Insulin price gouging shows Medicare should bargain for better drug prices

For patients with diabetes — particularly those with type 1 diabetes whose pancreases no longer produce the hormone insulin — daily injections of synthetic insulin are essential for life.

But many diabetes patients, including some with health insurance, can no longer afford to take the dosage of life-saving insulin prescribed by their doctors because of price gouging by the pharmaceutical industry.

For some of these patients, the rationing of unaffordable insulin has proved to be fatal but the law that established coverage for pharmaceutical benefits prohibits Medicare from negotiating with drug companies to get better prices.

Medicare is a government-run health insurance program that covers every American over the age of 65 along with citizens who suffer from one of three chronic medical conditions.

January 2019 study by the Health Care Cost Institute in Washington, DC, found that the annual gross insulin cost for patients with type 1 diabetes in the U.S. essentially doubled from $2,864 in 2012 to $5,705 in 2016. During this same period, the average amount of daily insulin use for these patients increased by only 3 percent.

Likewise, the Right Care Alliance, a grassroots coalition of health care professionals, patients and community members that seeks to put patients, not profits, at the heart of health care, reported that Eli Lilly, Sanofi and Novo Nordisk, the three major manufacturers of insulin in the U.S., currently mark up the price of their insulin products by as much as 5,000 percent above the actual costs of manufacturing the drugs.

The outrageous price of insulin clearly is harming patients.

study published in the January 2019 issue of the Journal of the American Medical Association Internal Medicine examined how often patients underuse their insulin because of cost.

The study researchers surveyed 199 outpatients with type 1 or type 2 diabetes who were prescribed insulin and seen at the Yale Diabetes Center from June to August 2017. One-quarter of these patients reported underusing insulin because of cost.

Unsurprisingly, the patients who reported cost-related insulin underuse had worse blood sugar control than those who did not underuse insulin.

The Right Care Alliance reports that at least four young adults have died recently and many more have suffered because they could not afford enough insulin to adequately treat their illness and had to resort to rationing the drug.

The World Health Organization includes insulin on its Model List of Essential Medicines, which means the drug should always be available at all times in adequate amounts at an affordable price.

Disturbingly, insulin is not treated as an essential medicine in the U.S.

A 2011 study published in the American Journal of Public Health found that the application of the essential medicines concept to Medicaid preferred drug lists could reduce costs and provide more equitable and evidence-based health care to low-income patients in the United States.

A number of progressives have called for passage of the Medicare Negotiation and Competitive Licensing Act, which would authorize the Secretary of Health and Human Services to negotiate drug prices under the Medicare program and authorize generic competition when negotiations fail.

Unfortunately, powerful politicians assign greater weight to pharmaceutical industry profits than they do to public health, so Congress is unable or unwilling to legislate fair policies that favor taxpayers and patients.

The world’s biggest drugmakers and their trade groups cut checks to 356 lawmakers ahead of last year’s election — paying off more than two-thirds of the sitting members of Congress — in a barrage of contributions that amounted to more than $11 million distributed via roughly 4,500 checks from the political action committees affiliated with the companies.

It may be morally unacceptable that so many diabetes patients in the wealthiest country in the world are unable to afford life-saving insulin, but drug company contributions to political candidates are part of a system of legal bribery.

“If you want to believe that it’s a corrupt system and people are buying favors, I suppose nobody’s going to convince you otherwise,” said Billy Tauzin, a former Louisiana congressman who later served as CEO of the trade group PhRMA.

“Big Pharma is trying to buy maintenance of the rigged status quo,” Ben Wakana, the executive director of the advocacy group Patients for Affordable Drugs Now, said when asked about STAT’s analysis. “The breadth of these contributions shows drug corporations have no intention of doing anything to lower their prices — they are lavishing millions in campaign contributions to protect their power to dictate high prices for prescription drugs.”

Congress must swiftly pass legislation to stop pharmaceutical industry price-gouging and ensure that all patients have access to insulin and all other essential medicines at an affordable price.

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