Question

What is Insulin? What are the issues facing people with diabetes? Why is insulin so expensive and what can be done?

Answer 1

What is Insulin

Insulin is a hormone made by the pancreas that allows your body to use sugar (glucose) from carbohydrates in the food that you eat for energy or to store glucose for future use. Insulin helps keeps your blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia).

Issues to people with diabetes

Following are the issues which people face during diabetes:

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections

Reasons for expensiveness of insulin:

Following are the reasons for high price of insulin:

1. Only 3 Companies Control 90% of the Global Insulin Market

the ‘big three’ insulin producers – Eli Lilly, Novo Nordisk and Sanofi – dominate more than 90% of the world insulin market by value. Often only one of these companies supplies insulin in a country, which means they more or less hold a monopoly there and can set prices as they wish.

2. No Generic Insulin

Insulin is a therapeutic biological product (or 'biologic'), rather than a chemically synthesized molecule. This means it cannot be made as generic in the same way as other drugs. Creating what is called a biosimilar is a lot more complicated and expensive than just duplicating a chemical molecule. There is little market incentive to produce biosimiliars because it costs nearly as much as making new drug, and companies must go through all the approval stages and trials that a new drug is required to go through.

3.  Pay-for-Delay Schemes & Lawsuits

A ‘Pay for delay’ agreement is a patent dispute settlement in which a generic (in the case of insulin, a biosimilar) manufacturer acknowledges the original patent of a pharmaceutical company and agrees to refrain from marketing its product for a specific period of time. In return, the company receives a payment from the patent-holder. This means it is actually legal for one insulin producer to pay another one not to enter the market. this is profitable for the companies and cost more to the patients.

4. Patents

Patents give a person or organization a monopoly on a particular invention for a specific period of time. In the USA, it is generally 20 years. Humalog, Lantus and other previous generation insulins are now off patent, as are even older animal based insulins. So what’s going on? Pharmaceutical companies take advantage of loopholes in the U.S. patent system to build thickets of patents around their drugs which will make them last much longer (evergreening). This prevents competition and can keep prices high for decades.

What can be done

1. Improve transparency and pass discounts to patients: The supply chain through which drugs travel from manufacturers to pharmacy counters is complex and opaque. It encourages ever-higher prices as consolidation and rebate systems limit supply and hide the true prices paid. Manufacturers should be required to disclose more information about effectiveness, and all entities in the supply chain should report prices paid, discounts, and rebates received. Discounts and rebates should be shared with patients. Additionally, transparency would help patients understand their disease and the therapeutic effects of different insulin types, and make more informed choices.

2. Limit compound price increases: Drug companies can and do hike prices at any time, even multiple times per year. Reforms should be enacted to hinder price increases that are not the result of higher input costs or improved effectiveness. If prices of existing therapies like insulin increase at unjustified rates, Medicare should be permitted to enter direct long-term contracts, using a tool such as arbitration, to limit price increases.