Near Tripling of Prices 2002-2013
I read this paper and prepared a few slides relevant to a presentation I am putting together for a meetup I am organizing. As the title states, a working group convened by the American Diabetes Association convened a workgroup to examine the (significant) problem of insulin affordability.
I’ve placed stories next to the data to show the impact of the near tripling of insulin prices since 2003.
A Life or Death Need; Not What Frederick Banting and Charles Best Intended
For more information about the impact, you can follow the #insulin4all hashtag on twitter.
This article is a helpful review of the historical origin of our current situation: Why Is There No Generic Insulin? Historical Origins of a Modern Problem | NEJM
When the team (Banting and Best) applied for a U.S. patent in January 1923 (which they later sold to the university for $1), they stated that their goal was not profit, but ensuring the speedy and safe availability of their discovery to the public.Greene JA, Riggs KR. Why Is There No Generic Insulin? Historical Origins of a Modern Problem. N Engl J Med [Internet]. Massachusetts Medical Society; 2015 Mar 19 [cited 2018 May 13];372(12):1171–5.
While the 2017 ADA Workgroup attempted to understand exactly why the price of insulin has gone up so much and multiple solutions are offered, the path to resolution seems a little unsatisfying:
This diagram isn’t that complex. It’s missing a Flux Capacitor to go back in time to ask Banting and Best how they wanted their #Insulin discovery to be used. You might also want to add in a Sonic Agitator to distract us from your BS ($2,924,403 from Lilly in 2015) #Insulin4all pic.twitter.com/SPteOsCI6F
— Lori Ruder #Insulin4All (@LoriRuder) May 8, 2018
A High Carbohydrate Diet is not the Cause of this Crisis; Low Carbohydrate Diets Will Not Solve It
The paper did not address non-pharmacologic approaches to reducing insulin use. At the same time, the need for insulin is a matter of life and death, regardless of what diet is pursued, with vulnerable populations disproportionately affected:
“For millions of people living with diabetes, including all individuals with type 1 diabetes, access to insulin is literally a matter of life and death. The average list price of insulin has skyrocketed in recent years, nearly tripling between 2002 and 2013. Approximately 7.4 million Americans with diabetes use one or more formulations of insulin. People with diabetes using insulin come from varied economic, racial, and ethnic backgrounds. Almost 20% of African Americans with diabetes use insulin, either alone or with oral medications, as do 14% of Caucasians and 17% of Hispanics with diabetes. Of adults with diabetes earning below the poverty level, approximately 24% use insulin, either alone or with oral medications.” Sources: Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care [Internet]. 2018 May 8;dci180019.
Therefore, the slide below is not intended to criticize patients/humans for having an insulin requirement and/or their dietary choices.
It is a demonstration of some of the causes of insulin resistance in our society today, which is rising dramatically, in places where there should be greater awareness. If anything, the interest in metabolic health, diabetes reversal (for people who are type 2), and diabetes (type 2) prevention, is further spotlighting the problem of insulin affordability for all.
An interest in metabolic health brought me to #insulin4all. The video presentation in the tweet below gives an excellent overview.
Insulin prices -A system in disarray – good overview h/t @UWMedicine @DrJenShineDyer #Insulin4all @GilmerHealthLaw https://t.co/5nrZ8HixsJ
— Ted Eytan, MD, MS, MPH (@tedeytan) June 24, 2017
Citations
- Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care [Internet]. 2018 May 8;dci180019. Content above is used under the license for Non-commercial re-use, Version 1.0, of @ADA_Journals
- Greene JA, Riggs KR. Why Is There No Generic Insulin? Historical Origins of a Modern Problem. N Engl J Med [Internet]. Massachusetts Medical Society; 2015 Mar 19 [cited 2018 May 13];372(12):1171–5.