Expensive Insulin in the US

[EVT1]

Heard this on the way into work- and it reminded me of typical drug company tactics- make marginal improvements, keep the patents up, and keep the doctors pushing the new and expensive products.  $400 a month was quoted for a patient in the US- meanwhile in other countries the older and still effective products are available.  Demand but no supply......

www.npr.org/blogs/health/2015/03/19/393856788/why-is-u-s-insulin-so-expensive


     Dr. Jeremy Greene sees a lot of patients with diabetes that's out of control.  "Every week I see patients with glucose levels so high that you can't even record the number on the glucometer," he says.  Greene, a professor of medicine and history of medicine at Johns Hopkins University, started asking patients at his clinic in Baltimore why they had so much trouble keeping their blood sugar stable. He was shocked by their answer: the high cost of insulin.

     Green says there's no one reason that companies stopped producing the older animal versions, but they clearly felt it would not be profitable.  Dr. Kevin Riggs, a professor of medicine at Johns Hopkins and co-author of the new insulin study, says the newer, recombinant version of insulin may have had some advantages in terms of convenience and fewer side effects. But there was probably something else at work — doctors being influenced by marketing.

     Greene decided to call some local pharmacies, to ask about low-cost options. He was told no such options existed.  "Only then did I realize there is no such thing as generic insulin in the United States in the year 2015," he says.

     But newer drugs aren't always better, says Dr. Adriane Fugh-Berman, a professor of medicine and pharmacology at Georgetown University. That's partly because drug companies don't have to prove that a new drug is better than what is already on the market — they just have to prove that it's not worse.

Gotta love profit driven healthcare.

[fairlycrazy23]

Allow us to buy drugs from outside the US.

[justme]

Part of the reason they don't let us buy drugs from elsewhere is because countries like Canada put cost controls on drugs. Sometimes the drugs are sold lower than cost, though I don't know how the numbers actually shake out. If you're forced (using that word lightly) to sell something at a loss to one group of people you then overcharge another group to get back in the black (sounds an awful lot like Medicare/Medicaid and the private insurance problem, no?).

Of course other reasons like government bs come into play. Like how Europe and Canada have better sunscreen ingredients for years but the fda still hasn't approved it saying they need more studies, though I'm not sure why any that Europe did aren't good enough. I often wonder which governing body is better as is stops bad drugs.

[Blonde Granny]

It's not only insulin...I take a drug called Eliquis. It's a blood thinner, and more convenient than taking warfarin.  Eliquis is the drug with the dumb commercials that tells me I can " up my game" or "get a better vision" "I can keep digging" and another stupid one I can't remember.

Anyway, in March of 2014, unbeknown to me, I hit the donut hole with my Medicare Part D. To refill my 90 days script was going to cost me OOP $877.00. Due to the donut hole the rest of my drugs were also going to cost me full price, each having a cost of $100 OOP or more per drug.

Thank goodness my cardiologist is generous with the Eliquis samples, and if I hit the right day to call, like I did the last time, I walked out with 9 weeks of the drug.

I'm grateful that all 25 drugs my DH takes are from the VA. His disability is high enough that there are no co-pays for him, including the 2 different insulin drugs he takes. But, to get a drug off formulary with the VA takes more than an act of Congress. It took 5 phone calls within the pharmacy 4 weeks ago when DH fell to get a certain bandage that the VA normally doesn't want to give out. DHs PCP calls those people the pharmacy Nazis.

I never understood why many people cut their pill in half, or take the pill every other day.  At some of those costs you end up with no choice.

[wvugurl26]

I'd be more likely to blame drug manufacturers for a lack of generic insulin. The availability and supply of generic injectibles in this country is an issue. It is much more difficult and costly to maintain a sterile manufacturing environment for injectibles than pills. So many manufacturers have stopped producing all kinds of generic injectibles claiming they don't make enough money.

[wvugurl26]

Mar 19, 2015 10:43:13 GMT -5 Blonde Granny said:

It's not only insulin...I take a drug called Eliquis. It's a blood thinner, and more convenient than taking warfarin.  Eliquis is the drug with the dumb commercials that tells me I can " up my game" or "get a better vision" "I can keep digging" and another stupid one I can't remember.

Anyway, in March of 2014, unbeknown to me, I hit the donut hole with my Medicare Part D. To refill my 90 days script was going to cost me OOP $877.00. Due to the donut hole the rest of my drugs were also going to cost me full price, each having a cost of $100 OOP or more per drug.

Thank goodness my cardiologist is generous with the Eliquis samples, and if I hit the right day to call, like I did the last time, I walked out with 9 weeks of the drug.

I'm grateful that all 25 drugs my DH takes are from the VA. His disability is high enough that there are no co-pays for him, including the 2 different insulin drugs he takes. But, to get a drug off formulary with the VA takes more than an act of Congress. It took 5 phone calls within the pharmacy 4 weeks ago when DH fell to get a certain bandage that the VA normally doesn't want to give out. DHs PCP calls those people the pharmacy Nazis.

I never understood why many people cut their pill in half, or take the pill every other day.  At some of those costs you end up with no choice.

I completely understand not wanting to pay those costs. Based on what you quoted though you'd be through the donut hole quickly and into catastrophic where you pay 5%.

[Blonde Granny]

I know, I just can't bring myself to do that. As long as the cardio is willing to give them away, I'm hoping I can get to the end of the year without having to buy them. In the meantime, I'm watching the RX balance in my new YNAB increase every month.

It takes so little to make me happy....

[wvugurl26]

I completely understand that, just something to remember if cardiologist doesn't have samples.

[EVT1]

So I guess it is true that Americans are lazy idiots as per the other thread?

     "In Canada, there actually is still an animal-derived insulin on the market, and that was really due to the efforts of consumer advocates," Fugh-Berman says.

     As the older versions have vanished in the U.S., newer versions have stayed expensive. The drug can cost up to $400 a month. Because of that high cost, many of the estimated 29 million people living with diabetes in the U.S. can't afford it.

It appears Canadians aren't going to stand for being screwed and let their fellow citizens go without.  My guess is they take one look at our health care system and it scares the crap out of them.  I am sure there are some privatization champions up there that can't wait to get drunk off health care dollars- but I don't see it happening.  The larger question is why do we put up with our crappy system?  I say hell yes you should be able to buy Insulin or any other drug wherever you want- I know if I needed it at $400 a month I would be trying to find a way.  Just another component to our national shame.

[Shooby]

And when someone hasa reaction, sue , sue, sue.

[deziloooooo]

Mar 19, 2015 9:30:21 GMT -5 EVT1 said:

Heard this on the way into work- and it reminded me of typical drug company tactics- make marginal improvements, keep the patents up, and keep the doctors pushing the new and expensive products.  $400 a month was quoted for a patient in the US- meanwhile in other countries the older and still effective products are available.  Demand but no supply......

www.npr.org/blogs/health/2015/03/19/393856788/why-is-u-s-insulin-so-expensive


     Dr. Jeremy Greene sees a lot of patients with diabetes that's out of control.  "Every week I see patients with glucose levels so high that you can't even record the number on the glucometer," he says.  Greene, a professor of medicine and history of medicine at Johns Hopkins University, started asking patients at his clinic in Baltimore why they had so much trouble keeping their blood sugar stable. He was shocked by their answer: the high cost of insulin.

     Green says there's no one reason that companies stopped producing the older animal versions, but they clearly felt it would not be profitable.  Dr. Kevin Riggs, a professor of medicine at Johns Hopkins and co-author of the new insulin study, says the newer, recombinant version of insulin may have had some advantages in terms of convenience and fewer side effects. But there was probably something else at work — doctors being influenced by marketing.

     Greene decided to call some local pharmacies, to ask about low-cost options. He was told no such options existed.  "Only then did I realize there is no such thing as generic insulin in the United States in the year 2015," he says.

     But newer drugs aren't always better, says Dr. Adriane Fugh-Berman, a professor of medicine and pharmacology at Georgetown University. That's partly because drug companies don't have to prove that a new drug is better than what is already on the market — they just have to prove that it's not worse.

Gotta love profit driven healthcare.

EVT...thanks for posting this thread...answered some questions I have had..

I am a diabetic..take two types of Insulin...Levimere ..long slow acting and another quick short term one...Just ran across a problem on refill as have changed doctors and needed new one as prescribing Doctor on Insulin...Had my mail order supplier..{Humana  is prime RX provider..under part D }call me wanting to charge me over $800 for who can remember how many vials..to make this short..some how they sent me four vials Levimer for a total of $42.00..think they screwed up { I am not telling..}BUT the main thing was..charged as full price toward medicare toward my donut hole over $900.  for the four vials..almost $250.00 per vial..


I called them and questioned that and they are correct on the charge..I had no idea Insulin actual cost was that high since it's been around for decades..believed discovered and introduced in Canada..Toronto I believe so thought cost would be a generic by now..


Your explanation now clears up a lot for me..Since my actual, cost was acceptable for me under my Insurance plan I never questioned it...Am also on a new drug to help on sugar and my doctor been most gracious in samples but realize this can't go on forever so will have a talk with  him this week..still hoping for samples when I see him but willing to also have a RX at my cost for some months..with out these Doctor samples with the new drugs today don't know what people would do..One of the diabetic ones he tried with me ..a once a day injectable pen..while in the full coverage , would have cost me just under $300 per month and when hit the donut hole , double..On that one I told him unless it is a  life saving only drug ....I can't afford and he agreed and fully understood..also didn't realize then full cost of..

[jkapp]

Mar 19, 2015 21:35:39 GMT -5 Shooby said:

And when someone hasa reaction, sue , sue, sue.

Exactly...and this is partly why we CAN'T have two options for insulin. If there are two options, and one option causes issue with someone, they'll demand the second option; but when they find out its more expensive, they'll take the first option again. Then they'll sue when they get the bad reaction they knew they were going to get.

Its really a damned if you do, damned if you don't situation with the litigious nature of our country. Take out the lawyers out of the equation and maybe things can start to  improve? 

[EVT1]

That's bullshit.  All drugs have potential side effects and people assume the risk.

The only time you see huge lawsuits are when drug companies in search of ever more profits tweak their studies or sweep them under the rug and fail to disclose them- and people get hurt or die.

Explain to me how it would be negligent for a doctor to prescribe a version of insulin that has worked for so long- especially when the patient inquires about and is concerned about cost?  They do it with blood pressure medicine- which can vary anywhere between dirt cheap and outrageous- yet the cheap stuff works just as good (depending on which doctor you ask of course). 

Any reason you would oppose being able to buy such insulin from Canada or Mexico?

[EVT1]

Why not?  Where do you think they get it from?

I would not, however, buy it from China- where it is probably horse piss.

[fairlycrazy23]

Mar 25, 2015 19:07:45 GMT -5 EVT1 said:

That's bullshit.  All drugs have potential side effects and people assume the risk.

The only time you see huge lawsuits are when drug companies in search of ever more profits tweak their studies or sweep them under the rug and fail to disclose them- and people get hurt or die.

Explain to me how it would be negligent for a doctor to prescribe a version of insulin that has worked for so long- especially when the patient inquires about and is concerned about cost?  They do it with blood pressure medicine- which can vary anywhere between dirt cheap and outrageous- yet the cheap stuff works just as good (depending on which doctor you ask of course). 

Any reason you would oppose being able to buy such insulin from Canada or Mexico?

You should at least have the option to buy from Canada or Mexico or wherever.

And why isn't the animal version still available? I would think there would still be money to be made from it by the companies that don't own the patents.

 

[EVT1]

The crux of the biscuit.  Why indeed.  Apparently it is just not available in the USA.

Makes me want to start a company and provide it.  Wish I had the resources.

[jkapp]

Mar 25, 2015 20:20:43 GMT -5 fairlycrazy23 said:

Mar 25, 2015 19:07:45 GMT -5 EVT1 said:

That's bullshit.  All drugs have potential side effects and people assume the risk.

The only time you see huge lawsuits are when drug companies in search of ever more profits tweak their studies or sweep them under the rug and fail to disclose them- and people get hurt or die.

Explain to me how it would be negligent for a doctor to prescribe a version of insulin that has worked for so long- especially when the patient inquires about and is concerned about cost?  They do it with blood pressure medicine- which can vary anywhere between dirt cheap and outrageous- yet the cheap stuff works just as good (depending on which doctor you ask of course). 

Any reason you would oppose being able to buy such insulin from Canada or Mexico?

You should at least have the option to buy from Canada or Mexico or wherever.

And why isn't the animal version still available? I would think there would still be money to be made from it by the companies that don't own the patents.

 

Which the pharmaceutical companies may have to sell at a loss ot those countries due to the countrys' regs...which means that the insulin would soon be available to NO ONE!  Good plan

[bean29]

Mar 26, 2015 18:22:17 GMT -5 jkapp said:

Mar 25, 2015 20:20:43 GMT -5 fairlycrazy23 said:

You should at least have the option to buy from Canada or Mexico or wherever.

And why isn't the animal version still available? I would think there would still be money to be made from it by the companies that don't own the patents.

 

Which the pharmaceutical companies may have to sell at a loss ot those countries due to the countrys' regs...which means that the insulin would soon be available to NO ONE!  Good plan

I actually don't buy that argument.

Obviously Americans are not wealthy enough to subsidize drug costs for the rest of the world.

If we allow Americans to buy drugs from other countries and pharmaceutical companies can't afford to produce the drug at such a low price, everyone will have to pay a reasonable price, the only ones it would be unavailable to would be the ones who think they are entitled to purchase drugs below cost.

There are many Diabetics in my family and 29 million is a big number. I hope this drives change in how Drugs are priced in the US.

[fairlycrazy23]

Mar 26, 2015 18:22:17 GMT -5 jkapp said:

Mar 25, 2015 20:20:43 GMT -5 fairlycrazy23 said:

You should at least have the option to buy from Canada or Mexico or wherever.

And why isn't the animal version still available? I would think there would still be money to be made from it by the companies that don't own the patents.

 

Which the pharmaceutical companies may have to sell at a loss ot those countries due to the countrys' regs...which means that the insulin would soon be available to NO ONE!  Good plan

It would make more sense for the drug company to just not sell at all in those countries, because every unity they sold would cost them money

[wvugurl26]

Mar 26, 2015 22:13:25 GMT -5 fairlycrazy23 said:

Mar 26, 2015 18:22:17 GMT -5 jkapp said:

Which the pharmaceutical companies may have to sell at a loss ot those countries due to the countrys' regs...which means that the insulin would soon be available to NO ONE!  Good plan

It would make more sense for the drug company to just not sell at all in those countries, because every unity they sold would cost them money

That's what ends up happening. We have options available here that are not sold in countries with price controls. We do fund R & D for pretty much the rest of the world.

[fairlycrazy23]

Mar 27, 2015 15:33:05 GMT -5 wvugurl26 said:

Mar 26, 2015 22:13:25 GMT -5 fairlycrazy23 said:

It would make more sense for the drug company to just not sell at all in those countries, because every unity they sold would cost them money

That's what ends up happening. We have options available here that are not sold in countries with price controls. We do fund R & D for pretty much the rest of the world.

Right, but if I just want to use the options available in Canada or Mexico I should be able to order my drugs from them.
We would still have a large group of people willing to pay a premium for the absolute best drug that money can buy.

[EVT1]

Mar 27, 2015 14:57:23 GMT -5 Sum Dum Gai said:

You guys do realize that this a free country right? Nothing stopping any of you from opening your own company to make generic animal based insulin and undercut big pharma and their synthetic stuff on price.

Nobody is willing to tackle problems and take risks anymore, they just want to whine and make the government do something.

Yes there is- I already indicated I would love to make it available.  You have any idea how much it would cost to startup? I could put everything I have on the line and would be nowhere close to being able to do it.

And even if you can make it- now you have to fight Pharma and their short-skirted representatives in order to get doctors to tell their patients there is a cost effective alternative than the 'new and improved' stuff.

I would gladly risk it all to do it- it isn't enough- you have to be financed.  So don't hand me that bullshit.

And it isn't whining at all- it is free market action.  The GOP bleats regularly that if only you could buy health insurance across state lines....... well why the eff cannot a patient buy drugs across national lines? 

And if you look real hard- you get the answer from the same 'free market' folks- something along the lines of 'patient safety' and 'unregulated products'   So what the "free-marketers" in this country mean is you are free to buy from markets within the borders- otherwise they are going to side with government regulation and the nanny state- because they want to protect the profits of drug companies you from yourself.

[bean29]

Mar 27, 2015 23:03:07 GMT -5 Sum Dum Gai said:

Mar 27, 2015 22:17:07 GMT -5 fairlycrazy23 said:

Right, but if I just want to use the options available in Canada or Mexico I should be able to order my drugs from them.
We would still have a large group of people willing to pay a premium for the absolute best drug that money can buy.

Not really. Very few of us buy drugs at anywhere near full price. By and large, we have insurance and only pay a small percentage of the actual cost. You'd think insurance companies would be lobbying pretty hard to allow foreign drug sales in the US though.

My deductible is $2600 my drug deductible is another $1000-1500 on top of that, it pretty much means we pay though the nose for all our drugs.

My FIL uses insulin and is on medicare. The in-laws drug costs seem astronomical in comparison to their income.

[mollyc]

I didn't remember a lot of details about why Canada ended up with access to animal-sourced insulin so I looked it up.  Cost isn't why another source was found.  When Eli Lily announced that it would be discontinuing animal-sourced insulin, diabetes groups and doctors went to the public and Health Canada for support for the people who used animal-sourced insulin.  I presume they were all like the woman quoted below and had adverse reactions to the recombinant version.  (Article from July 22, 2005)


diabetes-groups-worry-about-looming-lack-of-insulin-options


As many as 700 people use animal insulin in Canada, said Colleen Fuller of the Society for Diabetic Rights.

"I nearly died I don't know how many times," said Fuller, describing her reaction to the synthetic form of the drug. "I couldn't control my blood sugars."

"I could be standing here, just like this, and the next second I would be on the floor and unconscious."


A British company applied to sell its animal insulin.  I am assuming it is the same UK company that is listed on Health Canada's website as the animal insulin supplier.  That particular page hasn't been updated since 2010 so things must still be status quo.  The webpage does point out that the Government can't force anyone to manufacture a particular drug but they will do their best to find a safe supplier if required.  The webpage also points out that some doctors may not be aware that animal-sourced insulin is still available.  I didn't find anything about how many people use the animal insulin now.

Rather than buy insulin from Canadian sources, maybe it would be better to find out why Wockhardt UK Ltd. doesn't sell in the US.  It may be a regulatory issue.  It may be that they are selling at a loss to Canadians out of goodwill but the US numbers are too big.  It may be a turf issue.  That's something US Diabetic Groups need to look into and see if it can be changed.

Regarding the relative costs of drugs between our countries, the agreement with the Pharmaceutical companies is that we (Canada) will not pay more than the median global price.  The companies always have the option of taking their balls and going home, as it were.  The US government always has the option of working out their own agreement.  If, as always suggested, an agreement lowering the cost for US citizens makes it impossible for Pharmaceutical companies to engage in research, a couple of things could happen.  Companies could find a cheaper way of doing things or Governments could step in with more funding/actual research or everyone would have to change their agreements to pay more.  I'm sure there are other variations of how things could change.  Like "can any Province/State thrive as a separate nation", it isn't a question that can be answered unless it actually happens.
 

[wvugurl26]

You know we import stuff all the time? If it meets FDA standards then it's fine. That's one of their favorite audits to order stuff from foreign pharmacies and break it down in the lab to see what it actually is. Very rarely is it what they ordered. And insurance companies get discounts and rebates from drug companies all the time.

[wvugurl26]

Mar 28, 2015 12:14:37 GMT -5 Sum Dum Gai said:

My deductible is $2600 my drug deductible is another $1000-1500 on top of that, it pretty much means we pay though the nose for all our drugs.

My FIL uses insulin and is on medicare. The in-laws drug costs seem astronomical in comparison to their income.

Through the nose and full cost aren't the same thing in healthcare.

Astronomical compared to income and full cost aren't the same thing in healthcare either.

Some of the drugs we take are $500-1000 a pill. Hardly anyone pays that price out of pocket. It's insurance companies that cover the bulk of it, so they have the most to gain by allowing foreign sales and importing drugs from China.

I doubt the $80k hepatitis C cure is for sale in China.

[wvugurl26]

Mar 28, 2015 13:17:01 GMT -5 Sum Dum Gai said:

I doubt the $80k hepatitis C cure is for sale in China.

Probably not, but I'm sure they'd be more than happy to manufacture pills, throw 'em in a bottle, claim it has the same ingredients, and sell it to us for $40k or less.  Free market in action.  Isn't that what everyone here wants?

If I actually had hep C is want the real version of Solvadi. Now granted it is mega expensive but so is a liver transplant when hepatitis wrecks it. That's half a million dollars expensive.

[The Walk of the Penguin Mich]

Mar 25, 2015 19:07:45 GMT -5 EVT1 said:

That's bullshit.  All drugs have potential side effects and people assume the risk.

The only time you see huge lawsuits are when drug companies in search of ever more profits tweak their studies or sweep them under the rug and fail to disclose them- and people get hurt or die.

Explain to me how it would be negligent for a doctor to prescribe a version of insulin that has worked for so long- especially when the patient inquires about and is concerned about cost?  They do it with blood pressure medicine- which can vary anywhere between dirt cheap and outrageous- yet the cheap stuff works just as good (depending on which doctor you ask of course). 

Any reason you would oppose being able to buy such insulin from Canada or Mexico?

It didn't work as well as you seem to think it did.  Animal (I believe it was pig) insulin was the only game in town for a very long time until the recombinant versions came into town.  There were STILL a lot of issues with it but as it was the only game in town, you really didn't have a choice.

The recombinant versions is the human insulin gene inserted into a bacteria and the bacteria are producing a human version of insulin.

About blood pressure medicines, the cheap stuff may or may not 'work as good' and you don't know this until you try them out.  All people are not the same and titrating blood pressure is not easy.  I'm lucky in that I respond well to 2 generic, old ones that are fairly cheap.  My dad did not.  One of my coworkers did not.  Generally most doctors WILL try you on the cheapest meds and move up until they find something that works.  

For my coworker, she is black.  Not that long ago, scientists realized the hypertension was a greater risk in blacks and that they do not respond as well to the classic meds that work in the rest of the population.  So a new drug was formulated that works mainly in blacks and it is fairly expensive as it is still under patent (or it was the last time I discussed this with my coworker).

[EVT1]

I still think it needs to be an option- what good is the latest and greatest if one cannot afford it?

And I guess Sovaldi is expensive- gotta get a billion dollars for the CEO from somebody.

www.bloomberg.com/news/articles/2014-03-03/gilead-ceo-becomes-billionaire-on-84-000-hepatitis-drug