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ere’s a sticking point for diabetics: the cost of insulin more than tripled — from $231 to $736 a year per patient — between 2002 and 2013, according to a new analysis.

The increase reflected rising prices for a milliliter of insulin, which climbed 197 percent from $4.34 per to $12.92 during the same period. Meanwhile, the amount of money spent by each patient on other diabetes medications fell 16 percent, to $502 from $600, according to a research letter published Tuesday in the Journal of the American Medical Association.

“Insulin is a life-saving medication,” said Dr. William Herman, a coauthor of the analysis and a professor of medicine and epidemiology at the University of Michigan School of Public Health. “There are people with type 1 diabetes who will die without insulin. And while there have been incremental benefits in insulin products, prices have been rising. So there are people who can’t afford them. It’s a real problem.”

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The analysis also found that the cost of various widely used oral diabetes drugs either dropped in price or did not rise nearly as significantly as insulin. Metformin, for instance, which is available as a generic, fell to 31 cents in 2013 from $1.24 per tablet in 2002. And the newer class of diabetes drugs known as DPP-4 inhibitors rose 34 percent since becoming available in 2006.

The researchers analyzed data from nearly 28,000 diabetes patients found in the Medical Expenditure Panel, a database on health care costs maintained by the US Department of Health and Human Services. About 1 in 4 people used insulin and two-thirds took a pill. Toward the end of the study period, a small percentage began taking new injectable medicines that are designed to complement pills.

There have been previous efforts to track insulin prices in recent years, but the researchers explained this is the first attempt to examine national pricing data in this way for an extended period of time. And the findings are likely to further fuel the hot-button national debate over the rising cost of prescription medicines, which has also become a talking point in the presidential campaign.

More than 29 million Americans, or 9.3 percent of the population, have some form of diabetes, according to the US Centers for Disease Control and Prevention. Not surprisingly, there are numerous companies competing to grab a share of the market and newer forms of insulin have been introduced, notably, analog insulins that are man-made and differ slightly from human insulin.

Payers report that unit costs are rising. One exception has been the widely used long-acting form of insulin called Lantus, which is marketed by Sanofi. The drug maker has been encountering pushback from insurers, and so the unit cost for the medicine fell nearly 14 percent last year, according to Express Scripts, the nation’s largest pharmacy benefits manager.

More competition is expected for Lantus later this year when Eli Lilly is expected to launch a biosimilar version of the medication. But to what extent this drug will be affordable remains to be seen. Typically, when a generic version of a pill becomes available, the price drops 80 percent or more. But biosimilars are new to the United States and are forecast to cost about 20 percent to 30 percent less than a brand-name drug.

Meanwhile, some doctors say diabetic patients, who are typically 60 years old or more, have difficulty paying for drugs, especially those who have trouble once they hit the donut hole in the Medicare Part D program and have to cover costs themselves. “The cost of therapy is huge,” said Dr. Jane Bridges, a diabetologist in Vincennes, Ind. “I have patients who tell me that they have to stretch out the use of their medicines.”

But the Pharmaceutical Research and Manufacturers of America argued that focusing on list prices “misrepresents” reality. The industry trade group maintained that wholesale prices generally do not correspond to net prices — what companies, unions, and government agencies pay — because drug makers offer rebates. The group cited an analysis by SSR Health that net prices declined last year.

Spokespeople for Eli Lilly and Novo Nordisk, two of the largest manufacturers of diabetes medicines, echoed that argument and both companies noted that patient-assistance programs are available. The Novo spokesman added that “making comparisons between insulin and oral medications are not appropriate as each medication is designed to support a patient’s specific glucose-control needs.”

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A Lilly spokeswoman maintained that the net price for its Humalog insulin rose an average of 1.6 percent annually from 2010 to 2015. However, she did not respond to questions about the rebates that were offered. Drug makers and pharmacy benefits managers are facing increasing criticism for their failure to disclose rebates and discounts.

One analyst, meanwhile, contended that rising prices may not have any impact on patient outcomes.

“I don’t think you can draw a straight line from the rising cost of insulin to outcomes,” said David Kliff, who publishes Diabetic Investor. “Very few patients pay out of pocket for cost of insulin. So I don’t think prices truly impact the patient pocket book. There’s only a small percentage who don’t have insurance or enough insurance.”

But another author of the analysis disagreed.

“High costs can lead to reduced compliance, but more importantly the cost-effectiveness of high cost therapies … should be assessed, so they produce a greater clinical benefit for the patient,” Philip Clarke, a professor of health economics at the University of Melbourne in Australia. Other countries, he noted, routinely assess cost-effectiveness when setting prices for government-subsidized drugs.

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  • The suggestion that the cost of Lantus having dropped at all is a gross dereliction of journalistic integrity. Either you did NO research or you are lying to cover Big Pharma’s price gouging.

    • Hi T1Jedi,

      Thanks for your note. The story points out that the unit cost paid by the pharmacy benefits manager had fallen, due to rebates paid by the drug maker to the pharmacy benefits manager. That does not automatically translate into a lower price for the consumer if rebates are not then passed along. Those are two separate things.

      Hope this helps,
      ed

  • I am a type 1 diabetic and have been for 32 years. My Novolog insulin that I use in my pump has more than tripled in the last couple or years and my copay more than doubled last month making it over $400 a month with insurance. Because I have insurance, I am not eligible for any help through patient assistance programs. We have three children and two of them have major medical issues as well (they are adopted) and it is a struggle for us to pay for my insulin that I need to live every day. Big Pharma should have to be on the defensive for this! What they are doing to people with a life threatening chronic illness is inexcusable and it needs to stop!!!!

  • I spend 6k a year purchasing insulin. The “rebates” are very limited and the insurance companies are shifting the costs more and more. Humalog has been around since 1996 and there is no excuse for its price nearly doubling in the last 10 years.

  • I think you better check your figures again. The rise in insulin and metformin put me in the donut hole in July. Last year I never got there. My Medicare D pays 55% while in hole. My part of Levimir Flex Pen jumped from $48 to $200. It is only a 25 day supply and it is generic. I checked into getting insulin in a vial and it’s $265. Non of that touches the Metformin 1000 mg once a day. It went to $3000. That is not a typo.

  • In January 2016, with my mother’s insurance, it cost her $325 for 5 lantus pens. Each pen contained 300 units of insulin.

    She started on 18 units a day, so that’s 1.8 pens per month. So that box of five pens would last 2.77 months. So she’d need 4.33 boxes per year, which would come out to $1,408 per year.

    18 units per day is, on average, a low amount. Most people actually use 2 to 4 times that amount, as they tend to need more insulin over time.

    Right now she’s down to 1 unit of insulin per day due to carbohydrate restriction, but that’s beside the point.

  • I am the caregiver and diabetes educator of a elderly 80+ parent who has T2DM for over 30 years.I agree with this commentary and glad to see that someone is aware of this problem and is writing about it. I thought I was crazy when I found out that one insulin pen cost $25-35 each in pharmacies in the USA and even higher in Jamaica. She needs 35 units a day. Not sure how much the pen carries but about 5 pens are used in a month costing $125-205 a month. With little or no income, and a choice whether to eat or not to eat the appropriate foods, leaves the elderly at greater risk for becoming most uncontrollable and greatest risk for amputations, heart disease/strokes, blindness and chronic kidney disease. If this disease is rising in populations in the millions globally, then we must gear up for more complicated services to address these inevitable demise of our people. We need to wise up and tackle pharmaceutical companies, and the drivers for making these prices so high. The question is what can we do about it ? Focusing on prevention is just one way but is this enough?

  • I’m a Medicare case manager with Aetna, The monthly charge for a member with short and long acting insuln in the Coverage Gap was 545 dollars , they cannot get help until they hit the coverage gap and the process takes 3-4 weeks before all the forms and doctor signatures are obtained and then the pharm company to approve it . The rocess must be repeated , if the ap which many aren’t and don’t have a case manager the time between finding out the cost and getting help is lengthened .

  • This article is interesting in that I can totally relate to some of the facts.I am a diabetic patient and I am finding it difficult to purchase my meds, the insulin to be exact. I am retired and I have Medicare parts A and B , I also carry a “gap” insurance and part D because I use insulin. It is hard to pay the bill because of the way the insurance is structured. There should be a better way to get to “catastrophic” than doing without real food or shelter. The drug companies do not let the users of their drugs know about rebates and discounts and the insurance companies sure don’t give out the information, how are we supposed to get the information? I “fall into a crack” because of my retirement income, I don’t fit most of the subsidized programs I have read about or come across trying to reduce or get my insulin at a discount.I will keep trying and checking back to see if your column has more information on the situation.The drug companies “lie” the price has gone up way out of control and there needs to be control because people’s lives depend on the drug.

    • Our retirement money is going to insulin….it is so outrageous! We use 12 vials a month…one vial is 270 dollars.

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