In US, di­a­bet­ics turn to black mar­ket or Canada for in­sulin

In US, di­a­bet­ics turn to black mar­ket or Canada for life-sav­ing in­sulin

Muscat Daily - - FRONT PAGE -

On a frosty Jan­uary morn­ing in a Min­neapo­lis sub­urb, Abi­gail Hans­meyer leaves her car engine run­ning and takes out a brown pa­per bag car­ry­ing nee­dles and a vial, hand­ing it over to its re­cip­i­ent in an anony­mous shop­ping cen­tre park­ing lot.

The ex­change is tech­ni­cally il­le­gal, but th­ese aren't il­licit drugs.

In­stead, the vial con­tains in­sulin: A medicine that has since its dis­cov­ery in the 1920s trans­formed a di­ag­no­sis of di­a­betes from a swift death sen­tence to a man­age­able disease.

Yet its price has sky-rock­eted in the US over the past decade, cre­at­ing in­for­mal net­works of people who build up stock­piles and give to oth­ers what they don't need them­selves.

"Thank you so much," says An­nette Gen­tile, 52, as she takes the bag from Abi­gail, check­ing the la­bels and doses. "I've been on a roller coaster in the last few days," she adds, be­cause of her el­e­vated blood sugar lev­els.

An­nette doesn't live in ab­ject poverty. She re­ceives a monthly dis­abil­ity al­lowance of US$1,200 and has pub­lic health in­surance. Cru­cially, how­ever, that in­surance does not cover pre­scrip­tion medicine.

The con­tents of the bag she just re­ceived, which will keep her go­ing for a month, would cost her about a thou­sand dol­lars at a phar­macy. "I purely rely on do­na­tions," she says.

Her 29 year old bene­fac­tor Abi­gail is un­em­ployed and has type 1 di­a­betes, a chronic con­di­tion that ap­pears in child­hood where the pan­creas pro­duces lit­tle or no in­sulin, the hor­mone that lets sugar en­ter cells to pro­duce en­ergy.

People who have it need to in­ject them­selves with in­sulin sev­eral times a day for the rest of their lives.

Both women are part of a group of di­a­bet­ics who con­nect with each over Face­book or text mes­sages to hand out or re­ceive their prized med­i­ca­tion, free of cost, some­times us­ing code words like "life­wa­ter" to evade de­tec­tion.

Nearly all of the stock that cir­cu­lates comes from the rel­a­tives of pa­tients who died.

For Pres­i­dent Don­ald Trump's ri­vals in the Demo­cratic party, who be­gin their pri­mary con­tests on Mon­day in Iowa, there are few scan­dals greater than the price of in­sulin: The epit­ome of phar­ma­ceu­ti­cal price-goug­ing that blights the US health care sys­tem.

"We're not poor," says Abi­gail. Her hus­band works and has started a small busi­ness; she has her own car, and the cou­ple live in a house that pet dogs and rab­bits also call home.

But her hus­band's em­ployer doesn't sub­sidise its work­ers health in­surance. Not poor enough to qual­ify for state in­surance, and not rich enough to buy their own, the cou­ple gave up look­ing in Jan­uary.

They joined the ranks of the 27.5mn Amer­i­cans with­out cov­er­age, pray­ing that no calamity be­fell them.

"My en­tire adult life I've gone in and out of ra­tioning my in­sulin," Abi­gail tells AFP.

A few years ago, when she won a bat­tle against her then in­surer for an in­sulin pump, a com­put­erised de­vice that con­tin­u­ously re­leases the right amount of the hor­mone, she re­mem­bers cry­ing with hap­pi­ness.

Abi­gail acts as a go-be­tween for her com­mu­nity of Min­neapo­lis area di­a­bet­ics, con­nect­ing those in need with those who have. And one of her ma­jor sources is a re­frig­er­a­tor in the base­ment of a house be­long­ing to one Ni­cole Smith-Holt.

Ni­cole opens its door to re­veal a trea­sure trove: Dozens of vials of in­sulin, and a large stock of sy­ringes, test strips and other sup­plies. She guesses its value at around US$50,000.

"It is strictly il­le­gal," she says.

Sell­ing or even giv­ing away pre­scrip­tion medicine is tech­ni­cally a mi­nor crime. But for Ni­cole, it's a cause that is dev­as­tat­ingly close to her heart.

"We don't need an­other Alec," she says, about her late son, who died in June 2017.

Alec Rae­shawn Smith was cov­ered by his mother's in­surance un­til he turned 26, the age up to which in­sur­ers are obliged by an Obama-era law to al­low adult chil­dren to re­main cov­ered by their par­ent's plans.

Af­ter cross­ing that thresh­old, he found him­self un­able to af­ford his own in­surance on his mea­gre salary as a restau­rant worker.

He died 27 days af­ter his in­surance lapsed from di­a­betic ke­toaci­do­sis as a re­sult of a lack of in­sulin.

There was not a drop of in­sulin to be found in his apart­ment, said Ni­cole, but there was ev­i­dence her son had tam­pered with his in­sulin pens to try squeeze out the last bit.

"I think un­til I take my last breath I'll feel a sense of guilt in some sort of way," said Ni­cole. "I wish he would have asked for help."

The death of her son, who was him­self a fa­ther, trans­formed Ni­cole into an ac­tivist. One day she's on tele­vi­sion, the next she's lob­by­ing lo­cal politi­cians, or protest­ing out­side a phar­ma­ceu­ti­cal com­pany.

O Canada

Fur­ther to the north, di­a­bet­ics can look to providers on the right side of the law but the wrong side of the bor­der: Cana­dian phar­ma­cies.

Un­like the US, Canada caps the price of in­sulin. Ev­ery three months, alone or with oth­ers, 47 year old Travis Paul­son makes the two hour drive from Eveleth in north­ern Min­nesota to Fort Frances in Canada's On­tario prov­ince, cross­ing the Rainy River to buy his in­sulin with­out pre­scrip­tion.

Cus­toms agents don't bother him so long as his sup­ply is less than three months' worth.

His in­surance is ex­cel­lent as far as doc­tor vis­its go, but only pays half the price of medicines.

He pulls out two al­most iden­ti­cal vials of in­sulin: one is la­beled NovoLog and costs US$345 in the US, with his in­surance leav­ing him re­spon­si­ble for half the bill.

The Cana­dian vial is sold un­der the brand name NovoRapid, and costs about US$25. The math isn't hard.

"It's phar­ma­ceu­ti­cal greed. It's greed is all it is, sim­ple as that," he says.

A Bernie San­ders sticker on his fridge shows off Paul­son's sup­port for the self-pro­fessed demo­cratic so­cial­ist, who has vowed to cut drug costs in half.

But even that might not be enough to re­duce the ap­peal of his Cana­dian road trips.

My en­tire adult life I've gone in and out of ra­tioning my in­sulin ABI­GAIL HANS­MEYER

It's phar­ma­ceu­ti­cal greed. It's greed is all it is, sim­ple as that TRAVIS PAUL­SON

Abi­gail Hans­meyer (left) gives in­sulin medicine to An­nette Gen­tile (right) on Jan­uary 17, 2020, in Min­netonka, Min­nesota

(AFP photos)

Travis Paul­son stores in­sulin medicine in a box in a cold stor­age base­ment room on Jan­uary 16, 2020, in Eveleth, Min­nesota

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