Insulin: A Uniquely American Problem

Posted at 10:05 PM on Apr 3, 2023


Authors: Grace Shults, Jakob Cisco, and Lauren Reynolds, President, National Student Advocacy Committee (NSAC). NSAC brings together student advocates across the country to build support for and further Prescription Justice’s legislative and policy agenda to end the crisis of high drug prices.


The NSAC authors are proudly responsible for their own content.


When looking at the history of insulin, it feels impossible to imagine that the cost of the medication would be such a problem today. Following the Inflation Reduction Act and reaction from private companies, some progress has been made in making insulin affordable to Americans, but considering how the discovery of insulin unfolded it is outrageous where we ended up in America.


In 1921, in Canada, Frederick Banting, John Macleod, Charles Best, and James Collip began experimenting with methods to remove insulin from the Pancreas. In January of 1922, Insulin was used to treat someone with diabetes for the first time. In 1923, Banting, Collip, and Best were awarded U.S. patents for Insulin. The patents for insulin and its production were then sold to the University of Toronto for $1 each, the equivalent of around $17 today. Banting justified their decision with the quote: “Insulin does not belong to me, it belongs to the world.”


For those with Type 1 Diabetes, a lack of insulin can rapidly lead to Hyperglycemia. Insulin helps sugar enter cells to be turned into fuel. When sugar is unable to enter cells, the body is forced to turn body fat into an acid called Ketones. These ketones can build up in the bloodstream and create diabetic ketoacidosis or DKA. Without treatment, DKA leads to death. For those with Type 2 Diabetes or early onset Type One, the potential effects of having insufficient insulin levels may take months to take effect. For those with traditional Type One Diabetes, sickness can take place within days to weeks.


In 2022, 1.3 million Americans were forced to ration their Insulin due to the high costs of the drug.


The disparity between the intentions of Banting, Collip, and Best for the cost of insulin and the current cost of insulin in the U.S. can be attributed to the greed of pharmaceutical companies.


A uniquely American problem among rich countries.


Negative health effects of diabetes where patients do not have access to affordable insulin are a worldwide problem. Among high income countries, however, Americans are disproportionately hurt by the costs of insulin. The average cost of insulin in 2000 was $19 per unit. By 2022, the cost had skyrocketed making the average annual cost of Insulin around $6000. The discrepancy with Canada shows how exorbitant the U.S. prices are. According to proceedings of the Mayo Clinic,The average American insulin user spent $3490 on insulin in 2018 compared with $725 among Canadians.” More broadly, the cost of Insulin in the United States is 4.5 times higher than the country with the second highest costs.


Capping insulin cost to $35 per month is only a partial victory


Fortunately, some policymakers are starting to turn things around but we have a long way to go.


In February of 2022, Senator Raphael Warnock introduced the Affordable Insulin Now Act. While this legislation did not pass, certain provisions were in the Inflation Reduction Act. The result is a $35 a month cap for Medicare beneficiaries, mostly older Americans. Unfortunately, policies to implement a price cap in the private market have still not passed Congress.


As of January 1, 2023, the Medicare Insulin price cap is now in effect. While this is a great step in the right direction, there is an important fact to remember: many people who need insulin are not covered by Medicare.  In fact, according to the American Diabetes Association, 32.7% of diabetics who need Insulin are covered by private insurance or uninsured entirely. This ends up excluding around 21 million Americans from the reduced price.


Insulin is not the only cost borne by people with diabetes


Insulin, while essential for those living with diabetes, is not the only medical cost those affected face. Between 2012 and 2017 the cost of living with diabetes increased by 26%. For them, 30% of medical costs are taken up by prescription drug prices and 30% to hospital inpatient care. With these increased costs of living with Diabetes, in 2017  those diagnosed spent an average of 2.3 times more on medical expenditures than they would have without Diabetes. Considering the already exorbitant prices of insulin, the cost of living with Diabetes is nearly unbearable.


As of March 1, 2023 the pharmaceutical company Eli Lilly has decided to cut the out of pocket costs for their Insulin to $35 a month for everyone. David A. Ricks, Eli Lilly's Chair and CEO, is calling for policymakers to push for legislation that will make insulin affordable for everyone regardless of insurance coverage.


On the heels of the Inflation Reduction Act and Lilly’s decision to reduce their prices, Prescription Justice urges Americans to push for more. Urge representatives from each district to place insulin prices at the top of their agendas; not just for those covered by Medicare, but also those covered by private insurance. ALL Americans who need insulin deserve affordable access, regardless of their insurance status. Together, we can make that happen.


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