Patents and pharmacy benefit managers are part of the reason diabetes medication prices keep going up.
Almost everyone seems to agree that prescription drug prices are too high.
On Monday, House Democrats announced they have begun an investigation into the pricing practices of the pharmaceutical industry.
This came less than a week after Democratic leaders unveiled a multi-pronged legislative effort to reduce drug prices.
For his part, President Donald Trump last year introduced his plan to deal with what he called the “unfair practices” of the drug companies.
The cost of prescription medication can be burdensome to even people who take drugs occasionally or for short periods of time.
The impact, however, can unrelenting for people with diabetes who must take medication every day to keep their disease in check.
Here’s a look at two of the drugs that can break the bank for people with diabetes and how these medications got to be so expensive.
Manufacturers of insulin have been under scrutiny for soaring prices — even on drugs that have existed for nearly two decades.
This includes Lantus insulin, which has seen a 49 percent increase in price, according to a recent study from the University of Pittsburgh.
“These types of insulin have been around for a while,” said Inmaculada Hernandez, PhD, an assistant professor at the university and a lead author of the study. “Whereas the original patent for Lantus expired in 2015, dozens of secondary patents prevent competition, and it is this lack of competition that allows manufacturers to keep increasing prices much faster than inflation.”
The study examined the list price for thousands of drugs. They found that the brand-name of oral medications increased by 9 percent and injectable brand-name drugs increased by 15 percent.
The specialty versions of oral medications have seen a 21 percent increase, and 13 percent for injectables, according to the study.
For people with diabetes and the medical professionals who treat them, the cost of adequate healthcare has become alarming.
“I have a 32-year-old male patient with type 2 diabetes,” explained Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York as well as at Fifth Avenue Endocrinology. “He’s on metformin, Jardiance, and Ozempic, as well as an older mixed insulin.”
This patient’s HbA1c is still 12 percent, putting him at severe risk for diabetes complications.
Sood said she desperately wants to put him on newer insulins for more intentional dosing around meals rather than outdated mixed insulins that simply don’t cover his insulin needs properly.
“Mixed insulins are not state-of-the-art endocrinology care,” Sood told Healthline. “Ideally, he would be on a continuous glucose monitor and multiple daily injections of a long-acting insulin and a rapid-acting insulin to better cover his needs.”
When she wrote him a prescription for long-acting insulin Tresiba, and rapid-acting insulin NovoLog, they quickly discovered his out-of-pocket costs would total $600 per month just for insulin.
“I can’t ask him to spend that much of his paycheck on insulin when he has bills to pay and mouths to feed,” said Sood. “I’ll go above and beyond to get my patients samples of insulin so they have access to what they need, but that’s not a sustainable long-term plan.”
Sood and her team were able to get the patient a co-pay card from Novo Nordisk that would provide insulin at no cost for two years because of his income level.
“But what happens after two years? Is he forced to go back to the dark ages and use inadequate older insulins?” Sood asked.
Sood said she can’t blame her patients who struggle to improve their blood sugar levels when they can’t get access to the medications they truly need.
The design of the U.S. healthcare system, she said, “is making an already insurmountable problem completely impossible.”
Sood points to metformin as another example of the effect of drug prices on people with diabetes.
Metformin — a generic diabetes medication that is one of the most prescribed drugs on the planet — can cause significant stomach distress in many patients.
For some, this means it isn’t possible to continue taking it.
One brand name version of metformin — Glumetza — has proven effective for patients with type 2 diabetes and does not cause digestive issues, but it costs $5,000 per month.
“I have yet to find a patient who takes Glumetza who doesn’t tolerate it,” Sood said. “It’s the best-tolerated version of metformin out there and it is nearly inaccessible.”
Sood adds that out of the 6,000 diabetes patients she treats, she can count on one hand the number of times an insurance company has been willing to cover Glumetza.
“It’s 2019,” said Sood. “This is the United States. This whole system is ludicrous. And those who are most affected — patients and doctors — have the weakest voices in the system.”
“As a doctor who prescribes insulin,” explained Sood, “I can tell you that when a patient is told by their insurance they must switch to a new medication or get their prescriptions from somewhere like Express Scripts, it’s all a veil.”
The veil, she said, is a coverup for a game that ensures pharmacy benefit managers (PBMs) and pharmaceutical companies profit as much as they can.
“If those middle player PBMs weren’t there, there would be potential for things to improve,” said Sood.
“PBMs are absolutely part of the problem,” added Marina Tsaplina, a patient activist, scholar, and the lead artist at Reimagine Medicine at Duke University. “There are three PBMs who have 75 percent of the market, and it’s a huge concentration and abuse of power.”
Tsaplina said she wants “to see a healthcare system that delivers the promise of care for all of us.”
Tsaplina says there are four trusted organizations that do not accept funding from Big Pharma and advocate for a more honest, affordable healthcare system.
- Patients for Affordable Drugs
- T1International and its #insulin4all hashtag in social media
- Right Care Alliance
- The CREATES Act
These organizations are pushing on various fronts via activism, increasing understanding in patient and doctor communities, and working with legislators to support bills.
“Any attempt for true genuine care has obstacle over obstacle,” said Tsaplina. “It’s a big hill and we are a lot of ants.”
Ginger Vieira is an expert patient living with type 1 diabetes, celiac disease, and fibromyalgia. Find her diabetes books on Amazon and her articles on Diabetes Strong. Connect with her on Twitter and YouTube.