Executive summary
According to the Health Care Cost Institute (HCCI), in 2016, the annual cost of insulin for a patient with type 1 diabetes amounted to $ 5,705, which is almost twice as high as in 2012 – $ 2,864 (Hargraves & Frost, 2017). As a result, some patients put their own health at risk. According to experts from the Yale Diabetes Center in New Haven, many people with diabetes are forced to reduce their intake of insulin-containing drugs due to their high cost. One in four diabetic patients took less insulin than doctors recommended due to the high price of the drug, which led to an increased risk of complications compared to those who used insulin-containing drugs regularly (Herkert et al., 2019). Inappropriate insulin intake in people with type 1 diabetes can be fatal, and in the case of type 2 diabetes, patients may have an increased risk of long-term complications (blindness, kidney failure, nervous system problems, and amputation).
Introduction
In recent months, it has become common in the United States that people with diabetes have reduced insulin intake because of its high cost. At the same time, daily insulin consumption increased from 2012 to 2016 by only 3% (Hargraves & Frost, 2017). The drugmakers say they need to periodically raise prices to offset the significant discounts they offer to buyers under their health plans. The current analysis looked at data from 15,000 patients with type 1 diabetes who were prescribed insulin at least once a year. As a result, it was found that from 2012 to 2016, the average price of insulin increased from 13 cents per unit to 25 cents. For an average patient, using 60 units per day, the daily cost increased from $ 7.8 in 2012 to $ 15 in 2016.
The study by Herkert and colleagues involved 199 patients with type 1 or type 2 diabetes. Of these, 51 people (25.5%) admitted to using less insulin due to financial difficulties (Herkert et al., 2019). Thirty-one patients who had reduced their insulin intake reported this to their doctor, and 15 of them switched to another less expensive drug. In patients who reduced the consumption of insulin-containing drugs, a deterioration in blood glucose levels was recorded.
According to the forecast of researchers from Stanford University, the number of people with type 2 diabetes who need insulin-containing drugs in the world will increase by about 79 million people by 2030, which will lead to a sharp increase in the need for insulin (Basu et al., 2019). The experts reviewed data from the International Diabetes Federation and 14 separate cohort studies, affecting more than 60% of people with type 2 diabetes worldwide. As a result of the analysis, it was found that the number of such patients will grow from 405.6 million in 2018 to 510.8 million in 2030 (at least by 20%). Given these data, it is estimated that the average amount of insulin used annually will increase from approximately 516.1 million packs of 1,000 vials to 633.7 million over 12 years.
Approaches
The price that the end consumer pays depends mainly on insurance coverage, so the price level is regulated not so much by the market as by the manufacturers themselves, especially since there are three major players in this market in the US – Sanofi, Novo Nordisk, and Eli Lilly. In addition to the main links in this chain (patient, pharmacy, insurance company, pharmaceutical manufacturer), it should also be remembered that insurance companies use intermediaries, drug benefit managers. Therefore, it is not surprising that experts consider the lack of transparency in mutual settlements to be part of the problem with this system (Conner et al., 2019). Plus, unlike many other countries, the US gives pharmaceutical companies the freedom to set prices. Thus, today Eli Lilly, Novo Nordisk, and Sanofi control 96% of the global market (Conner et al., 2019). The lack of competition has led to higher prices, which has created a problem of access to these drugs both in the United States and abroad, analysts say (Conner et al., 2019). Until a truly competitive market exists, it is difficult to say a fair price for this drug.
Conclusion and Recommendations
To address this issue, legislation needs to be passed to reduce the cost of prescription drugs. The government should also make changes to the insulin production process. It is also essential to keep an eye on the players in the market. It is possible and necessary to increase their number, but at the same time, the quality of the generics produced should be monitored very carefully. Since the rise in prices is essentially the initiative of producers, an important step towards solving the problem is the introduction of a price regulation policy.
References
Basu, S., Yudkin, J. S., Kehlenbrink, S., Davies, J. I., Wild, S. H., Lipska, K. J.,… & Beran, D. (2019). Estimation of global insulin use for type 2 diabetes, 2018–30: a microsimulation analysis. The Lancet Diabetes & Endocrinology, 7(1), 25-33.
Conner, F., Pfiester, E., Elliott, J., & Slama-Chaudhry, A. (2019). Unaffordable insulin: patients pay the price. The Lancet Diabetes & Endocrinology, 7(10), 748.
Hargraves, J., & Frost, A. (2017). Price of insulin prescription doubled between 2012 and 2016. Healthcare Cost Institute. Web.
Herkert, D., Vijayakumar, P., Luo, J., Schwartz, J. I., Rabin, T. L., DeFilippo, E., & Lipska, K. J. (2019). Cost-related insulin underuse among patients with diabetes. JAMA internal medicine, 179(1), 112-114.