NPR this morning ran a story on insulin pricing. Costs for patients have tripled over the past 10 years.
Of course, costs for all patients have not tripled, only costs in the United States and only for those patients who don't have some sharp advocate at a work HR dept or in a union to watch out for them.
The insulin story as it ran on Morning Edition was one of "human interest" sob stories about sympathetic people who are struggling to pay the $600 monthly for a medication they cannot live without. In some cases, the costs were $30,000 annually, for reasons which were unclear.
As heart rending as these stories may be, they are the "easy" story, the low hanging fruit for today's media--all you have to do is send out a reporter with a microphone and interview people taking insulin.
But the real stories here are not as easy to uncover:
1. Why are insulins so expensive?
2. Why are some insulins $600 a month and others $25 a month?
3. What are the decision drivers for the big Pharma companies, whose executives in their glass windowed corner offices are pricing these products?
4. Who are the "good guys" in this story, from the point of view of John Q. Public?
So there is a story here about journalism failing to do its job.
There is also the story about how the commercialization of medicine drives costs without benefits.
There is the story about the failure of government, with some notable exceptions, to meaningfully address this scandal.
And there is the Trumpsky story: He has randomly tweeted the way he does, about drug prices, but then, as always, lost interest.
Insulin was discovered in Toronto by Banting and Best in 1921-1922, one of the most important triumphs of 20th century science and medicine. (Who knew? Every school child learns about generals and Presidents: Can your kids tell you what Banting and Best did?)
From the time of its discovery, new insulins have been developed, new delivery systems have been invented but, truth be told, these are all just nibbling around the edges--insulin therapy has not progressed much since it was first discovered. Oh, it's been refined, but still you inject it, and wait for it to start working and when it stops, you give some more.
In the United States, there are only 2 companies which make the standard, basic insulins: Eli Lilly and Novo Nordisk. There are other companies which make "newer" insulins, which they claim are significantly better than the old ones, but which in fact, are not; they are only more expensive, not better.
All insulin, in the end, is the same when it arrives at the insulin receptor at the cell and fits into that receptor like a key fitting into a lock, where it opens the door to the cell and allows sugar, which is hanging out in the blood doing nobody any good, to be sucked inside the cell where it is used to generate energy.
All insulins, or almost all, are now packaged into more convenient, souped up delivery systems called "pens" or in insulin pumps. But it's the same insulin, just a different vehicle. The old insulins (N and R) are like the Chevy with the standard shift; the new insulins range from the Mercedes (insulin pump) to the BMW (insuln pens) with prices to match. The "new" insulins with different structures and huge price tags are really no different than the old insulins, although their manufacturers and marketers will shriek with indignation to deny that.
If you go for fancy delivery systems, you pay the premium for all that engineering, glass and plastic. A very large premium.
And yet, oddly, in some places, like the Commonwealth of Massachusetts, if you are on Mass Health (Medicaid), you can get the pens and the latest versions of insulin at no cost or very low cost.
How much does it cost to manufacture insulin? Professor Google says about $72 per patient per year. Presumably this is for the standard, basic insulins (NPH and Regular.) The drug companies which make the newer insulins (Novolog, Humalog, Lantus, Basilar etc) will argue there were research costs in developing these, but this would only justify their costs if they were somehow superior to the old, standard, basic insulins.
Just remember: all insulin looks the same to the insulin receptors on the cells. The only real difference among any of the insulin is in their different "kinetics" i.e., how fast or how slowly they begin working and how long they last. But in the end, all insulins are the same; we are just arguing about convenience and price.
If the government took over manufacture of insulin, the prices for the patients, for the American citizens, would drop from $30,000 a year (in some cases) to $75 a year.
Consider who would benefit and consider who would be hurt by this outcome.
You will understand the answer to the "why" question of why we have this current state of affairs insulin pricing.
Of course, costs for all patients have not tripled, only costs in the United States and only for those patients who don't have some sharp advocate at a work HR dept or in a union to watch out for them.
The insulin story as it ran on Morning Edition was one of "human interest" sob stories about sympathetic people who are struggling to pay the $600 monthly for a medication they cannot live without. In some cases, the costs were $30,000 annually, for reasons which were unclear.
As heart rending as these stories may be, they are the "easy" story, the low hanging fruit for today's media--all you have to do is send out a reporter with a microphone and interview people taking insulin.
But the real stories here are not as easy to uncover:
1. Why are insulins so expensive?
2. Why are some insulins $600 a month and others $25 a month?
3. What are the decision drivers for the big Pharma companies, whose executives in their glass windowed corner offices are pricing these products?
4. Who are the "good guys" in this story, from the point of view of John Q. Public?
So there is a story here about journalism failing to do its job.
There is also the story about how the commercialization of medicine drives costs without benefits.
There is the story about the failure of government, with some notable exceptions, to meaningfully address this scandal.
And there is the Trumpsky story: He has randomly tweeted the way he does, about drug prices, but then, as always, lost interest.
Insulin was discovered in Toronto by Banting and Best in 1921-1922, one of the most important triumphs of 20th century science and medicine. (Who knew? Every school child learns about generals and Presidents: Can your kids tell you what Banting and Best did?)
From the time of its discovery, new insulins have been developed, new delivery systems have been invented but, truth be told, these are all just nibbling around the edges--insulin therapy has not progressed much since it was first discovered. Oh, it's been refined, but still you inject it, and wait for it to start working and when it stops, you give some more.
In the United States, there are only 2 companies which make the standard, basic insulins: Eli Lilly and Novo Nordisk. There are other companies which make "newer" insulins, which they claim are significantly better than the old ones, but which in fact, are not; they are only more expensive, not better.
All insulin, in the end, is the same when it arrives at the insulin receptor at the cell and fits into that receptor like a key fitting into a lock, where it opens the door to the cell and allows sugar, which is hanging out in the blood doing nobody any good, to be sucked inside the cell where it is used to generate energy.
All insulins, or almost all, are now packaged into more convenient, souped up delivery systems called "pens" or in insulin pumps. But it's the same insulin, just a different vehicle. The old insulins (N and R) are like the Chevy with the standard shift; the new insulins range from the Mercedes (insulin pump) to the BMW (insuln pens) with prices to match. The "new" insulins with different structures and huge price tags are really no different than the old insulins, although their manufacturers and marketers will shriek with indignation to deny that.
If you go for fancy delivery systems, you pay the premium for all that engineering, glass and plastic. A very large premium.
And yet, oddly, in some places, like the Commonwealth of Massachusetts, if you are on Mass Health (Medicaid), you can get the pens and the latest versions of insulin at no cost or very low cost.
How much does it cost to manufacture insulin? Professor Google says about $72 per patient per year. Presumably this is for the standard, basic insulins (NPH and Regular.) The drug companies which make the newer insulins (Novolog, Humalog, Lantus, Basilar etc) will argue there were research costs in developing these, but this would only justify their costs if they were somehow superior to the old, standard, basic insulins.
Just remember: all insulin looks the same to the insulin receptors on the cells. The only real difference among any of the insulin is in their different "kinetics" i.e., how fast or how slowly they begin working and how long they last. But in the end, all insulins are the same; we are just arguing about convenience and price.
If the government took over manufacture of insulin, the prices for the patients, for the American citizens, would drop from $30,000 a year (in some cases) to $75 a year.
Consider who would benefit and consider who would be hurt by this outcome.
You will understand the answer to the "why" question of why we have this current state of affairs insulin pricing.
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