# Is the Public’s Lack of Empathy to Blame for Increased Insulin Costs? (USA)



## Northerner (Feb 13, 2018)

How exactly did insulin become unaffordable? This is the question that Drew Pendergrass explores in a widely read piece for _Harvard Political Review_, which was published on January 22, 2018. Pendergrass begins by telling the story of Alec Raeshawn Smith, who recently died after an all-too-common practice: rationing insulin due to expense. Pendergrass then explores the sinister practices that have led to situations like Smith’s. For instance, he discusses price fixing between the major manufacturers, the lack of generic options, and the “twisted accounting” of the rebate-driven drug pricing system.

It’s the last item that seems to have most excited the diabetes online community. This may be because Pendergrass does such an exceptional job of unpacking such a convoluted scheme. In short, he explains how Pharmacy Benefit Managers (PBMs) and insurers pocket drug rebates from manufacturers that should be issued to patients. The tight-knit relationship between manufacturers, PBMs, and insurers negatively impacts all patients, but it has been especially detrimental for individuals with diabetes. There are a few reasons for this: these individuals need insulin to live, the drug costs are extraordinarily inflated, and there are no generic options.

http://insulinnation.com/living/is-the-publics-lack-of-empathy-to-blame-for-increased-insulin-costs/

Fred Banting must be spinning in his grave


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## mikeyB (Feb 13, 2018)

I suppose this is the inevitable result of a profit driven health system. It would interesting to compare insulin prices that the NHS pays compared to the US. Is there a difference?


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## HOBIE (Feb 13, 2018)

I always get the last few drops out & do not waste any. Its magic stuff !


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## Northerner (Feb 13, 2018)

mikeyB said:


> I suppose this is the inevitable result of a profit driven health system. It would interesting to compare insulin prices that the NHS pays compared to the US. Is there a difference?


I seem to remember reading a while back that the NHS pays around £40-£50 for 5 novorapid or lantus cartridges - at that time the cost of all supplies (needles, test strips and insulin) was about double. Now it appears that insulin has had a massive price hike


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## trophywench (Feb 13, 2018)

For a long long time they paid about £30-35 for 5 cartridges or one 10ml vial - and anyone including me could view the BNF to find this out.  The Government stopped it being open info approx. 5 years ago cos they decided we weren't allowed to know.

I know Eli Lilly agreed to purify and supply it FOC to begin with to get it established cos he was convinced it really would take off and he'd be able to make money once it was accepted into the mainstream and he succeeded of course BUT it's hardly in the spirit of wanting to preserve human life, is it?

But then in America 'all' human life is not valued equally and that's that.


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## Davein (Feb 13, 2018)

The Regional Drug and Therapeutics  Centre (Newcastle) have published drug cost comparison charts (Oct 2017) online . Makes interesting reading


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## Northerner (Feb 13, 2018)

Davein said:


> The Regional Drug and Therapeutics  Centre (Newcastle) have published drug cost comparison charts (Oct 2017) online . Makes interesting reading


Thanks @Davein  Link to document here:

http://rdtc.nhs.uk/sites/default/fi...ort/cost_comparison_charts_-_october_2017.pdf

Section 6 covers insulin, test strips etc.


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## trophywench (Feb 13, 2018)

Still looks about £30 to me!


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## mikeyB (Feb 13, 2018)

Aye, well in the USA there are reports of cost of filling a pump for a month with Novorapid has gone up from around $130 to $495. I’d have to stop eating.


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## Davein (Feb 13, 2018)

Just locked my Pethidine tablets in the safe. Didn't realize they cost that much !!


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## HOBIE (Feb 13, 2018)

Everything is expensive these days.


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## mikeyB (Feb 14, 2018)

There’s expensive, and there’s naked profiteering.


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## Lucy Honeychurch (Feb 14, 2018)

Thank God I don't live in Trumpland or I'd be dead


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## trophywench (Feb 14, 2018)

Well you wouldn't because you'd be on mixed insulin cos that's cheaper, you'd have to eat to the insulin, use your syringes multiple times each till they are completely blunt - dunno if they still make glass ones you can boil up, but the disposables are only 12.5p each and test your pee for glucose, though of course it doesn't start spilling over into urine until your BG is 11, so I daresay there would be a lot of us without limbs, blind etc but there you go.

Otherwise you could do as they encourage folk to do in America - get good grades at school and get a good job and keep climbing the ladder (without worrying whose fingers you tread on whilst climbing) in order to afford private healthcare.  Throw a bit of cash at something - probably a prog run by whatever church you happen to belong to - and sleep a self satisfied sleep every night.


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## trophywench (Feb 14, 2018)

What do you mean - cynical?  Moi?


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## mikeyB (Feb 14, 2018)

Aye, Jenny, you and me both


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## eggyg (Feb 14, 2018)

Well that was an eye opener, not my medical needs but Mr Eggy’s. He was changed from Clopidigral to Prasugrel last year ( anti platelets) as it appeared he was resistant. The cost of a year’s treatment of Clopidigral is about £50, the Prasugrel is over £600! No wonder the pharmacist said she had never heard of it before, it obviously is only used on special occasions!  I think we are very lucky to have the NHS.


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## Abi (Feb 14, 2018)

The origins of DAFNE style education are from Germany( basal bolus and flexible meal times/ intake with carbohydrate counting). This was pioneered in the 80s when only actrapid and humulin I type insulins were available- athough heaven knows whether anyone could really make this work well when we all know actrapid is pretty useless unless you are eating a pretty low carb diet, or maybe for a huge pizza fest or indian meal.And we have all heard of the perils of NPH/isophane/ humulin I
Interestingly DAFNE until recently was suggesting twice daily NPH (humuin I/ insulatard) as a basal regimen and some people seem to be able to make this work quite well in a flexible regimen i.e one which does not necessitate fixed mealtimes or snacks.
Horses for courses I suppose.
If I was to change from my twice daily levemir I would want it to be to either Toujeo or Tresiba- although when I used the older insulins I could have probably improved a lot with proper carbohydrate counting/ analysis of meal composition without having necessarily to adhere to strict mealtimes or snacking.
I dip into a lot of forums which are mainly used by Americans who were forced into stupidly anal regimens on the older insulins ( how one was supposed to have a job or a life I do not know).
In the UK even with the older insulins 4 injections was pushed as superior to 2 due to supposedly freeing one up from rigid mealtimes Why the heck someone would agree to more injections if they had to live  like a frail little OAP is beyond me.

The real inequity I would have thought, in the Us is that wealthier people or people with better insurance would probably have more autonomy at work regarding mealtimes etc whereas a blue collar worker maybe at the mercy of a "hire and fire" type of mentality with no freedom what so ever to take a few minutes to abort a hypo with a snack-so those people who cannot access the newer insulins are less likely to be allowed the adjustments needed to manage their diabetes on the older insulins
There was a case of a supermarket employee being sacked due to drinking orange juice ( which she had payed for) to treat a hypo- She fought it and received some compensation and I think her old job back (I do not know what insulin she used0 but wouldn't it be a much nicer state of affairs if the people involved could have realised that an insulin user may occasionally need instant access to fast acting carbs to treat a hypo and not put  her (and themselves) through this


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