We’ve all seen the news stories about diabetics who are being charged too much for insulin. Why would a drug company charge so much for something that was discovered more than 100 years ago?
Let’s break it down. First, the insulin developed in 1922 is a vastly different molecule than the molecules treating patients today (when’s the last time you passed a Model T on the highway?). The original insulins were purified from animal pancreases, they were only available in small quantities and were of varying qualities and potency. Early advances included better purification technologies to boost yields; eventually synthetic versions of early insulins were developed, then those were ‘humanized’ to lessen allergic reactions. Today’s insulins more closely resemble human insulin and are designed to be shorter or longer acting as necessary.
Take a look at this five-minute video about the discovery of insulin, its use over the past 100 years, and the ongoing research to develop even better versions for patients.
And here’s a timeline of advances in insulins and insulin delivery — though because it’s from one of the major insulin manufacturers you’ll see only certain brand names here.
Just like today’s new cars aren’t 100 years old just because we had Model T cars way back when, today’s insulins aren’t the ancient discoveries some would make them out to be. And while no one makes cheap Model Ts anymore — or even cheap 1981 Ford Escorts — you can still get some older insulins for very little, it’s just that almost no one wants them. That’s the market’s way of saying that the latest insulin analogs launched most recently are materially better than the insulins first launched in the 1980s.
Even so, the real prices insulin manufacturers charge have been falling for several years. Those falling prices are often masked by the strange trip a drug takes between its manufacturer and the patient. And most insulins on the market should have gone totally generic. Many do have generic/biosimilar equivalents yet drug supply chain middlemen (PBMs, which you’ll learn about in Chapter 7) often make them more expensive to access than branded insulins or prevent access altogether.
We’d argue that no insulin — brand or generic — ought to come at any cost to the patient. While most are available for less than $35 per prescription out of pocket, why bother charging anyone who needs insulin even a modest copay? It’s not like people use it for fun.