In­sulin prices in­flict cri­sis on di­a­bet­ics

Those whose lives de­pend on drug strug­gle to pay for it

USA TODAY International Edition - - FRONT PAGE - Shari Rudavsky

IN­DI­ANAPO­LIS For the first two decades Jes­sica Price had di­a­betes, she never wor­ried about the price of her in­sulin and sup­plies, be­cause her mother’s in­sur­ance cov­ered the cost. Then she switched to her em­ployer’s high-de­ductible in­sur­ance plan.

Sud­denly, she faced bills of a few thou­sand dol­lars each time she went to the phar­macy to pur­chase her sup­plies for the next three months.

“It’s never a ques­tion of if I’m go­ing to hit my de­ductible but a ques­tion of how quickly can I hit it,” said Price, who works for a non-profit group and has found her­self hav­ing to bor­row from her par­ents to help with the bills. “If I don’t hit my de­ductible un­til June or July, I start to worry.”

His­tor­i­cally, get­ting in­sulin did not re­quire those with di­a­betes to ded­i­cate en­tire pay­checks. But the in­crease in high-de­ductible in­sur­ance plans, cou­pled with a steadily in­creas­ing price of the medicine, has left many pa­tients scram­bling for the in­sulin they need to sur­vive.

“It’s an es­ca­lat­ing cri­sis,” said Ge­orge Hunt­ley of the Na­tional Di­a­betes Vol­un­teer Lead­er­ship Coun­cil and a long­time ad­vo­cate for peo­ple with di­a­betes. He was di­ag­nosed with Type I di­a­betes in 1983 at age 20.

Re­search sug­gests 57% of peo­ple who use in­sulin in the USA face pay­ing list price for their sup­ply at some point dur­ing the year, said Hunt­ley, who is based in In­di­anapo­lis.

Of the 6 mil­lion peo­ple in the

USA who de­pend on in­sulin, about 1.25 mil­lion have Type I di­a­betes, a con­di­tion in which their pan­creases don’t pro­duce the hor­mone in­sulin, ac­cord­ing to the Amer­i­can Di­a­betes As­so­ci­a­tion.

The re­main­der have Type II di­a­betes and take in­sulin to help out their bod­ies, which do not pro­duce suf­fi­cient in­sulin on their own.

One of the newer types of in­sulin saw 24 price in­creases from 2001 to 2014, from $44 to about $300, said Wil­liam Her­man, pro­fes­sor of in­ter­nal medicine at the Univer­sity of Michi­gan, who has writ­ten about the chang­ing cost of the drug.

Of­fi­cials from Eli Lilly, which man­u­fac­tures in­sulin, ac­knowl­edged that the cost of in­sulin is a real prob­lem that touches peo­ple ev­ery day. They said the an­swer may not be as easy as sim­ply low­er­ing the price of the drug, and the so­lu­tion does not rest on their shoul­ders alone.

“It’s a com­plex prob­lem to solve,” said Mike Mason, vice pres­i­dent of Lilly Di­a­betes. “When you take a look at our prices, our list prices have gone up, but our net re­al­ized prices have gone down.”

One fac­tor be­hind the ris­ing costs has been the ar­rival of a next gen­er­a­tion of in­sulin, so­called ana­log or syn­thetic in­sulin that one day could re­place its less ex­pen­sive pre­de­ces­sors, hu­man or an­i­mal in­sulin. Though pre­vi­ous-gen­er­a­tion in­sulins re­main on the mar­ket, the newer drugs do a bet­ter job of keep­ing blood su­gar con­stant.

Peo­ple with di­a­betes have taken sev­eral steps to en­sure they have enough in­sulin. Some rely on sam­ples from their doc­tor’s of­fices. Oth­ers use ex­pired drugs. Face­book groups have arisen to con­nect those who have ex­tra in­sulin with those in need. Peo­ple liv­ing near the Canada bor­der may go abroad to buy sup­plies.

Many, in­clud­ing Price, try to limit their use of the life­sav­ing drug as much as they can.

“You start in­sulin ra­tioning, which can be dan­ger­ous, but it comes down to: I’ve got to make this in­sulin bot­tle last,” Price said.

Those on high-de­ductible plans of­ten have very dif­fer­ent ex­pe­ri­ences in large part be­cause of a com­pli­cated dance be­tween phar­ma­ceu­ti­cal com­pa­nies, in­sur­ers and third-party phar­macy ben­e­fit man­agers, who ad­min­is­ter pre­scrip­tion drug plans.

Con­sider a drug with a list price of $100, Mason said.

The com­pany might of­fer a 70% re­bate, which would lower the price to $30.

If a pa­tient had a tra­di­tional in­sur­ance plan, the co-pay might be $25, and the in­sur­ance com­pany would kick in the re­main­ing $5. The drug com­pany would re­ceive $30.

High-de­ductible plans, in which em­ploy­ers aim to de­fray some of the money they spend on in­sur­ance, up­end that equa­tion. The pa­tient no longer has ac­cess to the re­bate and has to pay the full $100. The drug com­pany still gets $30 and now the in­surer in­stead of pay­ing $5 gets $70.

“Why has the list price risen? One of the big­gest driv­ers is that they started play­ing this re­bate game. (Phar­macy ben­e­fit man­agers) are not ne­go­ti­at­ing for low­est price, they’re ne­go­ti­at­ing for the re­bate,” Hunt­ley said. “No­body cared un­til the pa­tient starts pay­ing list price at the cash reg­is­ter.”

Di­a­betes ad­vo­cates call for more trans­parency across the sys­tem.

Hunt­ley’s group started a cam­paign to per­suade em­ploy­ers to make in­sulin ex­empt from the de­ductible.

En­sur­ing peo­ple have ac­cess to in­sulin could save money in the long term by help­ing to stave off more costly health emer­gen­cies, he said.

“If we can get enough of them to do it, per­haps that will be­come the nor­mal plan de­sign. I do be­lieve there is a need to fix the trans­parency for the unin­sured,” he said.

MICHELLE PEMBERTON/INDYSTAR

Jes­sica Price says sup­plies to treat her di­a­betes, which in­clude in­sulin, can cost her $500 a month out of pocket.

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