By Hannah B., Lagniappe Wellness Dietetic Intern
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| Over 31% of people with diabetes are prescribed daily insulin injections |
The Humble Origin of Insulin
In 1921, Canadian medical scientist and physician Fredrick Banting discovered what would be known as the most significant medical invention of all time (NATAP, n.d.). His breakthrough research would enable insulin to be extracted from various animals to be used therapeutically for individuals with diabetes. Insulin is a peptide hormone that aids in carbohydrate metabolism by allowing glucose uptake into cells. Prior to the discovery of insulin therapy, those with type 1 diabetes were given a life expectancy of three years. Banting sold the patent for insulin to the University of Toronto for just $1 to become affordable and accessible to the masses. The physician thought it unethical to profit from a therapy that could save lives. Despite its charitable origins, insulin has become a prime example of medical price gouging, making this life-saving medicine less accessible to those in need.
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| An early model of clinically used insulin (Iletin) in its original packaging (Wendt, 2013). |
The National Cost of Diabetes
The CDC 2020 National Diabetes Statistic Report found that over 1 in 10 Americans (34.2 million) have diabetes. This staggering statistic indicates that a significant proportion of the American population relies on medical intervention for blood sugar management. Among these interventions is insulin, which will have its 100th anniversary for human clinical use in January 2022. Diabetes costs the United States more than $327 billion per year with the many intensive medical therapies for blood sugar management and diabetes-related complications (Cefalu et. al, 2018). Without proper management, diabetes can result in complications including neuropathy, kidney disease, retinopathy, poor wound healing, and cardiovascular disease.
The Deadly Cost of Price Gouging
The price of insulin has skyrocketed over time. The Healthcare Cost Institute reports a rise in the annual cost of insulin from $2,864 in 2012 to $5,705 in 2016 (NATAP, n.d.). With just three major companies controlling 96% of the global insulin market, the price of insulin has become severely gouged (Cefalu et. al, 2018). These pharmaceutical manufacturers can produce a vial of insulin for just a fraction of the average market price. Regardless of the increased awareness, the cost of diabetes-related medications continues to rise.
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| Rising list prices of diabetes medications and supplies from 2014 to 2019 (Mui, 2019). |
This high cost may deter many from following an appropriate insulin therapy regimen, leading some to split or skip doses to ration their insulin (Commonwealth, 2020). Insufficient insulin can lead to diabetic ketoacidosis: a severe and sometimes fatal complication of diabetes occurring with inadequate insulin. Thirteen deaths occurred between 2017 and 2019 from insulin rationing due to lack of accessibility and affordability. The price gouging of insulin has become a deadly consequence of big pharma that Banting worked hard to avoid.
A Solution for the Insulin Crisis
In recent years, the struggle of insulin affordability has gained traction in many journals and news outlets. The price gouging of insulin keeps those who struggle to afford their medications at acute risk of death (Battino, 2019). This now calls into question the responsibility and morality of our current healthcare system. How can we deny Americans access to life-saving medical treatment?
There are several proposed solutions to the extreme prices. Eli Lily, a major manufacturer of medical insulin, announced plans to produce a generic form of original medicine at half price (Battino, 2019). Although a step in the right direction, the list price of $137.35 will still pose a burden to many American families. The creation of generic forms of these medications becomes complicated by patents and allows for the monopolization of pharmaceuticals. Granting the FDA and other pharmaceutical companies permission to develop quality off-patent forms of these medications is an essential next step in responding to this insulin crisis. Another solution is to create reforms that block the increase in the list price of drugs unrelated to increased production cost or cap out-of-pocket spending (HCCI, 2021).
Many healthcare providers and patient advocates are beginning to respond to the plea of a financially burdened population. There is a moral struggle amongst these medical representatives about where the responsibility falls and how to control the pharmaceutical market without setting dangerous precedents. The bottom line remains: consumers need access to affordable insulin. As Frederick Banting once said, “insulin does not belong to me, it belongs to the world.” Although insulin therapy has changed the world, we have strayed far from his vision for this 1921 invention.
References
“The Absurdly High Cost of Insulin” – as High as $350 a Bottle, Often 2 Bottles per Month Needed by Diabetics, https://www.natap.org/2019/HIV/052819_02.htm.
Battino, Gabby. “Policy Solutions to Address the Rising Cost of Insulin.” NCHC, 21 July 2020, https://nchc.org/policy-solutions-to-address-the-rising-cost-of-insulin/.
“Capping out-of-Pocket Spending on Insulin Would Lower Costs for a Substantial Proportion of Commercially Insured Individuals.” HCCI, https://healthcostinstitute.org/hcci-research/capping-out-of-pocket-spending-on-insulin-would-lower-costs-for-a-substantial-proportion-of-commercially-insured-individuals-1.
Cefalu, William T., et al. “Insulin Access and Affordability Working Group: Conclusions and Recommendations.” Diabetes Care, vol. 41, no. 6, 2018, pp. 1299–1311., https://doi.org/10.2337/dci18-0019.
Mui, K. (2019). Diabetes Medications and Supplies. The GoodRx List Price Index Reveals the Rising Cost of All Diabetes Treatments – Not Just Insulin. Good RX. Retrieved December 12, 2021, from https://www.goodrx.com/healthcare-access/research/goodrx-list-price-index-rising-cost-of-diabetes-treatments.
Mulcahy, Andrew, et al. “Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis.” 2020, https://doi.org/10.7249/rra788-1.
“National Diabetes Statistics Report, 2020.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 Feb. 2020, https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html.
“Not so Sweet: Insulin Affordability over Time.” Commonwealth Fund, https://www.commonwealthfund.org/publications/issue-briefs/2020/sep/not-so-sweet-insulin-affordability-over-time.
Wendt, D. (2013). A bottle of 1920s Iletin (Lilly insulin), which is the finished product seen below being labeled and packaged. Two tons of pig parts: Making insulin in the 1920s. National Museum of American History Behring Center. Retrieved December 12, 2021, from https://americanhistory.si.edu/blog/2013/11/two-tons-of-pig-parts-making-insulin-in-the-1920s.html. Rajkumar, S. Vincent. “The High Cost of Insulin in the United States: An Urgent Call to Action.” Mayo Clinic Proceedings, vol. 95, no. 1, 2020, pp. 22–28., https://doi.org/10.1016/j.mayocp.2019.11.013.