By Matt Smith
WebMD Health News
Reviewed by Brunilda Nazario, MD
Nov. 8, 2016 -- First, the price of EpiPens drew fire. Now, it's insulin's turn.
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A steady increase in the price of the life-saving diabetes treatment over the past decade has spurred anger among people living with the ailment -- with some lawmakers calling for a federal investigation of the companies that make and sell it.
"We don't want these companies to go out of business. They're manufacturing something that's keeping our children alive," says Nicole Nichols, who started a petition calling on Congress to intervene. "We just want to them realize that while they're taking home billions of dollars -- millions in their CEOs' pockets -- there are middle-class and poor American families who are suffering."
Nichols lives outside Jackson, MS. Her husband and 8-year-old daughter have type 1 diabetes, which requires them to take insulin so their body can process sugar. And she's watched as the price of that drug has climbed steadily. While her daughter's costs are largely covered by the Children's Health Insurance Program, Nichols says that her husband ends up shelling out about $600 a month for his insulin, on top of what they pay for health insurance.
"You can go to Canada and buy a vial of insulin for $35. I can go to Europe and buy a vial of insulin for $35. I can go to Mexico and buy a vial of insulin for $35," Nichols says. We are not the greatest country in the world if our health care is that prohibitively expensive."
About 6 million Americans require daily insulin to manage their diabetes. And the cost of that medication has been climbing since the 1990s, when faster-acting and longer-lasting insulin hit the market. That's put more strain on families and on organizations like the Diabetes Foundation of Mississippi, which tries to help low-income families that struggle with the costs.
"It certainly seems that over the past several years that this has gotten out of control," says Irena McClain, the group's associate director.
Without assistance, the costs of controlling diabetes can run up to $2,500 a month for some, McClain says.
The wholesale price -- what the pharmacy pays the manufacturer -- of a 10-milliliter vial of NovoLog, a fast-acting insulin often used in insulin pumps, went from about $116 in mid-2011 to $264 in July, according to the Elsevier Gold Standard Drug Database, which tracks U.S. drug prices. That's before the drugstore marks it up for retail sales: Those prices are currently running about $300 without discounts, according to GoodRx.com, which keeps tabs on retail prices.
NovoLog is manufactured by Novo Nordisk. Its main rival, Eli Lilly's Humalog, saw a nearly identical jump in wholesale prices over the same period, from just under $116 to $264 So did other common brands, including Sanofi's Lantus and Novo Nordisk's Levemir, both long-acting insulins: Levemir went from $113 to $269, while Lantus jumped from $114 to $248, Elsevier found
These newer insulins are far better suited to patients, allowing them to control their eating schedules and their lives better, Nichols said -- but there are no generics available.
Criticism From Congress
The price hikes have drawn the ire not only of consumers like Nichols, but of lawmakers critical of the pharmaceutical industry. Vermont Sen. Bernie Sanders, the former Democratic presidential hopeful, has said drug companies are making "outrageous" profits while people struggle to pay for their medication.
Sanders and Maryland Rep. Elijah Cummings, the ranking Democrat on the House Oversight and Government Reform Committee, have asked the Federal Trade Commission and the Justice Department to investigate the insulin manufacturers for possible collusion. They point to a pattern of near-simultaneous price increases that have more than tripled prices since 2002. Similar complaints about the price of the EpiPen, the popular epinephrine self-injector used to head off life-threatening allergic reactions, led to the CEO of manufacturer Mylan being hauled before a critical House committee in September.
Drug companies have responded to the complaints by arguing that the spread of high-deductiblehealth insurance policies since the Affordable Care Act passed has left consumers exposed to higher prices that might have been covered by previous plans.
Other critics, including Nichols, blame pharmacy benefit managers -- third-party administrators who handle drug coverage -- for the increases.
Lilly, Sanofi and Novo Nordisk all have patient assistance programs that offer discounts for consumers as well. However, some experts have said those discounts do little to address the overall problem of high drug prices -- insurance companies still pick up the full tab, and they pass those increases on to their consumers with higher premiums.
Novo Nordisk defended its pricing in a written statement, saying it's working to develop "innovative medicines" for people who have diabetes.
"We stand by our business practices and our efforts to improve the lives of patients with diabetes," the company said.
Sanofi, meanwhile, says that Lantus' net price -- what people end up paying -- has actually decreased in the last 5 years because of efforts to remain as the drug of choice for insurance carriers.
"There is strong competition in the marketplace that also factors into how we set the prices of our treatments," the company says. "The suggestion stated in the (Sanders and Cumming) letter is false."
Lilly did not immediately respond to a request for comment.
The Kaiser Family Foundation, which studies health care issues, recently found that drug prices were the top problem on consumers' minds. Democrats, Republicans, and independents across the board supported making sure that people with chronic diseases had affordable drugs, according to an October poll by the nonprofit.
Nichols said she hopes the renewed political pressure will result in some relief. But she adds, "I'm a cynic. So as loud as I'm screaming, I wonder if we're being heard at all."
SOURCES: CDC: National Diabetes Statistics Report, 2014. Elsevier Gold Standard Drug Database. U.S. Sen. Bernie Sanders' office. Kaiser Family Foundation: Kaiser Health Tracking Poll, October 2016. Novo Nordisk statement. Sanofi statement.
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