Diabetes is a devastating disease that has reached near-crisis levels in America. The CDC estimates that over 100 million adults —9.4% of the US population — are currently diabetic or prediabetic. And that doesn’t even include the rising number of children affected by the disease.
For people with Type 1 or severe Type 2 diabetes, regular insulin shots are the difference between life and death. But over the past few years, insulin prices have skyrocketed, leaving many people unable to afford it.
If it’s required for so many people’s survival, why is insulin so expensive? It’s more complicated than you might think. Read on for eight true facts about the insulin price crisis.
1. Insulin Prices Have Increased Over 300%
In 2001, a single vial of insulin cost between $30 and $40. Today, that same vial will cost you well over $250, no matter what company you buy it from.
The confusing part? Other antihyperglycemic medicines haven’t followed suit. When controlled for inflation using constant dollars, the costs of non-insulin blood sugar drugs have either stayed fairly constant or decreased.
When people have a high-deductible private health insurance plan — or no insurance at all — they can end up paying more than a thousand dollars out of pocket each month for insulin alone. That doesn’t include the other costs associated with diabetes management, like doctor visits and blood sugar monitoring supplies.
2. People are Rationing Insulin Due to Cost
Skipping doses of insulin can have dire consequences. But due to the price increases, an estimated one in four people have been rationing their insulin doses to stretch their supply as far as possible.
Insufficient insulin can lead to ketoacidosis, a condition in which your body breaks down fats for energy to compensate for being unable to process sugars. The breakdown of fats produces high levels of ketones, which are acidic molecules released into the bloodstream. If left untreated for even a few days, diabetic ketoacidosis can be fatal.
3. Insulin Is Made by Only Three US Companies
The insulin market in the United States has unusually low levels of competition compared to other drugs.
Eli Lily, Novo Nordisk, and Sanofi are the only three companies producing modern insulins. These companies supply the vast majority of the world’s insulin, allowing them to raise their prices without the usual consequences of decreased demand.
4. There’s No Generic Form of Insulin
Most prescription and over-the-counter medication prices are kept in check by competition from numerous smaller generic brands. Unfortunately, the insulin market doesn’t have any generic options available.
The chemical makeup of insulin means it’s even more expensive and difficult to produce a synthetic version than it is to collect the naturally produced variety. This has kept smaller drug companies from being able to pursue more affordable options for production.
5. Patent Protection Removes Market Competition
The “big three” insulin companies have another strategy for keeping their hold on the market: an impenetrable fortress of patents. Even though a drug patent expires after 20 years, these companies have patented every aspect of their products and processes. This makes it incredibly difficult for competitors to enter the market without getting sued for patent violations.
The irony of this situation is that the original patent for insulin was sold for only $1. The scientists responsible hoped that this lifesaving drug would be available to all at a low cost. Their intentions were noble but didn’t stand up to the for-profit pharmaceutical market.
6. FDA Regulation Backfired
FDA regulation is necessary to protect consumers from dangerous, un-researched drugs. But the particular way they’ve classed and regulated insulin may be doing more harm than good.
Insulin is classed as a biologic medicine, meaning it’s made from living organisms or cells. Generic competitors hoped to enter the market with synthetic insulins (known as biosimilars). Until recently, the FDA didn’t have a process for regulating biosimilar drugs, so they put one into effect beginning March 20, 2020.
The downside is that the 2020 regulatory cutoff date means that any biosimilar patents pending on that date will be automatically rejected and will have to start the process over again. Because the timeline for drug patent approval is so slow, this has kept most new companies from submitting insulin patents for the past few years.
7. Doctors Don’t Prescribe Inexpensive Options
Some older forms of insulin are still available at reasonable prices. Unfortunately, many doctors are hesitant to prescribe them, despite their effectiveness for many people. Whether they’re convinced by drug salesmen or are afraid to seem “behind the times,” they often prescribe more expensive insulins without offering cheaper ones as an option.
If you suspect your doctor isn’t trying to keep your insulin cost low, ask them if you can try an older daily variety instead of the newer weekly insulins.
8. People are Buying Insulin Abroad to Survive
With prices continuing to increase, some people have started to take drastic measures to afford this lifesaving medication. They’ve started traveling in insulin caravans—groups of people who travel abroad together with the sole purpose of buying insulin in bulk.
One of these groups, Caravan to Canada, was able to save a collective $15,000-$20,000 by buying their medicine across the border. The same vial that would have cost them $320 in America was a mere $30 in Canada.
Why Is Insulin So Expensive, and What Can We Do About It?
As you can see, unraveling the question of “why is insulin so expensive?” isn’t an easy task. Between a lack of competition, federal red tape, and no caps on out-of-pocket costs, more people are struggling to afford their insulin than ever before.
If you’ve been affected by the price crisis, don’t stay silent! Talk to your doctors, friends, and government representatives about the need for change.
For more information on staying well in our modern world, make sure to check out our health archives.