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Thank you Mr. Obama! Insulin price spike leaves diabetes patients in crisis
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Bradley K. Sperman
2016-08-30 07:24:25 UTC
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A massive spike in insulin prices is causing a health crisis for
millions of diabetes patients who depend on the lifesaving drug,
doctors say.

Now, after years of rapid increases having nothing to do with
available supply and not matched elsewhere in the world, those
in the U.S. insulin supply chain are blaming each other.

Tens of thousands of medical professionals are engaged in an
intricate therapeutic ballet performed to protect the health,
limbs, and lives of the almost 30 million people in the U.S.
suffering from diabetes.

But their efforts have been dramatically complicated by the
soaring increase in the cost of insulin. They find themselves
balancing the cost of the essential medication and their
patients' ability to pay.

"The manipulation of insulin cost is a medical crisis in Montana
and everywhere else in this country," said Dr. Justen Rudolph, a
diabetes specialist at St. Vincent Healthcare in Billings. "My
patients having trouble with their insulin availability range
from teenagers to a 90-year-old man, and there's not a day that
goes by when I'm not talking to a patient about the cost of
their insulin.

"They try to spread out the insulin they have to make do, and
that's not how you can control diabetes," said Rudolph.

This hit-or-miss medicating concerns many practitioners.

"Precision is needed to ensure the patient is getting the best
type of insulin for their specific condition, in the right
doses, at the right time, to achieve the greatest benefit," said
Dr. Irl Hirsch, professor of medicine in the Division of
Metabolism, Endocrinology and Nutrition at the University of
Washington in Seattle.

State statistics and those of the American Diabetes Association
show that 65,000 to 70,000 people have been diagnosed with
diabetes in Montana, and another approximately 26,000 are
believed to have the disease but have not been officially
diagnosed.

In Missoula, Certified Diabetes Educator Carla Cox of the
Providence Medical Group cautioned that switching to other forms
of insulin "can present a greater risk because it is less like
the action of insulin produced by the pancreas."

PRICES SOARING
From 2011 to 2013 the wholesale price of insulin went up by as
much as 62 percent. From 2013 to 2015 the price jumped again,
from a low of 33 percent to as much as 107 percent, said Dr.
Mayer Davidson, professor of medicine at the Charles R. Drew
University of Medicine and Science in Los Angeles, who has
carefully tracked the rapid and repeated increases.

"This borders on the unbelievable," Davidson said, citing an
extremely concentrated insulin which "in 2001 had the wholesale
price of $45. By last year, the cost had skyrocketed to $1,447"
for the same monthly supply.

Susan Pierce, a diabetes educator at Philadelphia's Chestnut
Hill Hospital, said she's seeing similar increases, with her
patients reporting that the cost of their insulin is doubling,
tripling or worse.

"People who paid $200 or less are now getting bills of $400,
$500 and even more for the same amount of insulin. Meanwhile,
most insurance is paying less for medications, and the required
co-pays are higher, so it is a double whammy that prevents the
patient from getting the insulin to stay alive," said Pierce.

The medical community is concerned about patients who can't
afford their insulin, "so what they have to do is they ration
it," said Davidson, who has been heralded for his creation of
programs to get quality diabetes treatment to underserved
communities.

"They take it only three or four times a week instead of every
day in order to make it stretch, and that's dangerous," he said.

Diabetes specialists attack their patients' increases or
decreases of blood sugars with the finesse of a commander
plotting how to use limited troops and supplies in a continuing
battle.

Patients and their practitioners live in a world where they must
select and prescribe insulin which either institutes immediate
changes in glucose or blood-sugar levels or is long-lasting and
doles out the vital medication over hours.

"We are not talking about concierge medicine or just fine-tuning
insulin therapy or something that a patent can live without.
We're talking about survival. Don't let anyone sugarcoat it,"
warns Hirsch.

NEGATIVE IMPACTS
The effects of diabetes are enormous. The disease is a leading
cause of blindness, strokes, kidney failure, heart attacks,
nerve pain, and amputation of the feet and legs.

Hirsch and many of his colleagues are not subtle when they
describe what "price gouging of a medication required for
survival" is doing to their patients.

"I had a patient tell me her insulin bill is suddenly costing
her as much as her mortgage," Hirsch said.

Others tell similar stories.

Dr. Claresa Levetan, chief of endocrinology at Chestnut Hill
Hospital, said "just about 100 percent of them are having
problems affording the higher cost of insulin."

"I see people every day in the hospital because they can't get
their required doses of insulin. Many are in the ICU with what
is called diabetic ketoacidosis, a life-threatening condition.
This lack of insulin brings the patients to a critical juncture,
where they will become extraordinarily sick, go into a coma, and
could ultimately die.

"I have patients who tell me that they have to make a decision
between food and insulin and their rent and insulin.

"I mean, seriously, food, rent or insulin," she said.

WHERE PRICES ARE HIKED
Pricing of insulin, as with other medications, is controlled by
the manufacturers, the insurance companies, and pharmacy benefit
managers — the middlemen who negotiate the prices that the
insurance companies pay.

"Both the pharma company and the pharmacy benefit managers jack
up the cost," said Hirsch, a former editor in chief of the
journal Clinical Diabetes, published by the American Diabetes
Association.

"We don't know what the benefit manager is paying for the
insulin from the pharma company. It's backroom deals," Hirsch
said. "You can call them rebates, you can call them kickbacks,
you can call them bribes, but those are secret deals on which we
don't have the details."


Pharmacy trade associations are pushing congressional committees
and state regulators to investigate the pricing practices of
these powerful benefit administrators. Of significant concern is
a "clawback fee" that the benefit controllers demand the
pharmacies impose on patients on top of their copays.

Most professionals on the front lines blame the snowballing
costs on the almost complete lack of regulation of pharmacy
benefit managers.

"But the companies say, 'No, no, no. It's not us,'" said
educator Pierce.

"You may not be able to prove who's behind the price rigging,
but remember these prices are not an issue in Canada or in
Europe or other countries where the governments keep the drug
makers from going wild. It's only in America."

Nevertheless, some diabetes experts say the pharmacy industry
should not be tarred with the same critical brush.

"Think of all the good things they actually do," said Cox in
Missoula, and ticked off programs for many low-income, uninsured
people as well as the industry's support of children at diabetes
camps and professional conferences.

DRUG MAKERS BLAMED
Three major pharmacy benefit companies were asked to comment on
the insulin price increase. Only one, Express Scripts, the
largest benefit manager in the U.S., replied.

The cost of insulin is high for patients because "drug makers
continue to increase prices significantly each year, and there
is no generic insulin available on the market," said Jennifer
Leone Luddy, Express Scripts spokesperson, who added that her
company's mission is "to keep prescription medication affordable
and accessible."

She described a major effort "to ensure patients get the right
medication, are using, and achieve the best results from their
medication."

The company seeks the most cost-effective medications, she said,
but added that Express Scripts does not establish the price a
patient pays for any medication; its clients — employers, health
plans, and government agencies — decide how much will be paid by
a patient.

In Gainesville, Texas, Jerry Meece, a clinical pharmacist and
certified diabetes educator, said he spends far too much time
trying to figure out what patients can afford versus what meds
are most appropriate for them.

"These patients are desperate. They do without their insulin,
skip doses, lower their prescribed dose to stretch out the
insulin they have, and end up in the emergency room or ICU with
long-term complications such as kidney failure, leg amputations,
or vision problems," Meece said.

Even some patients who can afford the higher prices are
endangered because the benefit managers are playing musical
chairs with the different brands of insulin they authorize, some
doctors said.

"I'm being told to make patients switch their insulin for no
good reason except to make somebody more money," said Dr. Loren
Wissner Greene of New York University's Langone Medical Center.

Greene, an NYU clinical professor of medicine, worries that her
patients are confused by the flip-flopping.

"I just barely taught them that the orange pen is the fast-
acting insulin and is to be taken with meals and the gray one is
the slow-acting insulin to take at night. Now, suddenly, I have
to switch them to a different brand to keep the pharmacy game-
players happy," she said.

"Big business wins again, and the patients lose."

Three pharmaceutical companies control almost all the world's
supply of insulin.

In addition to Eli Lilly, headquartered in Indianapolis, there
is the Danish company Novo Nordisk, which says it makes half the
insulin used by diabetics around the world, and the French
company Sanofi, which says it has 18 percent of the market.

All three companies were asked why people buying their insulin
were suddenly paying significantly more. Novo Nordisk and Sanofi
did not respond to the question.

Lilly said it could not speculate on why individual costs went
up.

"Lilly does not set the final price a patient pays for our
medicines. Wholesalers and pharmacies ultimately price the
product at retail," said communication manager Julie Herrick
Williams.

"The patient's insurer, the type of plan, and the individual
pharmacy all play a role in the price," she said. "Changes to
the U.S. healthcare system are the primary driver for increased
insulin cost for consumers. With the adoption of cost-sharing
plans, like high-deductible health plans, more direct costs are
shifting to the people who need treatments."

Insulin production earns pharmaceutical companies tens of
billions of dollars. The three pharmaceutical giants made an
estimated $12 billion to $14 billion in profits from the sale of
insulin last year, according to preliminary figures gathered by
industry watchdogs.

Insulin first hit the market in 1920 when three Canadian
scientists donated the patent for their life-saving discovery to
the University of Toronto for either one Canadian dollar, or
free — accounts differ.

Almost immediately, the university gave pharmaceutical
companies, including Eli Lilly, license to produce insulin
without payment to the school or the scientists, who won the
Nobel Prize for Medicine for its creation. The magical
concoction — extracted from the pancreases of pigs and cows —
was distributed almost worldwide within months. Since there was
no pharmaceutical treatment at the time, only rigid and
unhealthy diets, countless lives were saved.

Eli Lilly's corporate history reports that it took more than
4,000 pounds of animal pancreases to produce a cup — 8 ounces —
of insulin. Each year the company used organs from 60 million
animals to produce enough insulin for U.S. diabetics.

Lilly looked for a better way to produce the vital medication,
and in 1978, in a landmark in genetic engineering, Genentech
came up with the answer. Genentech's scientists cloned a
synthetic insulin from a human insulin gene and a benign strain
of the food-poisoning bacteria E. coli. It was the first
laboratory synthesizing of DNA that resulted in a much-needed
medication, and animal-based insulin was on its way out.

Physicians are insisting that a less-expensive alternative has
to be found and questioning why a medicine nearing its 100th
birthday is still so expensive.

Hirsch and his colleagues are lobbying hard to end the price
gouging.

"The government is going to have to get involved, and it's going
to get ugly," said Hirsch, who has lived with the disease since
his youth. He was diagnosed with diabetes when he was 6, and his
younger brother was told he had the disease when he was 15.

"The well being of our diabetes patients must come before the
profit-driven games being played over the price of the clear
liquid that keeps them alive," he said.

Andrew Schneider, an award-winning public health journalist, is
based in Missoula.

Comments:

Carolyn Stephens Aug 24, 2016 9:59am
Well, if Montana wasn't known for voting against it's own best
interest, and falling behind every clownish politician who tells
them what they want to hear, maybe, just maybe, Montana wouldn't
be full of jobless, or low wage workers who get their
information from right wing talking heads addicted to Oxycontin,
or lufas.

Report Add Reply
Wally Lindquist Aug 27, 2016 2:34pm
Carolyn you hit the nail on the head

Report Add Reply
Lee Graczyk Aug 23, 2016 11:43am
Thank you for taking the care to report on this issue. Americans
should not have to choose between buy food or paying their
mortgage and buying this life-sustaining medication.

People are taking extreme and sometimes shocking measures to
maintain access to insulin. We have been asking people to send
messages to the top three insulin manufacturers. It’s time to
put pressure on those responsible for these price spikes.
http://www.congressweb.com/RxRights/5

Report Add Reply
Wally Lindquist Aug 21, 2016 8:12pm
People dying and going broke, what is our GOP controlled
congress doing about this crisis? They do not care they have
great healthcare.

Report Add Reply
C Creek Aug 21, 2016 6:17pm
Well, This is one way of over-population Control...are you sure
that Mike Garrity , of Wild Rockies Fame and the Anti-Human
Enviros aren't behind all this????

Report Add Reply
JackO
john obrien Aug 21, 2016 6:26am
"This borders on the unbelievable," (Professor) Davidson said,
citing an extremely concentrated insulin which "in 2001 had the
wholesale price of $45. By last year, the cost had skyrocketed
to $1,447" for the same monthly supply."

"...increases having nothing to do with available supply and not
matched elsewhere in the world".

""We don't know what the benefit manager is paying for the
insulin from the pharma company. It's backroom deals," Hirsch
said. "You can call them rebates, you can call them kickbacks,
you can call them bribes, but those are secret deals on which we
don't have the details."

These are called Non-Disclosure Agreements. It's how the so-
called Free Market is really and truly a manipulated
marketplace. Not free. No information is available for free
market competitive practices because Congressmen such as Steve
Daines and Ryan Zinke pass laws which allow Corporations to put
blindfolds on everyone. That's no exageration... that's a fact.
These same people talk about "Free Markets"... but that is just
the opposite of what they intend.

How do they explain themselves?... that the United States of
America has the most expensive health care in the world because
of these fascist (no exageration there either)... fascist
corporate governance policies.... They blame Obamacare.

This is the perfect marriage of capitalism and corporate run
government. Benito Mussolini had NOTHING on these guys. ... what
they really are is unspeakable. Steve Daines even more than Ryan
Zinke is their boy... but Congressman Zinke als plays into their
hands (perhaps more unwittingly).

http://mtstandard.com/news/local/insulin-price-spike-leaves-
diabetes-patients-in-crisis/article_74cd6b23-7d9d-5f36-9df0-
9c72c5de9f1a.html
 
Ubiquitous
2016-08-30 10:02:07 UTC
Permalink
Post by Bradley K. Sperman
A massive spike in insulin prices is causing a health crisis for
millions of diabetes patients who depend on the lifesaving drug,
doctors say.
Now, after years of rapid increases having nothing to do with
available supply and not matched elsewhere in the world, those
in the U.S. insulin supply chain are blaming each other.
And you posted this off-topic article here because?
--
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