Diabetes drugs are the most expensive of any major class of pharmaceuticals. But why, and is anything being done about it?
The costs of diabetes drugs may be more debilitating than the disease itself.
Although 29 million people in the United States suffer from diabetes, there seems to be no control over the rising costs of the drugs to treat the disease.
In fact, last year was the fourth year in a row that spending on diabetes drugs was higher on a per-member basis than any other class of drugs, according to a survey by Express Scripts.
“This is a very complex problem,” Dr. Irl B. Hirsch, professor of medicine at the University of Washington Medical Center in Seattle, told Healthline.
Many diabetes patients take several drugs to help control their blood sugar. Manufacturers of those drugs have free reign to put a price tag on their product. But why?
“Because they can, at least in the U. S., and that’s part of the problem,” Hirsch explained. “There is simply no control on what the price is and the implications are significant.”
Christel Marchand Aprigliano is the creator of the diabetes blog ThePerfectD.
Diagnosed with type 1 diabetes 32 years ago, Aprigliano knows firsthand what it is like to bear the burden of high medicine costs.
“For any person with diabetes, navigating the health insurance labyrinth can be frustrating,” she told Healthline.
She said she changes plans each year in accordance to what benefits her wallet the most.
But the drug manufacturers have power over anyone with diabetes.
“Without insulin, bluntly put, we’re dead,” she said. “There is no way to federally regulate or cap the costs of insulin. Those of us who wish to use the best drugs are required to pay the price.”
A Health Care Cost Institute analysis revealed that per capita spending for people with diabetes in 2013 was $14,999. Those without diabetes spent an average of $4,305 per year.
The study collected data from 40 million individuals younger than 65 who had employer-sponsored insurance with one of three large insurers.
Much of what is available for purchase are brand name drugs, but Aprigliano said there are a couple generic drugs that she was offered after her diagnosis three decades ago. Those include ReliOn’s Regular and NPH insulins, both of which are sold by Walmart.
The Pharmaceutical Research and Manufacturers of America (PhRMA) dubs itself as a company that represents innovative biopharmaceutical research and discovery companies.
In its mission statement, PhRMA says it is devoted to advancing public policies in the United States and around the world that support innovative medical research, yield progress for patients today, and provide hope for the treatments and cures of tomorrow.
In a statement given by a company spokesperson to Healthline, the company stressed the value of the drugs.
“It is disingenuous to discuss costs without acknowledging the tremendous value these medicines provide to patients and the healthcare system. Improved treatment options for patients are one of the reasons that death rates for people with diabetes have fallen 40 percent since 1997,” according to the statement.
“It is critical that we maintain a robust ecosystem that fosters and encourages the development of new innovative medicines that have the ability to offer diabetics a way to control their blood sugar and lead a normal, healthy life,” the spokesperson added.
Hirsch concurred with the PhRMA statement that the drugs are getting better, but he said he’s unsure if the drugs are worth their high price tag.
“To be fair, insulins have incrementally improved over the years,” he said. “These small improvements are continuing with newer insulins in development. But are they worth this price?”
“I see people with type 1 diabetes withhold food to ration their insulin better or patients with type 2 diabetes simply not take their insulin at all,” he continued. “There is now a black market for insulin due to the high costs.”
Hirsch mentioned two patients with type 1 diabetes who developed ketoacidosis and would be admitted to an ICU because they couldn’t afford their insulin.
“The real question to me is if providing a life-saving medication to a child or adult with type 1 diabetes should be a right or a privilege,” Hirsch pondered. “Up until now it has been a right. We provide insulin to all walks of life, including prisoners in jail. If insulin is a privilege, perhaps the message is that the prisoner is worth more to our society than the 70-year-old in the doughnut hole, when many beneficiaries are responsible for paying a larger percentage of the cost of their drugs.”
However, Hirsch does see a light at the end of the tunnel that should bring a decrease in the cost of drugs.
“Very soon we will see biosimilar insulins in the U.S., which use live cells. This mandate theoretically should reduce the costs of the insulins,” he said.
The Food and Drug Administration mandated a regulatory pathway for biosimilar drugs to gain approval. Drug experts, according to a Kaiser Health News report, suggest that as insulin patents expire, biosimilar insulins could reduce the price by up to 40 percent.
But the same company will manufacture these new drugs, so the cost could be in question yet again.