The number of people living with diabetes today is four times higher than it was a generation ago. That’s 422 million adults worldwide as of 2014, according to a report out this week by the World Health Organization. The WHO report cites lack of affordable insulin as one reason why diabetes patients worldwide are suffering complications or dying prematurely.
According to an analysis in the Journal of the American Medical Association, the price of insulin has tripled from 2002 to 2013.
“There have been 13 price increases since 2009 in the long-acting insulin analogs in the US,” says Bill Herman, an author on that study and professor of internal medicine and epidemiology at the University of Michigan. “And the price of the insulin analogs is really very much out of keeping with other — both European countries as well as countries around the world.”
Herman says the price increase has a lot to do with how insulin has developed. Insulin was discovered in the 1920s and for 50 years was produced from animals. By the mid-1970s, however, scientists developed human insulin by splicing the human insulin gene into yeast and bacteria. With that development, the price of insulin increased. Then, in the 1990s, animal insulins went off the market, and many began using a new form of insulin — insulin analogs. Now 90 percent of American diabetics use insulin analogs.
“With the shift to the use of analog insulins, the prices have increased dramatically,” Herman says, “For analogs from $35 a vial now, to approximately $150 a vial for the short-acting insulin analogs, and pushing $300 dollars a vial for the longer-acting insulin analogs.”
The development in insulin analogs has provided some benefits to people with diabetes. Herman says short-acting analogs better mimic insulin secretion in response to food, and long-acting analogs better mimic basal insulin secretion. But Herman wonders how to weigh the benefits against the drastically increased cost.
“We definitely see people cutting back or skipping doses of insulin because they can't afford it,” Herman says. “It's well known that insulin is lifesaving for people with type one diabetes. And appropriate insulin treatment for anyone with diabetes can prevent blindness, kidney failure, amputations and cardiovascular disease, reduce mortality and in fact save costs.”
The relationship between pharmacy benefit managers and large insurance companies also means that insulin prices are often higher for those who can least afford the treatment.
“The cost to the pharmacy benefit managers is often substantially less than an individual without insurance who has to go to a local pharmacy to get a bottle of the insulin,” Herman says. “So there's really a lack of transparency in insulin pricing, which really is an issue of equity. The people least able to afford insulin often end up paying the highest price.”
Herman says he can think of at least two measures that would help bring down the outsized price of insulin.
“I think we need to call for greater transparency in insulin pricing,” Herman says. “I think it would also help for people and physicians when possible to use alternate preparations of insulin for their patients who require insulin. Perhaps human insulins rather than the analog insulins for patients with uncomplicated type two diabetes.”