The High Cost of Insulin

Public health officials are concerned about increasing awareness of diabetes and preventing it, but there is a more immediate concern for those who rely on insulin – that is the rising prices of the life-sustaining medication.

What American consumers who have been purchasing insulin have been experiencing for the last decade has been objectively verified by research conducted by the University of Melbourne, Australia and the University of Michigan regarding the price of insulin and other anti-hyperglycemic medications from 2002 through 2013 and published in the Journal of the American Medical Association on April 5, 2016.

The price of insulin has steadily risen since 2002, with insulin prices tripling by 2013; the average annual cost-per-patient rose from $231 in 2002 to $736 in 2013. During the same time period, the price of all other diabetes drugs fell, from an average cost-per-patient of $600 in 2002 to $502 in 2013. The World Health Organization (WHO) has cited the lack of affordable insulin as one of the factors leading to complications and deaths from diabetes.

Why Is It that Insulin, a Medication that Has Been Around for More than 90 Years, Should Be So Costly?

The answer is that the insulin of 90 years ago, manufactured from the insulin in the pancreases of cattle and pigs, is not the same insulin of today.

Dr. Jeremy Green, professor of medicine and the history of medicine at Johns Hopkins University, researched the history of insulin to learn why it was currently so expensive that some of his patients weren’t maintaining control of their blood sugar levels due to the cost of insulin. Green, along with Dr. Kevin Riggs, also a professor of medicine at Johns Hopkins, published the results of their research into the history of insulin and an explanation of why no generic insulin in available in current pharmaceutical markets in the New England Journal of Medicine in March 2015.

Early insulin was short-acting, requiring many people with diabetes to inject insulin multiple times daily for blood sugar control. There were also some people who experienced mild allergic reactions. Over the next decades, scientists worked to refine the animal-based insulin to remove impurities, reducing the risk of allergic reactions. Refinements over the years also included a way to make the insulin last longer in the bloodstream, reducing the need for multiple daily injections and improving overall blood sugar control.

In the 1970s, scientists developed a new method for producing insulin, recombinant DNA technology. This method utilizes the human gene for insulin that is then introduced into bacteria, allowing large quantities of insulin to be made. Along with this human-based insulin came higher prices, though not of the nature that would follow in the decades to come.

For a variety of reasons, animal insulins were no longer available. Riggs places part of the blame in the lap of health care providers who are influenced by pharmaceutical representatives. Riggs stated that health care practitioners are sometimes so caught up in the theoretical advantages of new products, such as the fewer side effects and convenience offered by the human recombinant insulins and fall into the trap of thinking that newer is better.

Riggs and Green also theorized that pharmaceutical companies didn’t see the same profit potential in continuing to offer animal-based insulin as was there for the recombinant insulin.

In the late 1990s, analog insulin was created. Analog insulin is a type of human insulin, created in a lab just as is recombinant insulin, but analog insulin is taken a few steps furthers by being genetically modified. Analog insulin acts as insulin, but is a man-made substance that resembles insulin. Analog insulin provides the benefits of both the immediate action of a fast-acting insulin and the prevention of peaks in slower-acting insulin.

As might be expected, the added benefits of analog insulin come with a steeper price tag than recombinant insulin or animal-based insulin that preceded both.

Six million people in the United States alone depend on insulin to regulate their blood sugar levels, with many more millions doing so worldwide. Health insurance co-pays aid some people in their ability to afford their needed insulin, as does national health insurance in those countries where it is available.

Still, there are some people who cannot afford to purchase insulin, or to take it in the prescribed dosage, leaving them with unregulated blood sugar – and the potential to experience one or all the complications of the disease. The availability of generic insulin could help alleviate this financial and health concern for some of these people.Pub

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