Health Letter, April 2019
By Michael Carome, M.D.
If you’re not outraged,
you’re not paying attention!
Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.
For patients with diabetes — particularly those with type 1 diabetes whose pancreases no longer produce the hormone insulin — daily injections of synthetic insulin are essential for life. But many diabetes patients, including some with health insurance, can no longer afford to take the dosage of life-saving insulin prescribed by their doctors because of price gouging by the pharmaceutical industry. For some of these patients, the rationing of unaffordable insulin has proved to be fatal.
A January 2019 study by the Health Care Cost Institute in Washington, DC, found that the annual gross insulin cost for patients with type 1 diabetes in the U.S. essentially doubled from $2,864 in 2012 to $5,705 in 2016. During this same period, the average amount of daily insulin use for these patients increased by only 3 percent.
Likewise, the Right Care Alliance, a grassroots coalition of health care professionals, patients and community members that seeks to put patients, not profits, at the heart of health care, reported that Eli Lilly, Sanofi and Novo Nordisk, the three major manufacturers of insulin in the U.S., currently mark up the price of their insulin products by as much as 5,000 percent above the actual costs of manufacturing the drugs.
The outrageous price of insulin clearly is harming patients. A study published in the January 2019 issue of the Journal of the American Medical Association Internal Medicine examined how often patients underuse their insulin because of cost. The study researchers surveyed 199 outpatients with type 1 or type 2 diabetes who were prescribed insulin and seen at the Yale Diabetes Center from June to August 2017. One-quarter of these patients reported underusing insulin because of cost. Unsurprisingly, the patients who reported cost-related insulin underuse had worse blood sugar control than those who did not underuse insulin.
The Right Care Alliance reports that at least four young adults have died recently and many more have suffered because they could not afford enough insulin to adequately treat their illness and had to resort to rationing the drug.
The World Health Organization includes insulin on its Model List of Essential Medicines, which means the drug should always be available at all times in adequate amounts at an affordable price. Disturbingly, insulin is not treated as an essential medicine in the U.S.
It is morally unacceptable that so many diabetes patients in the wealthiest country in the world are unable to afford life-saving insulin. Congress must swiftly pass legislation to stop pharmaceutical industry price gouging and ensure that all patients have access to insulin and all other essential medicines at an affordable price. A good start would be passing the Medicare Negotiation and Competitive Licensing Act, which would authorize the Secretary of Health and Human Services to negotiate drug prices under the Medicare program and authorize generic competition when negotiations fail.