The High Cost of Insulin in the United States: An Urgent Call to Action

Introduction

• Context: High cost of insulin in the U.S. has become an urgent issue.
• Case: Alec Smith, a young diabetic, died due to inability to afford insulin after losing his health insurance.

Insulin Pricing Disparity

• Insulin in the U.S. costs 10 times more than in other developed countries.
• Insulin is essential for Type 1 diabetes patients who will die without it.

Reasons for High Cost

1. Vulnerable Population: Patients willing to pay high costs for lifesaving insulin.
2. Monopoly/Oligopoly: Controlled by three major companies (Novo Nordisk, Sanofi-Aventis, Eli Lilly).
3. Patent Abuse: Evergreening and multiple patents prolong monopoly.
4. Barriers to Biosimilars: Complex regulatory process for biosimilar entry.
5. Middlemen and PBMs: Price manipulated by supply chain rebates and benefits.
6. Lobbying Power: Pharmaceutical companies prevent regulatory changes.

Policy Level Solutions

• Value-based Pricing: Regulations to prevent unreasonable drug pricing.
• Easier Biosimilar Entry: Simplified regulatory pathways.
• Patent Reform: Cap patent life, avoid overpatenting.
• Pricing Oversight: Government/nongovernmental agencies to oversee pricing.
• Rebate Transparency: Ensure rebates benefit patients.
• Nonprofit Manufacturing: Encourage affordable production of insulin.
• Emergency Access Laws: Ensure insulin access in emergencies.
• Advocacy: Increased awareness and action from professional and patient groups.

Solutions by Physicians and Institutions

• Discuss Affordability: Engage with patients on drug affordability.
• Price Awareness: Use resources like goodrx.com to find lower drug prices.
• Preferred Formularies: Choose cost-effective biosimilars.
• Advocacy and Policy Change: Support lower insulin prices in collaboration with lawmakers.

Conclusion

• Insulin pricing is a critical issue in the U.S.; healthcare professionals must advocate for change.
• Emphasizes the need for immediate action to prevent further loss of life.