First I'd like to summarize some of that I head from Dr. Irl Hirsch who has had T1 himself since the age of six and he really appreciates the patient perspective. Dr. Hirsch's talk was entitled "Changing Costs of Insulin Therapy." The US insulin market in 2005 was valued at $7.3B but by 2013 the market had grown to over $20B and has a 15% growth rate. There has been and continues to be major growth and presumably profitability in the insulin market. And unfortunately there is not a lot of transparency to costs. Often the prices are based on what is called Average Wholesale Prices (AWP) which is the benchmark used for reimbursement but Hirsch describes that cost as "fraudulent." It is an elevated price and is rarely what is paid. He gave an example of a 49 year old patient who needed 3 boxes of aspart pens and was given the AWP of $1481 but in fact paid $75.
|3 of the 15 Drugs That Had|
Greater Than 15% Rise Are Insulin
|Is There Collusion in the Insulin Market?|
|What Has Happened to U-500?|
And some of what has happened with U-500 may have been intentional manipulation of the market in order to pave the way for new insulin products. Toujeo from Sanofi is a U-300 version of the popular Lantus U-100 with three times as much insulin in each mL. Eli Lilly has also introduced a U-200 version of their Humalog which has twice the concentration of insulin. Unfortunately as I walked the exhibit floor and asked the companies about their pricing each of these products are expected to have the same price per unit as previous products. It seems crazy, the vast majority of pharmaceutical products have very modest price increases for higher dose/concentration products. After all the actual cost of the drug production is a very small part of the cost. None of these products will save costs. In fact they will likely increase patient costs.
Hirsch had only some weak recommendations on how to dig ourselves out of this situation. He recommended that medical residents and fellows be taught how to prescribe human insulin. He thinks patient grassroots advocacy is vitally important by it is really unclear about the role of the ADA and JDRF given their ties to industry. Technically it should be the mission of pharma companies to help patients and cure disease but unfortunately we don't always see them fulfill that mission. There are some organizations that look at how well pharma companies do in supporting access to medicine. One initiative called Access to Medicine rates companies on different factors in providing access.
But in the end, the insulin landscape looks pretty bleak. There is some innovation but it isn't likely to lead to any important improvements in insulin performance and it only likely increase costs. And the continued rise in insulin costs is hugely alarming. While many patients will likely continue to get coverage from insurance and other reimbursements, those costs in the end are passed on to patients and society. I came away from the ADA Sessions feeling like we need to stand up as patients and advocate against unethical and immoral behavior in the marketing of insulin. If we don't do anything who will?