The American Insulin Crisis – Winchester, TN?

September 19th, 2019 by Attorney John Colvin


Part II- The American Insulin Crisis

Multiple stories by The Washington Post and other media outlets have reported on the high cost of insulin being a life-saving medication whose price is skyrocketing, which is causing some desperate diabetics to start rationing and risking their lives due to unaffordability of this life-saving medication. While the opioid crisis was fueled by both generics and name brand drugs, the insulin crisis is created by Big Pharma’s reluctance to bring down the cost and develop safe and effective generics that are just as effective for diabetics.

Many type I diabetics reach a crisis stage when they come off their parent’s healthcare insurance and are trying to gain independence on their own and are unable to afford a health plan in the Marketplace that will keep insulin costs in check. One such example given by The Washington Post in its January 7, 2019 article is a young man that purchased a plan under the Healthcare Marketplace set up by the Affordable Care Act that only gave him options that were expensive. If he kept going to the same doctors, he was looking to pay about $450 monthly in addition to a high deductible of more than $7,000, which means paying out-of-pocket for most of his medical care. As a result, the young man decided to go without insurance, foregoing the expense to focus on paying for his insulin and supplies until he could find a better option. Unfortunately, the young man made a dangerous gamble that had life-threatening consequences. Within one month of going off his parent’s policy, he was dead.

Insulin in its various manufactured forms has been used to treat diabetes for almost a century. Before insulin was discovered, type I diabetes was fatal. Even when put on special diets, patients only lived for a few years. Surprisingly the researchers that developed the diabetes treatment won the Nobel prize and sold their patent to the University of Toronto for a mere $3. They hoped their discovery was a great gift for humanity; however, by the 1920’s insulin had become a commercial enterprise wherein Big Pharma jumped onto the profit machine that insulin could provide their shareholders. In 1996, when Eli Lilly debuted its Humalog brand of insulin, the list price of a 10 ml vial was a mere $21. Today the price of the same vial is now $275. The global insulin market is dominated by three companies, Eli Lilly, Sanofi, and Novo Nordisk. All three have raised their list prices to similar levels. For example, Sanofi’s popular insulin brand Lantus, which was $35 a vial when it introduced in 2001 is now $270. Novo Nordisk’s Novolog was priced at $40 in 2001 and as of July of 2018 is $289.

There is no denying that there is a soaring price of insulin that has overtaken the healthcare community, and diabetics are the ones suffering.  More than 7 million diabetic American’s who take insulin are stuck with debilitating cost. Many have taken caravans to Canadian pharmacies wherein they can secure a prescription that would cost $1,500 in America for a mere $300 plus $50 in shipping. While it is illegal to import medication from other countries, the Food & Drug Administration generally does not prosecute individuals if it’s a short-term supply for personal use. Much like the opioid crisis, America is starting to experience an insulin crisis due to the greed and profit-driven business models that have been pursued by Big Pharma and its allies.

Individuals who cannot afford insulin are left with rationing their supply to make it last longer which is a dangerous practice. Skimping on insulin can lead to someone having poor glycemic control that can lead to blindness, kidney failure, amputation, heart disease, and stroke. Individuals who stop taking enough insulin in the short-term can also lapse into diabetic ketoacidosis – a condition where blood sugars get too high and the body’s blood becomes acidic. Such a condition can become fatal in just a few hours or mere days. While many Americans are misinformed about the difference between Type I and Type II diabetes, there is a general mindset among the American public that people can control their blood sugar by just diet; however, this is not true for Type I diabetics.  A Type I diabetic’s lifeline is insulin. Without insulin, Type I diabetics cannot survive.

Many blame the current insulin crisis on the broken healthcare system, unaffordable health insurance as being too high, and out-of-pocket costs driving many from proper healthcare; however, when comparing the insulin crisis to that  of the opioid crisis, one common factor that comes into focus is Big Pharma preying upon people with medical conditions that are in need of appropriate healthcare.  The high cost of insulin is prompting many to ask whether a moral obligation exists in the corporate realm. Many say insulin is just like oxygen. Is it morally right for a corporate business model to profit off of what many consider to be oxygen when the true cost is questionable when considering the same insulin cost in Canada and countries within the European Union? When drug companies place profits over health and safety, the injured, disabled, and society’s most vulnerable are those who suffer.

However, there might be light at the end of the tunnel and the corporate mindset could be shifting. The cover article in the September 2019 Fortune magazine poses the question, “Profits and Purpose: can big business have it both ways?” The Fortune conversation article detailed a possible new purpose for corporations that has been announced by the business roundtable on August 19th, 2019, stating that a new purpose for corporations has been outlined and the old purpose has been put into the dustbin. Many say the old purpose was summarized by Milton Friedman, a Nobel Economist who wrote in 1970 that “there is one and only one social responsibility of business” and that is “to engage in activities designed to increase its profits.” Hence, a corporation’s job is to make money for shareholders. Interestingly one of the contributors to the Fortune Conversation in the September 2019 magazine article was Alex Gorski, the CEO of Johnson & Johnson, whose company is being taken to task for the recent opioid crisis and also was hit with a $572 million-dollar verdict in Norman, Oklahoma, as being responsible for fueling Oklahoma’s opioid crisis. Mr. Gorski was also a contributing member of the Business Roundtable that issued a statement on purpose of a corporation as published by the Business Roundtable was that Americans deserve an economy that allows each person to succeed through hard work and creativity and to lead a life of meaning and dignity. The Roundtable stated they believed the free market system is the best means of generating good jobs, a strong sustainable economy, innovation, a healthy environment, and economic opportunity for all. The Roundtable went on to state that they have goals for investing in employees and supporting the communities in which they work.

While at this time, these are mere words on paper and lofty goals, hopefully, the corporate mindset is shifting to one of responsibility and respect for people and their communities and investing in employees. As illustrated by both the opioid epidemic and the insulin crisis, without a reset of its core corporate values, the American public will continue to suffer.

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