Rising insulin, drug costs aren’t slowing down — even amid virus pandemic

Michael Costanzo, a Colorado farmer diagnosed with multiple sclerosis in 2016, has a well-honed ritual: Every six months, he takes an IV infusion of a medicine, Rituxan, to manage his disease, which has no cure. Then he figures out how to manage the bill, which costs thousands of dollars.

For a time, the routine held steady: The price billed to his health insurance for one infusion would cost $6,201 to $6,841. His insurance covered most of it, and he paid the rest out of pocket.

But last fall the cost for the same 20-year-old drug and dosage jumped to $10,320, even under the same insurance. “Why does it have to increase in price all of a sudden?” said Costanzo, who lives in a small town about 50 miles north of Denver. “I think greed is a huge problem.”

As drug prices escalate, politicians in Washington and states have sought to address the problem in limited ways, focusing mostly on insulin, which more than 7 million Americans rely on to manage diabetes and whose price more than doubled from 2012 to 2017.

With comprehensive drug price legislation stalled in Washington during the covid-19 emergency, seven states have enacted insulin payment caps of less than $100 per month. In March, President Trump’s health officials announced a Medicare test project limiting seniors’ monthly out-ofpocket costs to $35. In July, he signed multiple executive actions targeting insulin and a handful of other medications, boasting “it’s going to have an incredible impact.”

Insulin took center stage last year, after emotional demonstrations to lawmakers by mothers who had caravanned to Canada to buy lifesaving medicine for their children at a tenth of the U.S. price.

As price of insulin soars, Americans caravan to Canada for lifesaving medicine

Those measures have not solved the far more widespread pricing problem that voters, left and right, say Congress must fix.

Underlying the problem is that lawmakers have been at loggerheads about whether the government should have the power to set prices or limit price increases. Prospects for comprehensive legislation slipped away this spring as Congress turned its focus to the pandemic that has killed more than 194,000 Americans and tanked the economy.

So lawmakers played whack-a-mole by targeting insulin. But patients like Costanzo - and millions more - struggle evermore to afford unchecked increases for drugs treating HIV/AIDS, depression, asthma, autoimmune disorders, Type 2 diabetes and other diseases.

A 2019 survey from the Scripps Research Translational Institute published in the Journal of the American Medical Association found that the costs of 17 top-selling branded drugs more than doubled from 2012 to 2017. Many are household names: Lipitor and Zetia for cholesterol, Advair and Symbicort for asthma, Lyrica for pain and Chantix for smoking cessation.

“The general public doesn’t realize this is happening with all sorts of drugs,” Costanzo said. “We’re all suffering from increased prices.”

Insulin was a natural poster child for pharmaceutical greed, encapsulating America’s problem with high prices in a neat package.

“You have an illustration of the problem - politics gone awry and capitalism gone awry,” said Celinda Lake, a veteran Democratic pollster. “They think of it as being emblematic of everything that’s going on with the system.”

Three companies dominate the market for the diabetes treatment with essentially the same formula as when it was introduced in the 1920s. Not taking insulin can quickly turn fatal. In 2017, Minnesota resident Alec Smith died at age 26 after rationing insulin because he couldn’t afford it.

People dying “is what it takes for Congress to actually commit money and act, and then we solve these problems eventually,” said Andy Slavitt, who was acting head of the Centers for