Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What’s behind the rising cost of insulin?

Peter Ubel, MD
Meds
June 15, 2016
49 Shares
Share
Tweet
Share

She drew the life-saving medication into the syringe, just 10 cc of colorless fluid for the everyday low price of, gulp, several hundred dollars. Was that a new chemotherapy, specially designed for her tumor? Was it a “specialty drug,” to treat her multiple sclerosis? Nope. It was insulin, a drug that has been around for decades.

The price of many drugs has been on the rise of late, not just new drugs but many that have been in use for many years. Even the price of some generic drugs is on the rise. In some cases, prices are rising because the number of companies making specific drugs has declined, until there is only one manufacturer left in the market, leading to monopolistic pricing. In other cases, companies have run into problems with their manufacturing processes, causing unexpected shortages. And in infamous cases, greedy CEOs have hiked prices figuring that desperate patients would have little choice but to purchase their products.

Then there’s the case of insulin. No monopoly issue here — three companies manufacture insulin in the U.S., not a robust marketplace, but one, it would seem, that should put pressure on producers. No major manufacturing problems, either. There has been a steady supply of insulin on the market for more than a half-century. And there haven’t been any insulin company executives I know of who have been hustled in front of grand juries lately.

Yet insulin prices are rising to dizzying heights. In 1991, according to a recent study in JAMA, state Medicaid programs typically paid less than $4 for a unit of rapid acting insulin. After accounting for inflation, that price has quintupled in the meantime.

What explains the gravity-defying cost of insulin? I am not an expert on pharmaceutical pricing, but a few factors go a long way to explaining insulin prices. First, the insulin marketplace has been characterized by continual product upgrades. You see, there’s not just one chemical that makes up all insulin products. Instead, insulin treatments are a family of products, each with slightly different chemical makeup that influences things like how quickly the medicine is absorbed into the blood stream. Manufacturers have been toying with insulin molecules since at least 1936, when the manufacturer added protamine to insulin molecules to extend the duration of the chemical’s activity. In the 1960s, companies began synthesizing insulin, rather than harvesting it from pancreatic tissue. In the late 70s, they began producing insulin through genetic engineering.

So when I said that the price of insulin had quintupled over the decades, we have to keep in mind that today’s insulin is not the same as yesterday’s.

Newer forms of insulin are more expensive than older ones. Consider this figure, from the JAMA study mentioned above. It tracks how much money state Medicaid programs have been paying for insulin over the past 25 years. Two things to note in this picture. The line on top, the higher-priced insulin products, tend to be newer products. Just as importantly, both lines are moving up, meaning that the inflation adjusted price of both new and old drugs is rising over time:

Heres-Why-Some-Generic-Medications-Are-Too-Expensive

In other words, the newness of some insulin products does not fully explain this steep climb in insulin prices. Then what else contributes to such prices hikes?

As I mentioned above, the figure represents the price that Medicaid programs have been paying for insulin over the years. For some reason, Medicaid programs aren’t negotiating effectively with insulin manufacturers. I expect that programs face pressure from patients and providers to make sure all insulin formulations are covered. In some cases, in fact, they’re required to keep certain products on the market. Some states are small enough that they don’t have much leverage over the companies. And I expect many state legislatures are pressured by industry to pay robust prices for these products.

I’m eager to hear if any of my readers have further insights into this price problem. But from what I can tell, the bottom line is this: State Medicaid programs need to play hardball in negotiating insulin prices.  With three companies in the market, and plenty of effective insulin formulations available to patients, they should be willing to walk away from the table when companies refuse to budge on prices.

I recognize that switching insulin products will be a burden for patients. But that’s the price we have to pay to avoid having to pay such a high price for insulin.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Image credit: Shutterstock.com

Prev

The tears flow after chemotherapy

June 15, 2016 Kevin 1
…
Next

Why it takes more than doctors to fix medical errors

June 15, 2016 Kevin 9
…

Tagged as: Diabetes, Endocrinology

Post navigation

< Previous Post
The tears flow after chemotherapy
Next Post >
Why it takes more than doctors to fix medical errors

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

Related Posts

  • The cost of drugs confounds this gastroenterologist

    Michael Kirsch, MD
  • Why you shouldn’t be happy with $137 insulin

    Elisabeth Rosenthal, MD
  • The cost of avoiding cost: a medical student’s perspective

    Palak Patel
  • Generics aren’t going to help the cost of chemotherapy drugs

    Peter Ubel, MD
  • Is this cost-saving Medicare proposal doomed?

    Martha Rosenberg
  • A call for cost transparency

    Mukul Mehra, MD

More in Meds

  • Levamisole is good for your dog, but bad for your cocaine

    Robert Killeen, MD
  • 13.1 million missing Americans since 1980. Where’s the outrage?

    Steve Burgess, MD
  • Ketamine for mental health conditions: What every primary care physician needs to know

    Carlene MacMillan, MD & L. Alison McInnes, MD
  • Learn to be a Narcan hero: a comic tutorial

    Emily Watters, MD
  • The preference for insurance coverage of opioids over non-pharmaceutical options explained

    Amy Baxter, MD
  • A comic reveals the terrifying truth about fentanyl

    Emily Watters, MD
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician return-to-work policies

      Deepak Gupta, MD | Physician
    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
    • How my patients’ Zoom backgrounds made me a better doctor

      Joseph Barrera, MD | Physician
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
    • Innovations in surgical education [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 12 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Mortality Risk From Damaged Bronchi Extends to People Without COPD
  • ChatGPT Improving, but Still Lacks Reliability as a Clinical Support Tool
  • COVID Vax in Pregnancy Protects Young Infants Against Omicron
  • Repeat Tests for Inflammation Aid Prognosis After Acute Heart Failure
  • FDA OKs Another Injectable for Rare Kidney Disorder

Meeting Coverage

  • Hot Flashes: Precursor to Alzheimer's Disease?
  • SABR Offers New Hope for Older Patients With Inoperable Kidney Cancer
  • Menopausal Women With Obesity Endure Worse Symptoms, Less HT Relief
  • Study Pinpoints Growing Use of Cannabis to Manage Menopause Symptoms
  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician return-to-work policies

      Deepak Gupta, MD | Physician
    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
    • How my patients’ Zoom backgrounds made me a better doctor

      Joseph Barrera, MD | Physician
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
    • Innovations in surgical education [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What’s behind the rising cost of insulin?
12 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...