America’s Insulin: Oxygen with a Price

By Lily Wolfson ’21

Insulin is sold in Tijuana, Mexico for a fraction of the U.S. cost (Photo Credit: Escondido Grapevine)

In 2018, 10.5 percent of the American population had diabetes, according to the American Diabetes Association.

There are two types of diabetes: Type 1, which accounts for between 5 and 10 percent of people with diabetes, and Type 2, which accounts for between 90 and 95 percent of people with diabetes. Type 1 diabetes is an autoimmune disease that prevents the pancreas from producing insulin, so people with Type 1 diabetes need to take insulin, while people with type 2 diabetes do not always need to take insulin. Taking insulin, for people with diabetes who rely upon it, is equally as important as breathing oxygen.

Roughly 7.4 million Americans with diabetes use at least one form of insulin, and as many as one in four people with diabetes who rely on insulin are forced to ration their supply due to insulin’s unaffordability in the United States. People with diabetes either take their insulin or they die, so rationing their supply has proven an untenable option.

Insulin has been around for nearly a century and has hardly changed in the last twenty years. Prices, however, have changed dramatically. In the United States, in 2001, a vial of insulin cost $34.80. In 2019, that same vial had a going rate of $275. A box containing five pens of Tresiba has a going rate of $500 in the United States. In Spain, that exact same box is sold for five euros—$6.00.

This disparity does not occur by chance: outside of the United States, insulin prices are negotiated by the government. In the United States, private payers and manufacturers determine insulin prices.

The American system of negotiating insulin prices allows for American pharmaceutical companies to randomly increase rates to line their own pockets. By making minor adjustments to formulas or packaging, companies like Sanofi, Eli Lilly, and Novo Nordisk have the power to extend patents, restrict and prevent more affordable generics, and heighten prices with no one to regulate them. Insulin prices are heightened for what pharmaceutical companies call “safe harbor regulations.” These “safe harbor regulations” defend, essentially, illegal kickbacks between omnipotent pharmaceutical companies and benefit managers. Ultimately, the price for kickbacks becomes a burden for someone with diabetes.

Insulin is an essential for which no substitute exists, but many cannot afford it in the United States. Americans with diabetes have been forced to discover a cheaper alternative: buying insulin in Tijuana, Mexico. Tijuana has ubiquitous pharmacies that sell up to $10,000 worth of insulin for between 5 and 10 percent of American retail prices.

The trek to Tijuana can be arduous and inconvenient, and sometimes the listed expiration date of the insulin is unreliable. Americans with diabetes who seek another cheap option resort to apps like OfferUp and Instagram to trade diabetes supplies, which offer a wide selection. Unfortunately, because the insulin is dealt with via social media rather than through a doctor or pharmacy, it has proven to be unsafe and inconsistent.

Many representatives have suggested that people with diabetes should simply “go to the emergency room” if the need for insulin is truly grave, but people with diabetes can take up to ten shots of insulin per day. Are these representatives suggesting that people with diabetes permanently move into the emergency room?

In 2019, Congress began to investigate the rapidly rising costs of insulin, but an investigation is a far cry from tangible legislative change. Such change was possibly hindered because pharmaceutical companies like Eli Lilly tend to be big donors to congressional re-election campaigns. Per the nonpartisan Center for Responsive Politics, pharmaceutical companies spent more than any other industry on lobbying between 1998 and 2005—roughly $900 million. In 2019, Statista revealed that the pharmaceutical industry lobbying group spent about $295 million, rendering pharmaceutical companies a highly coveted supporter in elections.

On February 28, 2019, the Insulin Price Reduction Act was introduced in the Senate. This legislation would incentivize America’s insulin makers to lower their prices to the listed 2006 price, $68 per vial. While the Insulin Price Reduction Act is a start, many argue that the price remains nonsensical. Advocates for lower insulin prices assert that if insulin itself has not gone through any major changes in twenty years, the prices should be far lower than they were twenty years ago.

Under this proposed legislation, the price of a vial would be double the 2001 price. Many suspect that the new price was decided in an effort to appease pharmaceutical companies; the backlash would recede, but the prices would still remain higher than they were in 2001. Members of Congress will have to decide what is more urgent and ethical: retaining the support of pharmaceutical companies or making legislative change for the lives of millions of Americans who rely upon insulin.