Opinion

On Consumerism: Perilous times for diabetics: Part I of II

By ARTHUR VIDRO
After dining out with me, my friend Doug excused himself and headed for the restroom with a small kit containing a syringe.

Doug is an insulin-dependent diabetic. After each meal, he checks his sugar level and injects insulin as warranted. He and other diabetics need insulin injections to stay alive. Doug, a long-retired schoolteacher, can afford his insulin. But many diabetics can’t.

Not everyone has a quality health plan. Many of us have rinky-dink plans that make the consumer pay the bulk of all costs. Some of us lack insurance.

Meanwhile, the cost keeps going up and up, with no end in sight.

The major newspapers occasionally run stories about diabetics who have died while trying to ration insulin or do without any. It has gotten too expensive for many folks to keep buying.

How expensive is insulin? I asked the neighborhood pharmacist.

Most diabetics, he explained, purchase a box of five insulin pens. Insulin dosage varies from person to person, and even from day to day, based on eating patterns, body size, physical activity, and other factors. But by and large each pen lasts up to a week. The goal is for the five-pen set to last a month.

The pens most frequently distributed by the neighborhood pharmacy are made by Sanofi-Aventis. A person without health insurance would be charged $450 for a box of five pens. That price is dictated by the manufacturer, not the pharmacy.

Let’s do the math. Over a year, that $450 adds up to $5,400. Ouch.

On Dec. 19, pharmaceutical giant Eli Lilly paid big bucks for a full-page ad in the nation’s largest newspapers. It was titled, “To the Millions of Americans Who Rely on Lilly Insulin.” It should have been titled, “We’re Acknowledging an Insulin Problem Exists But Refuse to Shoulder Any of the Blame.”

The ad states: “We’ve heard too many stories about people with diabetes who struggle to afford their insulin. That needs to change. You should not have to ration your treatment, and you should not have to choose between insulin and putting food on the table.”

Makes sense so far.

But then it adds: “We’re starting to see meaningful answers for people who live with diabetes. Payers, for instance, are finding ways to pass rebates on to patients and lower co-pays for insulin. Across health care we need to build on these ideas. For people using Lilly insulin, we have several options for those who need help — such as limiting monthly prescription costs on many insulins to less than $100. We also offer a half-priced authorized generic insulin, some people are eligible for free insulin, and if you have an immediate need and nowhere else to turn, we can help you get insulin right away.”

Nowhere in the ad did Eli Lilly offer to lower its prices. The “payers” it refers to are the health-insurance companies that negotiate as middlemen between consumers and drug manufacturers. A major part of Eli Lilly’s “solution” is to dangle potential rebates to payers and hope the consumer benefits.

As for the ad’s mention of “generic insulin,” my pharmacist says: “Generic insulin is not the equivalent of insulin. A pharmacist cannot substitute a generic.”

Perhaps the ad was prompted by a caravan of West Virginians whose journey for affordable insulin began on Dec. 8. They headed to Canada, where insulin prices are reported to be about a tenth of the cost here.

A few times, I have ordered drugs from Canada when affordable versions were not available locally. But insulin is different. It requires refrigeration to maintain its effectiveness, and thus is not a good candidate for shipping by mail. A delay by Customs could ruin the batch.

Although federal laws prohibit bringing narcotics or other controlled substances across the border, the border guards tend to permit folks trying to bring home a supply of insulin that does not exceed three months’ worth.

It makes sense for Canada to attract insulin purchasers. Most of the groundbreaking work in insulin took place in Canada. One of the co-discoverers of insulin, intent on preventing pharmaceutical companies from turning it into a customer-gouging profit machine, sold his share of the patent to the University of Toronto for $1. He wanted the life-saving medicine to remain accessible.

Perhaps that is why, in Canada, insulin is sold over the counter. No prescription needed.

Historically, insulin remained accessible to Americans. The groundwork for today’s price shocks was laid in around 1980, when synthetic insulin (not extracted from living creatures) began appearing on the market as humulin. Eli Lilly now has the patent on many forms of synthetic insulin and seems determined to milk that cow for all the profits it can get — despite their full-page ads to the contrary.

Big drug companies charge more in America than they charge anywhere else. Yet they still make a profit in every country where they sell medicine.

In the United States, they just reap a much, much larger profit.

To be continued next week.

If you have consumerism questions, send them to Arthur Vidro in the care of this newspaper, which publishes his column every weekend.

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