Insulin prices have doubled but the drug has not changed

The same vial of insulin cost twice as much in 2016 as it did in 2014, according recent figures.

As drug companies block generic drug-makers and push one another’s prices up, insurers raise premiums to keep up. 

Desperate families are buying and bartering insulin online when they can no longer afford it. 

Lawmakers and patients have accused drug companies of colluding, but the prices for life-saving insulin have only continued to climb.  

The average price of insulin surged upward from $344 a month in 2014 to $666 in 2016, according to the Health Care Cost Institute 

Price hikes for insulin are nothing new. Between 2002 and 2013, the prescription’s cost tripled.

Insulin’s steady inflation is driven by a combination of drug companies’ ‘price-shadowing,’ improvements to the drug and competition-deterring patenting practices.  

Today, a one-month prescription costs $666 without insurance, according to data from the Health Care Cost Institute (HCCI), a sum that’s triggered outcry from US lawmakers who suspect drug company collusion.

The entire original patent for insulin was sold for $3 in 1923. A month’s supply of the essential drug now costs 222 times that.

An estimated 1.15 million people in the US have been diagnosed with type 1 diabetes. These peoples’ pancreases are unable to produce insulin, which breaks down carbohydrates and makes sugar useful to the body’s metabolism, on their own.

To maintain healthy blood sugar levels, people with type 1 diabetes must have shots of synthetic insulin.

Another 21.9 million people have type 2 diabetes. If lifestyle changes such as weight loss and improved diet and exercise habits do not improve their conditions, they may eventually need insulin as well.

The drug was originally derived from animals, but for the last several decades, advancements in genetically engineered drugs have allowed scientists to hone the synthetic to be more like the real thing.

Now, most insulin is made from E. coli bacteria.

As the technology has improved, it has also become more widespread. In basic economics, competition typically drives prices down, but the pharmaceutical industry works a little differently.

Drug companies get patents on their products, giving them exclusive rights to the formula for 20 years.

Once a patent expires, generic drug companies can make their own, cheaper version.

Liquid gold: Diabetes patients cannot go without insulin, and drug companies keep prices high by making continual, minor changes to their formulas for the drug 

Liquid gold: Diabetes patients cannot go without insulin, and drug companies keep prices high by making continual, minor changes to their formulas for the drug 

But there’s a catch. If a pharmaceutical company can make improvements to their drug that are small enough for it be functionally the same, but just significant enough to be called ‘novel’ by the patent office, they can effectively get a new patent on an old drug.

The practice, called patent ‘ever-greening,’ allows companies to keep raising or at least maintaining prices, and pushes their competitors to do the same. Each time these companies get a new patent, they push back the date when generic companies will be allowed to make their versions. 

In the mean time, three major pharmaceutical companies – Eli Lilly, Sanofi and Novo Nordisk have been playing constant catch up with one another’s prices. 

Patients and regulators have taken note that shortly after one company’s version of insulin becomes more expensive, the others quickly follow suit. 

In response, insurance companies shuffle around which company’s insulin they cover.  

Some families have taken matters into their own hands, resorting to buying insulin on a black market insulin or looking to match with families for a trade of their respective covered covered kinds of insulin in private Facebook forums. 

In January, a group of patients filed a class action lawsuit against the three main insulin producers for colluding to increase prices for the live-saving drug. 

A year ago, Senator Bernie Sanders and Representative Elijah Cummings wrote to a the Department of Justice and Federal Trade Commission calling for investigations of the same three companies. 

Earlier this month, President Trump nominated Alex Azar to be the next Secretary of the Department of Health and Human Services, hailing him as a ‘star’ for bringing down drug prices. 

Azar has said that getting costs under control will be a top priority, but his previous post as CEO of Eli Lilly – the first of the three major insulin makers – has generated doubt from some. Others have outright blamed him for being the first to triple insulin prices.

There may be some hope for diabetes sufferers, as patents for some of the earliest long-lasting forms of insulin are approaching their expiration dates, and generics will be able to make substitutes.