Key Findings From The Investigation Into United States Insulin And Drug Costs:
Drug manufacturers “aggressively” raised the list price of their leading insulin brands an average of 300% over the past decade “absent significant advances in the efficacy of the drugs.” As Sen. Grassley remarked, “There is clearly something broken when a product like insulin thats been on the market longer than most people have been alive skyrockets in price.”
Getting on a PBM’s formulary the list of drugs covered by health insurance plans that hire the PBMs is critical to pharmaceutical companies. Thus, the drugmakers offer rebates of as much as 70% of the drug’s list price to the PBMs. While most of the rebate is passed on to health insurers, PBMs keep a certain percentage meaning the higher the drug price the more money the PBMs make. It’s the same incentive for an administrative fee of as much as 5% often collected by PBMs.
In theory, competition drives down prices, as consumers sometimes see in “gas wars” between filling stations on opposite corners. But newly divulged emails from the drug companies show the reverse: Instead of seeking to undercut their competitors’ prices, drugmakers closely monitored what their rivals charged so they could raise their own prices as quickly as possible sometimes matching the competitor’s increase in as little as 25 minutes. This practice is dubbed “shadow pricing.”
Facts about diabetes:
* 7th leading cause of death in America
* More than 34 million Americans have the disease
The Role Of Insurance
The ADAs Insulin Access and Affordability Working Group report found that nearly half of Americans have employer-sponsored health insurance. About 20% are insured through Medicaid, and 14% are insured through Medicare. Approximately 7% of Americans purchase health insurance on their owneither directly from an insurer or through a health insurance exchange. About 9% of Americans remain uninsured.
Diabetes is considered a pre-existing condition. According to research published in Diabetes Care, an estimated 1.9 million uninsured people with diabetes gained insurance coverage after the Affordable Care Act went into effect. More than half of those who gained insurance were low-income.
Still, having insurance doesn’t mean insulin is affordable. Insured patients will often pay a copay or a percentage, rather than the list price, for their insulin. Redmond says that cost could range from $30 to $50.
In cases of high-deductible health plans, patients have to pay the list price for their insulin until their deductible is met, which often translates to thousands of dollars out of pocket. Many patients just have a problem paying that much, says Redmond.
How Much Is A Bottle Of Insulin
The cost of a single vial of insulin varies depending on the type of insulin and whether or not it is covered by insurance. Each insurance plan can cover insulin products differently.
In 2012, the average cost of insulin per diabetes patient was $2,864 per year. By 2016, just four years later, it had risen to $5,705.
Today, one vial of insulin can cost $250 and a pack of pens ranges from $375 to $500. Most patients require two vials of insulin per month or 1-2 packs of insulin pens, but some people need up to six vials per month.
Besides insulin, diabetic patients need other types of medication, which also tend to be high priced. According to a 2016 study, the total average out-of-pocket pharmacy and medical costs for patients with diabetes reached $18,500 in 2016 a surge of $6,000 from 2012 costs, half of which are accounted for by spending on insulin.
As a result of these exorbitant prices, one in four patients say that they ration their insulin because they cant afford full proper doses. In some cases, this practice can cost lives. For patients with type 1 diabetes, just a single day without insulin is enough to send them to the emergency room.
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The Person With Medicaid
For a person with diabetes with Medicaid drug coverage, co-payments are generally limited to a nominal amount for drugs on the preferred drug list. Medicaid drug coverage varies from state to state, however, all states include some insulins on their preferred drug lists. If a Medicaid enrollee needs a medication not on the states preferred drug list, the prescriber can submit a request on his or her behalf stating the medical need for the drug.
The Tragic Deaths From Insulin Rationing
Jeremy Crawford, age 39, Dallas, TX After losing his job and insurance, Jeremy was struggling to afford the insulin he needed to survive. He tried using Walmart insulin but it didnt work well for him. As he got sicker, he resisted calling 911 to get the help he needed because he could not afford it. He died from diabetic ketoacidosis.
Jesimya David Scherer, age 21, Minnesota In addition to managing his diabetes since he was age ten, Jesi worked two jobs to support himself, and was working on becoming an electrician. This year, however, it proved to be not enough, and he began rationing insulin, unable to fill prescriptions until the next payday. He was hospitalized in April with diabetic ketoacidosis. In June, two days after hed last seen his family, he called in sick to work. He was found dead the following day.
Jada Renee Louis, age 24, Virginia A type 1 diabetic since age 7, Jada Louis found herself faced with a terrible choice this year pay her rent or pay the $300 cost of insulin. After rationing landed her in the hospital for a week in June, she returned home in apparent good spirits. But a week later, she was dead. Jada, a lifelong lover of the performing arts, had a job at a local movie theater, but it was not enough to allow her to consistently afford her medications.
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Peopletrying To Water Down Their Medicine
Those who are not as fortunate to have good insurance often with up with Chuck Gehring, president and CEO of LifeCare Alliance, which includes the Central Ohio Diabetes Association.
He sees the diabetics who lack insurance or are stuck with a high-deductible plan. He watches the elderly struggle to keep up with higher insulin payments from their social security checks, especially if they are in Medicare’s “donut hole” a gap in coverage that hits after the recipient has spent a certain amount on prescription drugs.
If you are a family with a child who gets Type 1 diabetes, suddenly you get this bill for $400 or $500 a month, and how are you supposed to handle that? Gehring wonders. Its a house payment almost, or a car payment.
And he’s very aware of the horror stories of diabetics trying to cope.
“What we have seen that people are taking this into their own hands and cutting pills in half, or trying to water down their medicine,” said Gehring, who has been in his post some 19 years.
The COVID-19 pandemic has only made these problems worse. Not only are those with compromised immunity such as Type 1 diabetics more subject to the coronavirus, they are more likely among the low-income or minority communities hit the hardest financially, and thus less able to afford insulin, an American Diabetes Association study showed last July. About a quarter already had used savings, loans or money from stimulus checks to pay for diabetes care.
How To Save On Insulin Prices
Contact your insurance company and find out how your policy pays for insulin. Do they pay more for certain types of insulin? Do they exclude certain types? If their payments or exclusions dont work with what you are taking, talk to your healthcare provider about options. Some insurance companies will accept what is called a prior authorization, which means your doctor writes a letter explaining why you need a specific type of insulin. Find out what your deductible is and how you will need to pay out of pocket. Ask if they have any special programs for insulin, such as the one offered by Cigna.
If paying cash, take advantage of programs offered by pharmaceutical companies, such as the one provided by Sanofi. Add in additional costs of supplies to see what you will need to pay each month.
Look into patient assistance programs offered by most major pharmaceutical companies, like Eli Lilly and Novo Nordisk, and some non-profit assistance programs, such as Rx Hope, that provide prescriptions for free or low cost to low-income and uninsured.
Take advantage of a prescription savings card from Singlecare. Over 35,000 pharmacies accept SingleCare coupons. You can enter your zip code online or on our mobile app to find the pharmacy with the lowest price for your insulin. Then, bring in your prescription and your SingleCare card to receive the discount. Joining SingleCare is free.
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Reasons Why Insulin Is So Outrageously Expensive
20 Jan 2019, 6:08 p.m. in #insulin4all USA by T1International
Why does insulin cost so much to patients in the USA and around the world? Why is insulin, a widely sold drug of which most forms are now off-patent, so incredibly expensive? These are simple questions, but ones with a number of complicated answers. This post will break some of those answers down and point you in the direction further reading if you want to dive deeper.
1. Only 3 Companies Control 90% of the Global Insulin Market
The big three insulin producers Eli Lilly, Novo Nordisk and Sanofi dominate more than 90% of the world insulin market by value. Often only one of these companies supplies insulin in a country, which means they more or less hold a monopoly there and can set prices as they wish. In some countries, notably China and India, there are domestic insulin companies that can help drive down the price. This means we need more companies in markets like the USA to help bring prices down. Well touch on that a bit further down the list.
2. No Generic Insulin
3.Pay-for-Delay Schemes & Lawsuits
6. Price Fixing
These Business Insider graphs pretty much say it all.
7. Pharma Marketing Schemes
8. Payment for Influence
What Can be Done?
I Have Had T1 Diabetes Since The 8th Grade And Have An Extreme Hatred Of
|The Medical, Pharmaceutical, and Insurance Industries for stabbing me in the back and twisting the knife for most of my life, because they have all played a part in the Vulture Capitalism to use me as their golden goose to keep giving them obscene profits. And I resent the hell out of those building their financial portfolios off it, while looking down their fucking noses at my non-existent retirement portfolio as those people snicker at what I don’t have, because of the collateral damage done by that lucrative disease for them that also had to be paid for by me.And then there are the sleazy chicken shit Republicans who put Diabetes on the stock market for the Vulture Capitalists to swarm all over it like piranhas in bloody water, in the first place. I only view all of it as being ‘taxed and penalized’ my entire adult life by all of the above and nothing will ever change my mind, because nobody in the United States will ever remedy the financial damages done to me my entire life. Why? Because stupid ignorant Americans think capitalism destroying me is completely fair and right.|
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What States Have Capped Insulin Prices
Illinois followed in the footsteps of Colorado by signing the bill into law in January of this year. The law for Illinois will not go into effect until January of 2021, though.
Other states have proposed bills or are signing petitions similar to the laws in Colorado and Illinois. These states include Florida, Tennessee, Washington, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, and Wisconsin.
As time goes on, you will see other states across the U.S beginning to head in this direction.
Your Worst Nightmareis That Your Child Is Going To Wind Up With The Same Horrible Illness
The skyrocketing prices for insulin don’t come as a surprise for Mandy Seaton.
The wife and mother who lives on Columbus’ North Side has battled Type 1 diabetes for almost 32 years, ever since spending a week in the hospital when she was 13.
A blood sugar reading of under 140 is considered normal. Hers was 980.
“I was very lucky I didnt go into diabetic ketoacidosis,” Seaton said, citing a sometimes-fatal condition caused by a severe lack of insulin.
Although dealing with a chronic condition is difficult, “its also taught me how to be really strong and have a lot of perseverance and tenacity. I just made up my mind that my diabetes is not going to stop me,” she said.
Seaton lived in South America for 10 months, ran a marathon and traveled to Mongolia.
She said her toughest struggle both physically and mentally came with her pregnancy and delivery of son Ronin, now 9.
“Your worst nightmare is that your child is going to wind up with the same horrible illness you have, the pre-school teacher said.
At first, Ronin had no problems. But when he was 4, his mother recognized the symptoms right away.
Now, mother and son often do their tests and treatments together. Due to recent strides in technology, she and her husband can monitor their son’s blood sugar via their smart phones, even when the third-grader returns to classes this week at Colerain Elementary School.
While things are OK now, Seaton realizes that “in an instant, it could change” if they lose health insurance.
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Continued Innovation For Diabetes Therapies
One issue of importance to people with diabetes is the need for continued innovation in diabetes management and prevention. New technologies, pharmacotherapies, and strategies continue to be needed to prevent the disease, to diminish adverse side effects like hypoglycemia and weight gain, to promote adherence, and to prevent complications. Such innovation would generate substantial value to people with diabetes both now and in the future . One of the best ways to encourage innovation is to better link reimbursement to value . With value-based insurance design, the amount of cost-sharing for a medical treatment or service is set according to its value rather than its cost. Value-based insurance design provides coverage for evidence-based treatments that improve health by lowering or eliminating patient cost-sharing. Efforts to encourage value-based insurance design, wherein cost-sharing is linked to population health outcomes, may improve adherence and lower patient financial burden .
Insulin Makers Middlemen Stonewall Strike Back
“This industry is anything but a free market when PBMs spur drug makers to hike list prices in order to secure prime formulary placement and greater rebates and fees,” Grassley said in a statement.
“Our investigation worked to get to the bottom of this. We found that the business practices of and the competitive relationships between manufacturers and middlemen have created a vicious cycle of price increases that have sent costs for patients and taxpayers through the roof.”
Wyden said, “Insulin manufacturers lit the fuse on skyrocketing prices by matching each other’s price increases step for step rather than competing to lower them, while PBMs, acting as middlemen for insurers, fanned the flames to take a bigger cut of the secret rebates and hidden fees they negotiate.”
The American Diabetes Association notes that determining actual costs to consumers is difficult: “out-of-pocket costs vary depending upon the type of health insurance each individual has and the type of insulin prescribed.”
A study by Ohio-based 3 Axis Advisors of 41,000 prescriptions from more than 1,500 independent pharmacies for a three-pack of Lantus Solostar insulin pens shows an average co-pay of about $34, and a median of about $9, for January through October 2020. About 1 in 12 co-pays topped $110.
J.C. Scott, president and CEO of the Pharmaceutical Care Management Association, the trade group representing pharmacy benefit managers, said in a statement:
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Insulin Prices Are Dramatically Higher In The United States Than In Other Countries
TuesdayOctober 6, 2020
Insulin prices are more than eight times higher in the United States than in 32 high-income comparison nations combined, according to a new RAND Corporation study.
The study compared how much different types of insulin sold in the United States would cost if bought at prices in other countries. The average price per unit across all types of insulin in the United States was $98.70. Other countries would have paid a fraction as much for the same insulins.
U.S. prices were higher than each of the 32 comparison countries individually, ranging from 3.8 times higher than those in Chile to 27.7 times those in Turkey. U.S. prices were 6.3 times higher than those in Canada, 5.9 times higher than those in Japan and 8.9 times higher than those in the United Kingdom.
The study used manufacturer prices for the analysis. The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the United States because rebates and other discounts often drive down the price paid by individuals in the United States.
But even if such rebates and discounts drive down prices by as much as 50%, the prices paid by U.S. consumer are likely to be four times the average paid in other high-income nations, according to the study.
The study was sponsored by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services.
Robin Feldman Professor Of Law Uc Hastings College Of Law San Francisco
One would have to see how these orders were implemented to know how powerful and effective they will be.
We are still seeing many struggle in clinical practice with affordability, says Redmond. So it is unclear to most healthcare providers who gets these insulin cap benefits. Even myself as an expert would really love any more guidance on this. There are eligibility requirements that many patients still dont meet.
As with any legal order, the devil’s in the detail, Robin Feldman, Arthur J. Goldberg Distinguished Professor of Law at UC Hastings College of Law San Francisco, tells Verywell. One would have to see how these orders were implemented to know how powerful and effective they will be. We are, however, going to need some systemic changes to try to address the problems that are driving drug prices higher in general, and insulin prices higher specifically.
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