The Insulin Obstacle: How Do We Get More Affordable and Accessible Insulin In The United States?

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Introduction

In the United States(US), there is a public health crisis that is currently ongoing. This surrounds the relationship between Diabetes, an endocrine disorder, and insulin, a naturally produced and occurring hormone produced by beta cells in the pancreas, another part of the endocrine system. Diabetes occurs when pancreatic function is inhibited to the point where little to no insulin is produced. This is quite problematic because without insulin regulating blood glucose levels, individuals with diabetes are susceptible to many complications that come as a result of hypoglycemia or hyperglycemia, commonly known as extremely low and extremely high blood glucose levels respectively. To put in context how much of a problem this is to our country, the US has a population of around 328.2 million people. Of those 328.2 million people, 8.5% of them, or 27.8 million, are diagnosed with some type of diabetes. Out of that 27.8 million, 91.2% of them are Type 2 Diabetics, while 5.6% of them, or 139,485 thousand, are Type 1 Diabetics. This would become a problem when prices are too high, or the insulin is inaccessible, as a very large quantity of people could be placed in danger. This is the problem that we as a United States currently face as a result of the increase in insulin prices, which leads to the rationing of insulin, cutting costs, and in some cases, death.

 

What’s Happening In The News?

In the media, we’re seeing an uptick in press and coverage on this issue, from a multitude of sources. Ranging from independent policy briefs to op-eds, to investigative journalism reports, a lot of these articles seem to point to Pharmacy Benefit Mangers, known as PBMs, as the root of this problem. In a November 2020 policy brief released by The Greater Good Initiative, the role of PBMs was quite eloquently stated. GGI’s Economic Policy team writes, “PBMs typically are toted for their ability to keep drug prices and premiums lower as they promote competition between the manufacturers. This is due to companies vying to get their products on the insurance company’s formulary — a list of prescription drugs that are carried by the insurance plan. While PBMs serve as a “middle-man” in drug distribution, cutting out the administrative waste for the insurance companies, they still markup the prices in order to receive a worthy gross profit. In many cases, PBM interactions are found to endanger patients by driving up consumer costs, putting unnecessary burdens on pharmacies, overcharging insurance plans, and continuously defending the drug manufacturers.” The other thing that has been in the news is the essential monopolization of the insulin market by 3 companies: Novo Nordisk, Eli Lilly, and Sanofi. In an Oxford University article by Ryan Knox, this is described as “Only three companies—Novo Nordisk, Sanofi, and Eli Lilly—provide insulin the United States market, despite the existence of several other manufacturers globally. The insulin market has been insulated from the traditional expectations and trends of pharmaceutical markets, especially concerning price and competition.”

 

What Legislative Responses Exist?

 

Currently in the US, there have been a number of calls to action by legislators across the nation, both Democrat and Republican. In Oklahoma, House Bill 1019 has recently come across Governor Stitt’s desk. The bill, co-authored by two Republicans, wants to institute a pricing cap on insulin, designed to help combat the rapidly increasing prices on insulin throughout the nation. In Kentucky, another bill has passed their Senate designed to do the same thing. The Affordable Care Act, introduced under the Obama Presidency, is a response that focuses on ensuring that all Americans have access to insurance and competent healthcare.

 

What Do Medical Professionals Say On The Topic?

 

For this project, I interviewed Doctor Brendan Carr, Professor and Chair of Emergency Medicine in the Mount Sinai Health System. Dr. Carr has over 20 years of medical experience, and he specializes particularly in emergency medical care. When asked his thoughts and opinion on diabetics rationing off insulin because they can’t afford it, he describes it as “brutal, dangerous, and criminal.” Dr. Carr continues with, “It should be framed as simply withholding a critical element required for life. No different than oxygen or water.” It is important to note that there are voices within the medical field who even feel that this practice that comes as a result of unaffordable insulin is very dangerous and can even be deemed as criminal on the part of manufacturers. When asked to comment on why this exists in the first place, Dr. Carr said, “We long ago decided however that healthcare is a private sector business. Not a right. This isn’t all that different than many other things we don’t treat because of cost. Like food and housing…it is all the same.” 




What Is My Response?

 

After researching on this topic, and leaning on insight gained from my interviews with my mentor and my experience in the field of public policy, I devised a programmatic policy response that works to do two things: Incentivize the use of other brands of insulin besides those produced by the big 3 companies, and lower the mean cost of insulin across the United States. This response gains a lot of inspiration from the Affordable Care Act. While there is some disagreement amongst legislators and Americans on the merits and effectiveness of the ACA, the core values of accessible, affordable, and competent healthcare definitely can be applied to this response, with a strong emphasis on how this is applicable to the insulin crisis. This can first be applied on a lower scale basis, similar to the Oklahoma and Kentucky bills, except on a city level. I would apply this first in Philadelphia, the perfect role model: the poorest big city in the US. For medical companies that move insulin production to the city, tax credits could be offered in exchange for their cooperation as the primary insulin provider. In turn, this would help lower the mean cost of insulin, due to the basics of supply and demand law. If there is a large supply at a cheap price, this will manipulate the currently monopolized insulin distribution system into decreasing their prices, leading to a lower mean cost of insulin. The diversity in business also helps the economy and the consumers in need, so long as the product is quality.

 

Conclusion

 

In conclusion, this is a very clear problem in America. Failure to address this on a large scale level can lead to an increase in lives lost, and also could help further depress the economy and lower currently impoverished populations into further poverty. Below in the comments, please add your answers to these 3 questions, and feel free to propose additional responses or questions!!

 

  1. How can I as an individual make a difference in the insulin crisis?
  2. What ways do I currently contribute to healthcare monopolies?
  3. How do public health crises impact me as an individual who might not be directly affected?

 

Click Here for Notes and Sources 🙂

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