi Offices In Massachusetts

Statements From Insulin Manufacturers Eli Lilly, Sanofi And Novo Nordisk

Eli Lilly

We want to provide help for people who need it while not disrupting access for the thousands of Humalog patients who pay lower prices because of their insurance designs. The significant rebates we pay on insulins do not directly benefit all patients, and this needs to change. For people with diabetes, a lower-priced insulin can serve as a bridge that addresses gaps in the system until a more sustainable model is achieved.

The current healthcare system operates on a high list price/high rebate model. Cutting the list prices would significantly disrupt the healthcare system for patients. Approximately 95 percent of people who use Humalog pay less than $100 for their monthly prescription because of their insurance design and or cost-savings programs. Lilly Insulin Lispro is a less disruptive approach to reducing list prices that still provides an answer for people who need help.

Sanofi

Since 2012, the net price of Sanofi insulins has declined by 25 percent, yet patient out-of-pocket costs has continued to rise. Take Lantus, for example, our most prescribed insulin. The net price has fallen over 30 percent since 2012. Over this very same period, average out-of-pocket costs for patients with commercial insurance and Medicare has risen approximately 60 percent.

Lastly, it’s important to note that Sanofi has implemented new innovative programs to ensure individuals without insurance or those without adequate insurance have access to our medicines. The most notable is our Insulins Valyou Savings Program, which sets a fixed, deeply discounted price ($99 for each 10 mL vial or $149 for each box of pens) to help lower out-of-pocket costs for Sanofi insulins (Lantus, Toujeo, Admelog, and Apidra). For some patients with diabetes, the program could offer a savings of up to $3,000 per year.

Again we really insist on the following for your coverage: anyone who is prescribed a Sanofi medicine, and who may be having financial challenges or trouble navigating their insurance, please call (800) 633-1610 where eligible patients can be connected to the resources they need at no cost.

Novo Nordisk

We know a growing number of Americans with diabetes struggle to pay for their healthcare, and this can include paying for medicines we make.

One of the reasons for the disparity between list prices and net prices is the demand by payers for higher rebates. These increasing demands for rebates from payers allow Novo Nordisk to maintain and expand the availability of its medicines on formularies – the lists of medicines health plans cover – and ensure that patients have access. However, Novo Nordisk has no ability to control whether the rebates it pays to enable broader access to medicines result in lower out-of-pocket costs. What a patient pays at the pharmacy counter is also influenced by how one’s insurance plan is designed, which causes those in high-deductible health plans to pay list prices.

We’ve provided several offerings for some time to support people who have difficulty affording their insulin, including:

Human insulin – the type of insulin used to establish the current diabetes standards of care – can be found at many national pharmacy chains for $25/vial. This has been used effectively to lower blood glucose for decades by millions of Americans and people around the world
Co-pay cards to help defray the costs of those who are experiencing high out-of-pocket costs driven by list price, and
A patient assistance program that, in 2018, provided free medicines to tens of thousands of people with diabetes who didn’t have health insurance

Because people are looking to us to continue innovating against this serious disease, we remain committed to identifying additional solutions to address access and affordability. It will require efforts from all parties in the US health care system to solve this challenge, and we want to be part of the solution.

Ultimately, any solution has to make buying medicines easier for patients, and effectively work within the broader healthcare system.

From The Reading List

Washington Post: “ Life, Death and Insulin” — “Insulin, in its various manufactured forms, has been used to treat diabetes for almost a century, since Canadian researchers isolated the hormone in a lab in 1921. Before their discovery, what we now know as Type 1 diabetes was fatal. Even after being put on starvation diets, patients often lived no more than a few years. The researchers who transformed diabetes treatment won the Nobel Prize, and they sold their patent to the University of Toronto for a total of $3. ‘Above all, these were discoverers who were trying to do a great humanitarian thing, and they hoped their discovery was a kind of gift to humanity,’ historian Michael Bliss told The Washington Post in 2016.

“Soon, though, insulin became a commercial enterprise. By 1923, the American pharmaceutical company Eli Lilly was manufacturing enough insulin for diabetics across North America. For decades, manufacturers improved formulas, first using animal parts, then producing human insulin using bacteria and recombinant DNA. The 1990s saw the advent of insulin analogs, synthetic drugs made to better mimic the body’s own insulin production.

“Today, critics argue that the price of insulin has far outpaced any innovations. In the past decade alone, U.S. insulin list prices have tripled, according to an analysis of data from IBM Watson Health. In 1996, when Eli Lilly debuted its Humalog brand of insulin, the list price of a 10-milliliter vial was $21. The price of the same vial is now $275. Those costs can be compounded by the multiple vials that diabetics may require to survive each month. ‘It’s a very big problem,’ says Robert Gabbay, chief medical officer at the Joslin Diabetes Center in Boston. ‘It’s a tragic barrier to care.’ ”

Vox: “ Congress is grilling pharma CEOs. Here are 8 ideas for bringing down drug prices.” — “Americans have said for years that they’re frustrated with the price of medicine and it should be high on lawmakers’ to-do list. Now Congress has put together an extensive menu of ideas for reducing prescription drug costs.

“Democrats have made drug prices a top priority for their new House majority — and this is one of the rare policy areas where they might find some common ground with Republicans.

“Seven executives from major pharmaceutical firms are appearing before the Senate Finance Committee on Tuesday, where they should face tough questions from senators about rising drug costs. Sen. Chuck Grassley (R-IA), who heads the influential committee, has signaled he wants to pursue a few targeted bills this Congress, leading to new optimism that bipartisan compromise on the issue is within reach. Rep. Elijah Cummings (D-MD) and Sen. Bernie Sanders (I-VT) also recently released a slew of bills to lower prescription drug prices, pulling together some of the most popular ideas already out there.”

ABC News: “ Big pharma defends rising cost of drugs, lawmakers say they are gaming the system” — “In a rare show of bipartisan consensus, Republican and Democratic senators on Tuesday grilled seven top executives from the world’s biggest drugmakers on why prices remain historically high.

“The most heated exchanges came from Democratic Sens. Ron Wyden and Sen. Maggie Hassan, with several Republicans signaling they, too, were prepared to regulate the industry if it didn’t agree to drive down prices.

“The testimony from several drug industry CEOs is the first of its kind following President Donald Trump’s promise last year that the industry would agree to ‘massive’ pricing cuts. Appearing before the Senate Finance Committee were the CEOs of AbbVie, AstraZeneca, Bristol-Myers Squibb, Pfizer and Sanofi, and a top executive for Johnson & Johnson.”

Anna Bauman produced this hour for broadcast.

This article was originally published on WBUR.org.