Here & Now

The High Cost of Insulin

Frederica Freyberg:

This month, the governor signed an executive order creating a task force on reducing prescription drug prices in Wisconsin. Tonight, we have an inside look at how for diabetics the cost of life-saving insulin has gone through the roof more than tripling since 2002. For patients in Wisconsin, new legislation, even apart from the task force, could provide hope for curbing those costs. As Marisa Wojcik reports from Appleton, that would be welcome news for a woman there who cannot afford the high price of insulin sold in the United States.

Julia Flaherty:

I would do 267 minus 125 which is where I like to be. It’s my good target number and then I divide by 35.

Marisa Wojcik:

25-year-old Julia Flaherty has gotten good at mental math.

Julia Flaherty:

Yeah, I’ll do that in my head. It’s just like brushing my teeth. It’s become second nature. I hope I have good blood sugar. I’m a little high right now actually.

Marisa Wojcik:

Before every meal, she calculates what’s in the food she’s about to eat and how much fast-acting insulin she’ll need to give herself. Julia has Type 1 diabetes, a disease she’s been living with since she was ten years old.

Julia Flaherty:

I realized that even at ten, I was going to have to be very responsible and very aware of my body.

Marisa Wojcik:

She lives in Appleton and works as a digital marketing specialist, a steady job that includes health insurance benefits. Even so, the price of living with diabetes adds up.

Julia Flaherty:

I go to see my endocrinologist. That’s about $500 visit each time.

Marisa Wojcik:

There’s a different kind of mental math that Julia’s gotten good at.

Julia Flaherty:

$300, $200, $315, $75.

Marisa Wojcik:

By far the most cost prohibitive is the life-saving drug that regulates her diabetes: insulin.

Julia Flaherty:

For 90 days of Humalog, it would cost about $1800 in the U.S. whereas the same exact medication from Canada is about $315 for me. There’s no premium insulin. There’s no generic.

Marisa Wojcik:

In the United States, reports show the cost of insulin has tripled since 2002. While Julia gets some help from her insurance plan, she has a very high deductible, which means most costs come out of her pocket.

Julia Flaherty:

We don’t have a choice. We have to buy it or we die.

Marisa Wojcik:

All Type 1 and some Type 2 diabetics need insulin. Without it they face serious health risks, including death. But despite the serious dangers, a recent Yale study says one in four diabetes patients reported rationing their insulin due to high costs. For some diabetics including Julia, they’re turning to Canada for cheaper prescription drug prices.

Julia Flaherty:

I was kind of skeptical about it for a while. I was looking into if there was any legal implication or ramification that could come back at me.

Marisa Wojcik:

It wasn’t an easy process.

Julia Flaherty:

I had to go through a lot of forms and back and forth with the nurses and my doctor, but they were willing to work with me on that. So I was very appreciative. But that’s not a solution, you know. It’s a work-around.

Marisa Wojcik:

But new state legislation is hoping to change that. Modeled after a recent bill passed in Colorado, a Wisconsin Democratic bill aims to place a cap on the price of insulin insurance co-pays at $100 per month. So far the bill has no Republican support. The Wisconsin Association of Health Plans has said they’re still reviewing the proposal, but said, “Drug manufacturers are responsible for setting and regularly increasing the high list price for insulin. This proposal does nothing to address the actual and unsustainable price of insulin.” But Julia is still encouraged. She supports the cap and is using her digital marketing background to bring awareness online.

Julia Flaherty:

I would like to see costs be more affordable and accessible despite your socioeconomic status, not just in Wisconsin, but across the United States. There are petitions going up state by state every day on websites like change.org. I’m happy that the conversation is stronger around it. But this is really just the beginning.

Marisa Wojcik:

Reporting from Appleton, I’m Marisa Wojcik.

Frederica Freyberg:

To dig into the challenges people with diabetes face, as well as how legislation might curb the cost of insulin, we turn to Dr. LaShawn McIver of the American Diabetes Association, who joins us from Pennsylvania. And thanks very much for doing to.

LaShawn McIver:

Thank you for having me.

Frederica Freyberg:

How concerning is it to you that people with diabetes might be rationing their insulin because of the high cost?

LaShawn McIver:

It’s extremely concerning. This is something that we hear now almost on a weekly basis from our constituents, that people are having to ration their insulin, go without their insulin or make hard life choices regarding utilities and housing expenses and other expenses for daily living because of the high cost of insulin. In addition, there are life-threatening consequences associated with a person not taking their medication as prescribed.

Frederica Freyberg:

Why is the price of insulin increasing so much?

LaShawn McIver:

So that’s something that the American Diabetes Association took a very long look at. In 2017, our board of directors commissioned a work group to study and examine what are the issues driving the high cost of insulin. And from that project, we learned that there are many things that are contributing to it, but one of the big issues we walked away from or conclusions is that there’s a lack of transparency in the insulin supply chain. What we do know is the high list price for insulin, it creates incentives throughout the insulin supply chain. So the higher the list price, the more that’s shared throughout the insulin supply chain. So we are hopeful that the state and federal bills that are addressing insulin pricing will help bring transparencies to the issue but more importantly reduce the cost for people with diabetes.

Frederica Freyberg:

As for the high cost, insurance companies we understand are kind of pointing the finger at drug manufacturers. Should the drug manufacturers be the ones held accountable?

LaShawn McIver:

You know, when we did our project, what we found is that there’s a lack of transparency. So every stakeholder within the insulin supply chain said another entity was responsible for the high cost. But, as I said, there’s an incentive for a high list price, where that benefit is shared throughout. So we’re hoping through transparency we can understand where are areas that we can put forth long-term solutions to reduce the price of insulin.

Frederica Freyberg:

Julia in Appleton whom we just heard from said while she buys her insulin from Canada, she believes it’s not a long-term solution. Why wouldn’t that be?

LaShawn McIver:

So not everyone has the means to travel outside the country to try and solve this issue. What we’re focused on at the American Diabetes Association is solving this problem within our country. As you mentioned, Colorado and now Wisconsin are looking at solutions that would lower the cost of insulin for people with diabetes and that’s what we want to focus on, is how can we make insulin more affordable for people in the United States.

Frederica Freyberg:

All right. Thank you so much for your time, Dr. Mclver.

LaShawn McIver:

Thank you.