{"id":1608,"date":"2020-03-26T09:50:04","date_gmt":"2020-03-26T16:50:04","guid":{"rendered":"http:\/\/mydiabeticsoul.com\/?p=1608"},"modified":"2020-03-26T09:55:48","modified_gmt":"2020-03-26T16:55:48","slug":"why-does-insulin-cost-so-much","status":"publish","type":"post","link":"http:\/\/mydiabeticsoul.com\/?p=1608","title":{"rendered":"Why Does Insulin Cost So Much?"},"content":{"rendered":"<div class=\"details\">\n<h3 class=\"clear-fix\"><a href=\"https:\/\/www.t1international.com\/blog\/2019\/01\/20\/why-insulin-so-expensive\/\">&#8220;8 Reasons Why Insulin is so Outrageously Expensive&#8221;<\/a><\/h3>\n<h5 class=\"post-date\">20 Jan 2019, 6:08 p.m. in <a href=\"https:\/\/www.t1international.com\/blog\/category\/usa-insulin4all\/\">#insulin4all USA<\/a> by T1International<\/h5>\n<h5 id=\"share-buttons\"><a href=\"https:\/\/plus.google.com\/share?url=https:\/\/www.t1international.com\/blog\/2019\/01\/20\/why-insulin-so-expensive\/\" target=\"_blank\" rel=\"noopener noreferrer\"> https:\/\/www.t1international.com\/blog\/2019\/01\/20\/why-insulin-so-expensive\/<\/a><\/h5>\n<div id=\"glitter_column_content\">\n<div class=\"glitter_page_blocktype_redactor glitter_page_block_first glitter_page_block glitter_page_block_odd glitter_page_block_last \">\n<p>&#8220;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.<\/p>\n<p><strong>&#8220;1. Only 3 Companies Control 90% of the Global Insulin Market <\/strong><\/p>\n<p>&#8220;The \u2018big three\u2019 insulin producers \u2013 Eli Lilly, Novo Nordisk and Sanofi \u2013 dominate more than <a href=\"https:\/\/www.t1international.com\/blog\/2015\/12\/16\/how-do-we-improve-affordability-insulin\/\" target=\"_blank\" rel=\"noopener noreferrer\">90% of the world insulin market<\/a> 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. We\u2019ll touch on that a bit further down the list.<\/p>\n<p><strong>&#8220;2. <\/strong><strong>No Generic Insulin<\/strong><\/p>\n<p>&#8220;When it comes to the question of generic insulin, we are faced with another complicated issue. Insulin is a therapeutic biological product (or &#8216;biologic&#8217;), rather than a <a href=\"https:\/\/www.fda.gov\/drugs\/developmentapprovalprocess\/howdrugsaredevelopedandapproved\/approvalapplications\/therapeuticbiologicapplications\/ucm113522.htm\" target=\"_blank\" rel=\"noopener noreferrer\">chemically synthesized molecule<\/a>. This means it cannot be made as generic in the same way as other drugs. Creating what is called a biosimilar is a lot more complicated and expensive than just duplicating a chemical molecule. There is little market incentive to produce biosimiliars because it costs nearly as much as making new drug, and companies must go through all the approval stages and trials that a new drug is required to go through. Not to mention, current biosimilar insulins on the market \u2013 primarily produced by the \u2018big three\u2019 \u2013 have only reduced the price by about 10-15%. For more on biosimilars and the 2018 FDA announcement read <a href=\"https:\/\/www.t1international.com\/blog\/2014\/11\/20\/whats-deal-generic-insulin\/\" target=\"_blank\" rel=\"noopener noreferrer\">this<\/a> and <a href=\"https:\/\/www.biopharmadive.com\/news\/how-a-regulatory-dead-zone-may-be-holding-up-copycat-insulin\/545121\/\" target=\"_blank\" rel=\"noopener noreferrer\">this<\/a>.<\/p>\n<p><strong>&#8220;3.<\/strong> <strong>Pay-for-Delay Schemes &amp; Lawsuits<\/strong><\/p>\n<p>&#8220;A \u2018Pay for delay\u2019 agreement is a patent dispute settlement in which a generic (in the case of insulin, a biosimilar) manufacturer acknowledges the original patent of a pharmaceutical company and agrees to refrain from marketing its product for a specific period of time. In return, the company receives a payment from the patent-holder. This means it is actually legal for one insulin producer to pay another one not to enter the market. A few years ago the company Merck announced plans to sell a biosimilar version of Sanofi\u2019s Lantus. <a href=\"https:\/\/www.wsj.com\/articles\/sanofi-files-suit-against-merck-on-patent-infringements-1474285467\" target=\"_blank\" rel=\"noopener noreferrer\">Sanofi sued<\/a>, and eventually Merck <a href=\"https:\/\/bioprocessintl.com\/bioprocess-insider\/global-markets\/merck-drops-lantus-biosimilar-blames-pricing-and-production-cost-concerns\/\" target=\"_blank\" rel=\"noopener noreferrer\">announced<\/a> that it was no longer pursuing it\u2019s biosimilar, presumably due to payments from Sanofi to stay away. If Pay for delay schemes don\u2019t work, the \u2018big three\u2019 can still <a href=\"http:\/\/www.pmlive.com\/pharma_news\/sanofi_fires_off_another_lawsuit_against_a_lantus_biosimilar_1136351\" target=\"_blank\" rel=\"noopener noreferrer\">sue other players<\/a>, prolonging processes and pushing players out of the market because of legal fees and time-wasting. All of these are win-wins for companies, and lose-lose for patients.<\/p>\n<p><strong>&#8220;4. Patents <\/strong><\/p>\n<p>&#8220;Why aren\u2019t we seeing more companies making insulin? There are many reasons for this, but patent evergreening is a big one. Patents give a person or organization a monopoly on a particular invention for a specific period of time. In the USA, it is generally 20 years. Humalog, Lantus and other previous generation insulins are now off patent, as are even older animal based insulins. So what\u2019s going on? Pharmaceutical companies take advantage of loopholes in the U.S. patent system to build thickets of patents around their drugs which will make them last much longer (evergreening). This prevents competition and can keep prices high for decades. Our friends at <a href=\"https:\/\/www.i-mak.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">I-MAK<\/a> recently showed that Sanofi, the maker of Lantus, is no exception. Sanofi has filed <a href=\"https:\/\/www.t1international.com\/blog\/2018\/11\/01\/sanofis-lantus-overpatented-and-overpriced\/\" target=\"_blank\" rel=\"noopener noreferrer\">74 patent applications<\/a> on Lantus alone, that means Sanofi has created the potential for a competition-free monopoly for 37 years.<\/p>\n<p><strong>&#8220;5. Politics<\/strong><\/p>\n<p>&#8220;Companies are not in the habit of throwing money away, and they are not in the habit of staying out of politics. Eli Lilly, Novo Nordisk, and Sanofi collectively rake in several billions of dollars in profits. That\u2019s not millions, but billions \u2013 with a B. We know they spend millions on marketing, but they also spend <a href=\"https:\/\/www.pharmaceutical-technology.com\/news\/us-pharma-lobbying-spend-surged-25-4m-2017\/\" target=\"_blank\" rel=\"noopener noreferrer\">millions on lobbying<\/a> politicians and donating to our decision-makers so that they keep quiet about price gouging. <a href=\"https:\/\/www.opensecrets.org\/industries\/recips.php?cycle=2018&amp;ind=H04\" target=\"_blank\" rel=\"noopener noreferrer\">Check<\/a> if your representatives receive contributions from one of the \u2018big three\u2019 insulin manufacturers or any pharmaceutical company. Chances are, they do. Not to mention, the revolving door between pharma companies and US Government positions. Our current secretary of Health and Human Services was previously <a href=\"https:\/\/www.thenation.com\/article\/alex-azar-trumps-hhs-pick-has-already-been-a-disaster-for-people-with-diabetes\/\" target=\"_blank\" rel=\"noopener noreferrer\">an Eli Lilly executive<\/a>. Obviously, his interests are not with people, but with power. This is why independent patient voices are so important.<\/p>\n<p><strong>&#8220;6. Price Fixing<\/strong><\/p>\n<p>&#8220;These\u00a0<a href=\"https:\/\/www.businessinsider.com\/rising-insulin-prices-track-competitors-closely-2016-9?r=UK\" target=\"_blank\" rel=\"noopener noreferrer\">Business Insider<\/a> graphs pretty much say it all.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/www.t1international.com\/media\/assets\/image\/insulin_increase_lock-step.png\" \/><\/p>\n<p>Several lawsuits alleging some form price-fixing are currently in the works. You can read more <a href=\"https:\/\/www.t1international.com\/blog\/2017\/01\/30\/patients-vs-pharma-hagens-berman-files-complaint-against-eli-lilly-novo-nordisk-and-sanofi\/\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a> and <a href=\"https:\/\/uk.reuters.com\/article\/us-minnesota-lawsuit-insulin\/minnesota-accuses-insulin-makers-of-deceptive-drug-pricing-idUKKCN1MQ2OA\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a>.<\/p>\n<p><strong>&#8220;7. Pharma Marketing Schemes<\/strong><\/p>\n<p>&#8220;Physicians in the United States and some other countries are allowed to collect fees from pharmaceutical companies for talks, advice, and more. Supposedly, these are to compensate physicians for their expertise and time. However, they can create loyalty to a company and may influence prescribing habits \u2013 a belief shared by some pharmaceutical <a href=\"http:\/\/www.cafepharma.com\/boards\/threads\/tresiba-lot-of-hype-high-price-and-not-more-effective.508890\/page-3\" target=\"_blank\" rel=\"noopener noreferrer\">salespeople<\/a>. In some countries like India, physicians are allowed to sell and profit off insulin directly through patients, or through pharmacies they themselves own, cutting out middlemen and the retail pharmacies. Thus, they lose the incentive to find the lowest price insulin for their patients. Insulin companies also focus on \u2018insulin-starts\u2019, or the insulin the physician diagnosing patients begins with. As patients are reluctant to change, a number of marketing and financial incentives are employed to <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5321364\" target=\"_blank\" rel=\"noopener noreferrer\">influence<\/a> this decision.<\/p>\n<p><strong>&#8220;8. Payment for Influence (or Silence)<\/strong><\/p>\n<p>&#8220;Many major key opinion leaders, influencers, and patient advocacy organizations take pharma cash. For example, the two biggest diabetes organizations \u2013 The American Diabetes Association and The Juvenile Diabetes Research Foundation \u2013 have <a href=\"https:\/\/khn.org\/patient-advocacy\/\" target=\"_blank\" rel=\"noopener noreferrer\">accepted huge sums<\/a> from insulin manufacturers. Other groups were actually created by money from the \u2018big three\u2019, like the World Diabetes Foundation which is funded by Novo Nordisk, and other supposed advocacy groups that are actually doing pharma\u2019s bidding, or at least are highly influenced by them. If this issue is important to you, check the funders of an organization you want to support, and if it\u2019s not transparent, you can ask if they take industry money.<\/p>\n<p><strong>&#8220;What Can be Done?<\/strong><\/p>\n<p>&#8220;Patients are speaking out about these issues all around the world. In the USA where prices have skyrocketed especially, T1International Chapters are being formed where patient advocates are educating and pushing for policy change. You can learn more about Chapter <a href=\"https:\/\/www.t1international.com\/insulin4allchapters\/\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a> and find more information and action related to the insulin price crisis <a href=\"https:\/\/www.t1international.com\/usainsulin4allaction\/\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a>. Whatever you do, wherever you are \u2013 don\u2019t stay silent.&#8221;<\/p>\n<p>For the complete informational article, please click on this link: https:\/\/www.t1international.com\/blog\/2019\/01\/20\/why-insulin-so-expensive\/. Thank you!<\/p>\n<p>Gosh, what a mess! I am T1D. I know the pains. Just sharin,&#8217; once again. #buckroth<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>&#8220;8 Reasons Why Insulin is so Outrageously Expensive&#8221; 20 Jan 2019, 6:08 p.m. in #insulin4all USA by T1International https:\/\/www.t1international.com\/blog\/2019\/01\/20\/why-insulin-so-expensive\/ &#8220;Why does insulin cost so much to patients in the USA and around the world? Why is insulin, a widely sold &hellip; <a class=\"more-link\" href=\"http:\/\/mydiabeticsoul.com\/?p=1608\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[6,287,311,57],"class_list":["post-1608","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-buckroth","tag-insulin-prices","tag-pharmaceuticals","tag-t1d"],"_links":{"self":[{"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=\/wp\/v2\/posts\/1608","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1608"}],"version-history":[{"count":4,"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=\/wp\/v2\/posts\/1608\/revisions"}],"predecessor-version":[{"id":1612,"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=\/wp\/v2\/posts\/1608\/revisions\/1612"}],"wp:attachment":[{"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1608"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1608"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/mydiabeticsoul.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1608"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}