04/08/2016

Diabetes Drug Prices Tripled in a Decade

11:29 minutes

The number of people living with diabetes today is four times higher than it was a generation ago. That’s 422 million adults worldwide as of 2014, according to a report out this week by the World Health Organization. The WHO report cites lack of affordable insulin as one reason why diabetes patients worldwide are suffering complications or dying prematurely.

And indeed, the price of insulin tripled from 2002 to 2013, according to an analysis in the Journal of the American Medical Association. Bill Herman, an author on that study, joins guest host John Dankosky to talk about why the price is rising—and what, if anything, might be done about keeping these life-saving drugs affordable.

Segment Guests

Bill Herman, M.D.

Bill Herman is a professor of Internal Medicine and Epidemiology at the University of Michigan in Ann Arbor, Michigan.

Segment Transcript

JOHN DANKOSKY: This is Science Friday. I’m John Dankosky– Ira Flatow is away. Later this hour, we’ll talk with an archaeologist who’s hunting for lost tombs in Viking settlements by scanning satellite photos. And yes, you can do it too.

But first, the number of people living with diabetes today is four times higher than it was a generation ago. That’s 422 million adults worldwide as of 2014, according to a new report out this week by the World Health Organization. One of the reasons the WHO cites for premature deaths and complications is the lack of access to affordable insulin. In fact, according to an analysis by my next guest, the price of insulin has tripled in the last decade. We’re talking prices of anywhere from $100 to $200 even $300 a vial for insulin analogs, and many patients need more than one vial a month.

Dr. Bill Herman is a professor of Internal Medicine and Epidemiology at the University of Michigan in Ann Arbor. He published that study on insulin prices in the Journal of the American Medical Association this week. Dr. Herman, welcome to Science Friday.

DR. BILL HERMAN: Thanks, John.

JOHN DANKOSKY: If you’ve experienced a price hike in insulin yourself, give us a call, we’d like to hear your story. It’s 844-724-8255. Again, that’s 844-SCITALK. You can also tweet us, @scifri. So doctor, why are prices going up so much right now?

DR. BILL HERMAN: Well, there have been changes in the available insulin preparations, and prices have gone up with advances in insulin. In the 1920s, Banting and Best discovered insulin, and it was for the next 50 years produced from the pancreases of cows and pigs. In the mid-1970s, it became possible to synthesize human insulin by splicing the human insulin gene into yeast and bacteria.

And with that advance, there was an increase in the price of insulin. And then in the mid-1990s, new designer were insulin analogs became available. And with that, there was another increase in the price of insulins.

JOHN DANKOSKY: So this is the part I don’t understand. As the need for insulin goes up, and new technologies are developed to produce insulin in new ways, how is it that the cost has gone up so much? To what can we attribute this?

DR. BILL HERMAN: Well, it’s been a subtle change. Insulin, the animal species insulin into the 1970s were available at about $5 a vial, a vial being 10 milliliters, or about two teaspoons full of insulin. When the human insulins were introduced, the price went from $5 a vial to $20 a vial. And with the introduction of the insulin analogs in the 1990s, the price went up to about $35 a vial.

Since the 1990s though, the market share has changed. So animal insulins are no longer available, and human insulin now represents only about 10% of the market. So about 90% of Americans are now using the insulin analogs. And with the shift to the use of analog insulins, the prices have increased dramatically for analogs from $35 a vial, now to approximately $150 a vial for the short-acting insulin analogs, and pushing $300 a vial or the longer-acting insulin analogs.

JOHN DANKOSKY: Do these insulin analogs work better for patients than the traditional forms that we had years ago?

DR. BILL HERMAN: So there have been incremental benefits with the analogs. The short-acting insulin analogs actually better mimic insulin secretion in response to food. There’s a rapid onset and offset of the insulin. And the long-acting insulin analogs provide a basal insulin, they’re non-peaking, so they better mimic basal insulin secretion. So yes, there are incremental benefits. They may be associated with less low blood sugar reactions and less weight gain than the older human insulins. But one has to obviously weigh the benefits against the increased cost.

JOHN DANKOSKY: And they don’t necessarily work better for all patients, right?

DR. BILL HERMAN: No, the evidence suggests that the analogs are probably preferred for patients with type 1 diabetes. But many patients with type 2 diabetes could probably still be treated as effectively with the human insulins, with the same results.

JOHN DANKOSKY: We’re talking with Dr. Bill Herman, who’s written a paper about the rising price of insulin, even as more people in America and around the world have diabetes and need this treatment. We’re taking some of your phone calls at 844-724-8255. Let’s go to Jessie, who is calling from Kansas City, Kansas. Hi Jessie. Go ahead, you’re on Science Friday.

JESSIE: Hi. It’s nice to be here.

JOHN DANKOSKY: Yeah, what’s on your mind?

JESSIE: It’s nice to hear someone talking about diabetes.

JOHN DANKOSKY: So what’s your story? Are you paying more for insulin these days?

JESSIE: I absolutely am. I was diagnosed on April Fool’s Day in 2009, so I’m kind of a relatively new diabetic. But I’ve lived in other countries where health care is free, and now I recently moved back to America. And I can tell you, the last time I went to go pick up my insulin, it cost me $175 after my insurance.

JOHN DANKOSKY: My goodness. And it’s gone up how much over time? So you said, diagnosed back in 2009 or so, so the price has gone up quite a bit over that time.

JESSIE: Absolutely. I mean, granted, when I was first diagnosed, and I was 18, my parents for helping me pay for it. But now I’m in my mid-20s, I’m on my own, and I can definitely see that the bills keep getting higher, and I don’t really see any solution in sight.

JOHN DANKOSKY: Jessie, thank you so much for sharing your story. So Bill Herman, this is what I think we might hear from a lot of people, they’re having this situation. But Jesse also says, I’ve lived other places where medicine is free in other countries. It’s going to be a lot easier to get to cheap insulin than it is here in the US.

DR. BILL HERMAN: That is true. There have been 13 price increases since 2009 in the long-acting insulin analogs in the US. And the price of the insulin analogs is really very much out of keeping with other both European countries, as well as countries around the world. So there is a premium price charged in the US for these insulins.

JOHN DANKOSKY: For many people, insulin is a life-sustaining drug. If they don’t get it, they’re going to die. Do you expect that some of the price increases that were seeing could actually be leading to premature death?

DR. BILL HERMAN: Well, we definitely see people cutting back, or skipping doses of insulin because they can’t afford it. I would hope that that wouldn’t happen, but I don’t see it as being outside of the realm of possibility.

JOHN DANKOSKY: Why is it no generic insulin available?

DR. BILL HERMAN: Insulin is a protein, and so there cannot be a generic form of insulin. There will be biosimilar insulins, which are the same basic protein structure. But because proteins vary in the way they are manufactured in their biologic activity, it’s not possible, and certainly under FDA rules, there are no generic proteins or insulins available.

JOHN DANKOSKY: Is there any way to go to target new insulin therapies to patients with specific genotypes, more of a type of personalized medicine for diabetics?

DR. BILL HERMAN: So not really at this point. There are lots of alternative treatments to insulin that can be used, probably a dozen different treatments– obviously, not for people with type 1 diabetes. But there are certainly alternatives to insulin for people with type 2 diabetes who do not yet require insulin.

JOHN DANKOSKY: I want to go back to the phone. So Sid is calling from Jacksonville, Florida. Hi, Sid.

SID: Hi. I was just going to say, at one point I had my insulin covered by insurance. After a divorce, I no longer had that insurance. I started taking trips down to the Dominican Republic. Whereas here I spend about $120 for a bottle of insulin, down there I pay $18 for a bottle of insulin. Same exact insulin, priced differently.

JOHN DANKOSKY: Sid, thank you for that. And we’ve heard stories, Doctor, about patients, of course, going up to Canada for this thing as well. Are you seeing any sort of movement of people trying to find a lower price drug?

DR. BILL HERMAN: Yes, certainly, there is a lot of that going on. One of the other problems with insulin is the issue of list price versus the price available to large pharmacy benefit managers. For instance, patients without insurance pay the list price. Pharmacy benefit managers who manage the pharmacy for large insurance companies can negotiate for rebates with the insulin manufacturers. And so, the cost to the pharmacy benefit managers is often substantially less than an individual without insurance who has to go to a local pharmacy to get a bottle of insulin will pay. So there’s really a lack of transparency in insulin pricing, which really is an issue of equity. The people least able to afford insulin often end up paying the highest price.

JOHN DANKOSKY: One more quick phone call. Noelle in Hartford, Connecticut. Go ahead, Noelle.

NOELLE: Yes, I am a type 1 diabetic for the last 25 years. And when I was first diagnosed, I paid about $25 to $30 a bottle. And I now have a high deductible plan, and my insulin costs about $400 a bottle. $400 a bottle– Noelle, thank you for sharing that story. And Doctor, we’re almost out of time. But what can doctors and patients do about this? Because it seems as though this is going to be a real problem with more and more people developing diabetes in America.

DR. BILL HERMAN: Well, I think we need to call for greater transparency in insulin pricing. And I think it would also help for people and physicians, when possible, to use alternate preparations of insulin for their patients to require insulin. Perhaps human insulins rather than the analog insulins for patients with uncomplicated type 2 diabetes.

JOHN DANKOSKY: It seems that treating diabetes would be more cost-effective in the long term in the health care system than paying for complications. I mean, it seems as though these prices going up are causing a real problem for our health care industry, isn’t it?

DR. BILL HERMAN: Yeah, absolutely. It’s well-known that insulin is lifesaving for people with type 1 diabetes, and appropriate insulin treatment for anyone with diabetes can prevent blindness, kidney failure, amputations, and cardiovascular disease, reduce mortality, and in fact, save costs.

JOHN DANKOSKY: Well, we’ve run out of time. But Dr. Bill Herman, a professor of Internal Medicine and Epidemiology at the University of Michigan in Ann Arbor, thank you so much for joining us today. I appreciate it. Thank you, John.

JOHN DANKOSKY: You can continue to tweet us some of your stories about the high price of insulin @scifri.

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  • Chunlin

    Dr. Herman dodged the question: why is the price of insulin increasing with more ways to make it? can’t we just make it from cow and pig at the old price?

    • Robert Thomas

      I’m unsure but apparently this is due to some combination of the availability of more hypoallergenic analogues that excite fewer adverse patient reactions and the advent of the analogue manufacturers’ proprietary invention of convenient and reliable dispensing pens (like “epi pens”) that patients have found easier to use – and other unintended pressures – have pushed animal-derived manufacturers out of the market in the U.S. Canadian people, I’m told, enjoy a more competitive market, for whatever reasons.

  • John Holden

    Thanks for the discussion on air. I have been a Type 1 diabetic for over 55 years. With each new generation of insulins, the prices do seem to go up, but I am fortunate to have a good insurance plan which has helped hold the line on prices. Both short term insulin and longer term insulins cost me $40 a vial (out of pocket). My biggest concern as I approach Medicare age is whether I can afford what those “new” rates and deductibles will be, compared to my current co-pays.
    Two comments about the newer analog insulins, vs the older animal based products:

    First, the onset of hypoglycemia is far more difficult to gauge now that I use analogs. More than a few times I have had a rapid drop in blood glucose, down to dangerous levels, without the usual shakiness, sweats and other symptoms noticed with.earlier forms of insulin.

    Second, I find there is a very noticable drop in efficacy of the analog insulins after using a vial for around 25 days. Blood glucose levels don’t stay at a predictable level, but slowly rise on a day to day basis. On starting a new vial, near perfectly predictable levels return. If there was a way to keep the insulin fresh just a few days longer, I could plan on using a vial for a full month.

  • Robert Thomas

    The cost of insulin analogues has indeed risen sharply in the last 48 months or so – utterly unaccountably.

    However, the various prices mentioned by Dr Herman and the call-in guests were all apple-orange comparisons that can’t be used for any sort of real comparison. Among the reasons for this are

    1) the inability of insulin users to understand how to relate their costs. Depending on their individual conditions different persons, when commiserating on internet bulletin boards will

    a) report what they pay per month, which can’t be compared with other individuals’ usage;
    b) report what they pay as a copay or in co-insurance, which changes depending on whether their insurer agrees with their doctor on what particular (similar) analogue is “preferred”;
    c) report what they pay before their deductible is exhausted;
    d) report what they pay after their deductible is exhausted;
    e) report what they pay for 1000units (10mL);
    f) report what they pay for 300units (3mL);
    g) report what they pay for one month’s supply before exhausting their deductible
    h) report what they pay for three months’ supply after exhausting their deductible
    i) etc.,

    without ever specifying any of these parameters, resulting in unaccountable reply comments of “Gee! That’s cheap!” or alternately “Gee! That’s expensive!”.

    2) doctors pride themselves in paying utterly no attention to the out-of-pocket medication prices their uninsured (or underinsured) patients pay and have no idea at all either how much insurers are actually charged by manufacturers for a prescribed medication.

    For one of the most commonly prescribed long-acting insulin analogues, Sanofil’s “insulin glargine” (trade name “Lantus”) – when bought for cash – the price has risen from about $0.17 / unit at the beginning of 2013 to something over $0.30 / unit today. Despite what Dr Herman reported, the price of fast-acting analogues such as Novo-Nordisk’s “insulin apart” (trade nam “Novolog”) has risen similarly.

  • Julie Lantis

    I am a long term type two diabetic. I developed an allergy to Levemir because of an ingredient, Creosol, that is in the carrier. It is in all the insulins. So, I was put on Victoza, liraglutide, two years ago. The side effect of nausea lasted four months, I lost 36 pounds. It has helped my a1c. However, without part D, medicare, I would not be able to afford it. My one month supply with Part D cost is $312.00 without Part D it would cost $738.oo for a daily dose of 1.8 mg. I work part time to pay med costs although I am 76 yrs old.

  • Andrew DePristo

    This was among the worst episodes of Science Friday that I have listened to. The host, John Dankosky, was poorly prepared. He didn’t know any statistics on the number of type-1 and type-2 diabetics (1.5-3M type-1 & increasing slowly, 30M type-2 & increasing quickly), didn’t ask intelligent questions about the improvement in treatment of type-1 with newer products, and kept focusing on the prices charged by pharmaceutical companies. Most importantly, he didn’t mention the cause of the rapid increase in type-2: the obesity epidemic. Type-2 is generally preventable (and indeed has been reversed in morbidly obese patients who undergo stomach size reduction surgery and lose enormous amounts of weight) if people stopped eating so much and getting so little exercise. And, type-2 can also be managed with much less powerful medicines than insulin if people will watch their diets, keep BMI under 25 and get out and walk. Instead of finger pointing at the drug companies, this episode would have been much stronger if it has emphasized the responsibilities of both patients and drug providers! The host was ill prepared and should never be invited back.

    • Steve Mushynsky

      You obviously attitude of “blame the patients” is offensive.

      • Andrew DePristo

        MY statement emphasized the responsibilities of both patients and drug providers in keeping people healthy. YOUR obvious attitude that patients need not be responsible for their own health is harmful to patients and extremely expensive to the health care system. People need to work to be healthy, not expect pills or shots to cure them!