Public Citizen News / March-April 2023
By Robert Weissman
This article appeared in the March/April 2023 edition of Public Citizen News. Download the full edition here.
On March 1, drug maker Eli Lilly announced it would reduce the prices of its most commonly prescribed insulins by 70%, cap out-of-pocket costs for uninsured people at $35 and cut the price of a key insulin product to $25 per vial, down from $126.
This was probably the biggest direct win against a drug company in two decades. It follows the most consequential drug pricing reform in 40 years – the provisions in the Inflation Reduction Act, passed last year, that will authorize some Medicare drug price negotiation.
A number of factors drove Eli Lilly’s decision but underlying them all was a major public pressure campaign. Public Citizen joined with a group of people with and impacted by type-1 diabetes to highlight the outrage of super-high insulin prices and the impact on real people – and to demand price reductions.
Over the past three decades, Eli Lilly and the other leading insulin manufacturers have spiked the price of their life-saving products, jacking up prices by more than 1,200%. Insulin was discovered as a treatment for diabetes 100 years ago. As a discovery of a naturally occurring substance, it was not patentable. But starting in the 1980s, Big Pharma companies began synthesizing insulin that mimicked human-made insulin, and those products were patentable. Over time, the companies found ways to extend patent and other monopolies on their insulin products by making some minor improvements, combining insulin with devices (such as injector pens) and other means.
A recent study by Public Citizen and researchers at Harvard Medical School and the City University of New York’s Hunter College showed that 1.3 million Americans with diabetes ration their insulin due to cost. Researchers have invented the term “catastrophic spending” to refer to people forced to spend more than 40% of their post-subsistence family income just on insulin. For 2017 and 2018, they found 14% of insulin users – or 1.2 million people – had reached catastrophic spending levels during the course of one year. Since 2017, at least 12 people in the United States have died from rationing insulin.
There is only one reason that Eli Lilly and the other insulin makers have price gouged so dramatically: Because they can. Other countries impose various forms of price controls and don’t permit individuals or their health system to be exploited. One recent study found the average price per insulin unit in the United States to be $98.70. In Japan, it was $14.40 – 85% less. It was even cheaper in other rich countries: $12.00 in Canada, $9.08 in France, $6.94 in Australia. The Australian price is just % of the cost in the United States.
Now pressure has forced Eli Lilly to bring its prices down into the realm of reason. Lilly’s price reductions will provide some relief to many patients, though not all, and also begin to ease the burden of high insulin prices on healthcare costs, for which everyone pays through taxes and insurance premiums.
There’s much more to do. Public Citizen is demanding the other major insulin manufacturers, Novo Nordisk and Sanofi, follow Eli Lilly’s example and enact price reductions immediately. Meanwhile, the federal government must ensure that all insulin products are affordable for everyone who needs them, regardless of age, or insurance type or status. Public Citizen has endorsed legislation from U.S. Sen. Bernie Sanders, (I-Vt.), that would cap the price of insulin at $20 a month.
With the insulin victory and the authorization of some Medicare drug price negotiations, there’s growing momentum to curtail Big Pharma’s scandalous pricing – sky-high prices that prevent people from getting the medicines they need.
These victories are a reminder that pressure works – and can defeat even the biggest corporate lobby in Washington, D.C. They instruct us in the importance of persistence. Big Pharma has prided itself on never losing policy fights and the industry has had a record to back up its bravado. But now Big Pharma is on its heels. And these achievements encourage us to think big – these are partial wins, but we achieved them by aiming high.
We’re certainly not satisfied and we are acutely aware of how much work lies ahead to ensure medicines are affordable and available to everyone who needs them. At the same time, every person part of Public Citizen – including every single organizational member – should take pride in these major victories. They will make a difference in the lives of millions of people.