How Far is Diabetes Affordable in the United States?

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Is Insulin affordable and easy accessible in the United States? This question arises when looking at a new Human Rights Watch (HRW) report that claims that all is now well with Insulin affordability in America.

In the 92-page report, “‘If I’m Out of Insulin, I’m Going to Die:’ United States’ Lack of Regulation Fuels Crisis of Unaffordable Insulin,”  the HRW says that the US government has failed in ensuring equal and affordable access to insulin. This violates the right to health for people with diabetes and regularly leads to tragic consequences for many of them, it added.

MARGINALISED GROUPS

The report shows how exorbitant insulin prices and inadequate health insurance coverage cause people with diabetes to pay high out-of-pocket costs for insulin. This led to dangerous and potentially lethal medicine rationing, forcing people to forgo other basic needs, and disproportionately affecting socially and economically marginalized groups.

On the situation,   economic justice and rights researcher at Human Rights Watch Matt McConnell said  “Since the US doesn’t regulate drug prices or ensure adequate coverage for insulin costs, countless people who can’t afford expensive insulin are not only straining their financial resources but paying with their health, lives, and livelihoods.”

INSULIN AND PRICE

In the United States, about 27 million adults have been diagnosed with diabetes, and about eight million adults use one or more types of insulin to regulate their blood sugar.

The most commonly prescribed form of this diabetes drug – insulin analogs – can cost more than US$300 for a single vial, easily adding up to more than $1,000 a month if they do not have adequate health insurance coverage. Analog insulin prices in the US are more than eight times the average across 32 other countries in the Organization for Economic Co-operation and Development, teh report said.

The report mentions that the drivers behind these high prices are

  • US does not directly regulate drug prices
  • no system is in vogue to establish a fair price for medicines before they enter the market
  • restrict how much manufacturers or intermediaries can increase prices.

The report quote one  Emily Grant, 29, of Dallas, Texas who says “We are the wealthiest country in the world, but people have to go without medication. There’s nothing I can do about the trajectory of my illness except follow the treatment plans my doctors tell me. And I don’t think it’s okay to say, ‘Oh well, you either afford it or you die.”

INSULIN PRODUCERS AND PRICE

For the study, the HRW says that it interviewed 50 people, including 31 with chronic health conditions, 18 of whom had insulin-dependent diabetes. They also reviewed secondary sources and publicly available price data for three of the most widely used insulin analogs: Humalog, Novolog, and Lantus. Each of these drugs is produced by one of the three multinational pharmaceutical manufacturers that collectively dominate the global market for insulin, respectively: the US-based Eli Lilly; the Danish company Novo Nordisk; and the French company Sanofi.

The HRW says that these manufacturers increased the prices for their drugs by hundreds of percentage points, when adjusted for inflation, since their introduction to the market in the late 1990s and early 2000s, according to information these companies to government inquiries and other publicly available data.  

However, the report mentions that the price have slowed or ceased in recent years under scrutiny by policymakers, patients, advocates, and the media. But still, the prices are high and adversely affect the lives of people who do not have adequate health insurance or charitable aid to help mitigate costs.

LESS INTAKE OF INSULIN

The HRW in the report said that almost every insulin-dependent person they interviewed said they had rationed analog insulin because it was so expensive. They took only less medicine than recommended by their doctor to stretch out their supply. Human Rights Watch also found that high out-of-pocket costs can undermine the standard of living for people who require insulin, as a larger percentage of their income goes toward this life-saving medicine instead of other basic needs, like food, rent, and housing.

THE WAY FORWARD
  • The US Congress should enact federal legislation to ensure that essential medications like insulin are, in practice, affordable to all people in the United States who need it, regardless of insurance, wealth, or citizenship status.
  • The Congress should consider legislation to provide insulin to all insulin-dependent individuals in the country free-of-cost. But in the absence of such legislation, and given the inevitability of coverage gaps in existing health insurance systems, Congress should consider legislation to lower and regulate the prices for essential medications like insulin to levels that ensure affordable access and eliminate the de facto discriminatory impacts of drug prices on marginalized groups in the country.
  • The US Congress should draft and enact legislation addressing the many profound flaws with the drug pricing system, including, among other things: establishing a consultative system to define the fair price for a drug before it enters the market; limiting how much manufacturers and intermediaries can increase the prices of their drugs after drugs enter the market; limiting the price-increasing influence of common industry practices like rebates and discounts; reforming the pharmaceutical patent system to limit abuse and provide for greater access to generics; and increasing transparency throughout the sector.
  • Federal departments, including the Department of Health and Human Services and Department of Commerce, and relevant agencies, such as the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Food and Drug Administration, and the Patent and Trademark Office, should also implement policies that will help lower prices for lifesaving medications like insulin to levels that ensure their affordable access.

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