Big Pharma, Insulin Prices and Elections

The 2020 presidential elections thrust insulin prices into the spotlight. Here is why 2022 voters need to track this issue.

Opinion by Hilary Van Hoose, Special to the Star

A $1000 per month price tag for insulin forces millions of Americans with Diabetes to ration the medication that keeps them alive, and many die trying. (Photo by Hilary Van Hoose/Special to the Star)

During the last election cycle, insulin inaccessibility became symbolic of the privatized/for-profit healthcare industry as a whole for American political candidates.

“Once the pandemic began, just like most things, I saw this conversation happening more last year than my entire life,” said Sam Zapiain, a Los Angeles video editor who has Type 1 Diabetes, as he described insulin price debates leading to larger discussions about healthcare. “People started to look around and go, “Oh my god, like, this has always been a thing. We’re just so used to it.”

In July of 2019, Senator Bernie Sanders tweeted,

"I just boarded the bus in Detroit with diabetics, on our way to Windsor, Canada, to buy affordable insulin.

Americans are paying $300 for insulin. In Canada they can purchase it for $30. We are going to end pharma’s greed."

On the campaign trail, Senator Amy Klobuchar frequently told the story of 26-year-old Alec Smith, who died as a result of insulin rationing after aging out of his mother's health insurance. Senator Elizabeth Warren co-prepared a 2019 report criticizing insulin manufacturer Eli Lilly.

Affordable healthcare was an important issue to voters.

A 2018 Reuters-Ipsos poll showed that 70 percent of Americans supported "Medicare for all,” with 85 percent of Democrats and 52 percent of Republicans in favor.

Amidst this news, voters might wonder what insulin is and why it is important.

Insulin is a hormone used by the body to process and absorb sugar in the blood. Type 1 Diabetes is an autoimmune disability in which the body produces little or no insulin, according to the ADA (American Diabetes Association). Diet and lifestyle habits do not cause Type 1 Diabetes.

It is surprisingly common. There are multiple types of diabetes, and approximately 52 percent of all American adults have diabetes or pre-diabetes, according to a study published in JAMA.

About 7.4 million Americans living with diabetes use insulin, according to a statement by the ADA. One out of every four diabetics ration insulin because of its high price and many die as a result, according to a survey from T1 International and a survey from Yale.

The inventors of insulin sold the patent for just $1 because they felt it was unethical to profit from this life-saving discovery, according to an article in the Journal of Clinical Investigation. Although a study published in the BMJ Global Health journal estimates per-vial production cost of insulin “between $3.69 and $6.16,” the previously mentioned 2019 report co-prepared by Senator Warren noted that the price of Humalog insulin had risen from $21 per 10 ml vial in 1999 to about $322, reflecting a price increase of more than 1400 percent.

The price hikes are still moving far faster than inflation. GoodRX currently lists the price of Humalog at $390 per vial. Eli Lilly also manufactures an analog variety called Insulin Lispro, priced at $175, but only 14 percent of chain pharmacies surveyed had this available, according to Warren's report.

Insulin prices have come to symbolize problematic healthcare policies and structures as a microcosm of the healthcare system for all Americans.

Almost 10 percent of Americans have no health insurance, according to the 2019 census report, and “43.4 percent of U.S. adults” are underinsured, according to the 2020 Commonwealth Fund Biennial Health Insurance Survey.

Dr. Alokika Patel, on rotation in a Florida hospital for osteopathic medicine and herself a Type 1 Diabetic, discussed this issue.

“It’s a challenge as a patient, but also as a doctor, or future doctor,” said Patel. “I feel like I can’t even provide appropriate care because a lot of times in the hospitals we’ll tell patients to get insulin that they can afford, which is not necessarily best for their health, but it’s better than nothing. It’ll at least keep them alive.”

As an article from NPR cautioned, different varieties of insulin, even if described as biosimilar, will not work the same as each other, and some patients can have allergic reactions to one variety of insulin and not another.

Legislators are making incremental progress.

Gov. Newsom's 2020-21 California state budget included proposals to “establish a uniform statewide schedule of prices at which drugs would have to be sold” and “have the state contract with drug manufacturers to create its own brand of generic drugs that would be available for purchase statewide.”

More than 90 percent of all existing patents for insulin products expired in 2020, according to a report by the World Health Organization (WHO). This and Gov. Newsom's proposals open a pathway for inexpensive insulins.

Additionally, the Build Back Better Act proposes capping co-pays for insulin countrywide, and allowing Medicare to negotiate prescription prices. “Medicare is forbidden by law to negotiate prices,” Mary Simon, M.D., a diabetologist and endocrinologist in California for over 30 years who herself has Type 1 Diabetes, explained in an interview. “It’s a ridiculous situation because Medicare patients have this thing called ‘the doughnut hole.’ For people with Diabetes, they’re always going to hit the doughnut hole.”

Unfortunately, co-pay caps do not help uninsured diabetics, or insured diabetics with high deductibles. The insurance potentially available to Alec Smith “came with a $7600 deductible and a monthly premium of approximately $440,” so he would have paid the same retail prices for insulin as someone without any insurance, according to an article in the Mayo Clinic Proceedings.

Next year, 39 gubernatorial elections, all 435 seats in the House of Representatives, and 34 of the 100 seats in the Senate will be contested. Will insulin accessibility be as big of an issue for political candidates in 2022?

"If not now, then when? You know?” Zapiain responded. “At what point does there have to be a mistake or another kid like [Alec Smith]? Why do we need more examples of people losing their lives to say this needs to stop?"said Zapiain, reflecting a timely poignance as ongoing and re-emerging healthcare crises mark a transition into the new year.