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Insulin was first used as medicine in 1922. US patents last for about 20 years. How the fuck is Insulin still expensive? Is it the process on making it that's hard? I really don't understand why it's not cheap or free.

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@art it's not hard to make but does require specific facilities, and there aren't many orgs in the US interested in setting up new ones. So the people already making it can charge whatever they want. It should be a little more costly than like an ibuprofen, but most of the price is straight up greed.

@art

It used to be cheaper than it is now.

Formerly pig insulin, a slaughterhouse byproduct, was used. This was cheap but not totally satisfactory. Today a perfect duplicate of human insulin is made using genetic engineering.

In the world of pharmacy, it's not enought to be able to make a product. You have to make it to strict purity requirements, in a consistent way, & be certified to do so. This poses a large "barrier to entry", giving drug makers pricing power independent of patents.

@publius
I'm not diabetic, but I read a while back that folks were obtaining canadian insulin, b/c it was so much cheaper. I think the only difference in production is the ingredient of more greed.
@art

@gemlog @art

Canadian law doesn't allow pharmaceuticals to be sold for "whatever the traffic will bear". In the USA, we're told it's a good thing, because all that money stimulates research & development. In fact, many promising drugs are left by the wayside because they don't show enough profit potential, while the rakeoff goes to pay the investors Martin Shkreli ripped off in his previous get-rich-quick scheme.

@publius
It applies to a lot of things in the world. I once read an article about the difference in price of a brand new x-ray machine from the same mftr in north america vs india...
Capitalism is simply enforced greed and silos away the bulk of capital away from the common good.
@art

@gemlog @publius @art Typically when you find monopolistic behaviour (such as prices far beyond the cost of production), government policy is an enabler. For instance, patents are a temporary government granted monopoly, to encourage innovation.

Why is insulin so expensive in the US? I'd bet FDA policy is a major part of it.

@mpjgregoire @gemlog @art

FDA has strict requirements, but they're not materially more burdensome than those in force in other wealthy countries. These burdens exist for good reason. The thing is, those other countries mostly have legal mechanisms in place to mitigate the effects of the quasi-monopolistic power which results from the "barriers to entry" so created.

@publius @gemlog @art *Some* regulatory requirements are certainly desirable for the production of insulin; whether the FDA's requirements are more stringent than those of other countries with safe insulin supplies, I don't know.

I accept that if US governments were tough negotiators and had different laws, they could force prices down to Canadian levels. But why doesn't competition keep prices low in the US as is?

@publius @gemlog @art Maybe the current barriers to entry are excessive; after all, companies in the 1930s made insulin.

A little research seems to show that producers don't currently make insulin using expired patents. Why not?

@mpjgregoire @gemlog @art

And drug makers in the '30s routinely poisoned people, as well.

Swine insulin is toxic in the long term. In the short term it's better than the alternative, but there are good reasons for preferring the biosimilar.

@mpjgregoire
I just had a look around pretending I was type 1.
In my province (provinces vary in canada) pharmacare covers the full cost of insulin, syringes, strips, etc. If you are old, first nations or on welfare. Low income people can also get pharmacare, but with some weird 'deductible'. Like if you only make 30k/yr, you need to pay the first 650CAD of medical costs (not counting dr. Visits, surgeries etc. Obviously - those are free for everyone, this is about drug costs).
A vial of insulin seems to be less than $50CAD, but I'll ask a pharmacist later today.
I think Saskatchewan's medical system includes all drugs? So zero cost there. I don't think type 1 diabetics should have to pay for insulin etc at all! Doesn't seem right.
@publius @art

@art
It will not be cheap or free as this is not the way things are done.
Take for example the MPEG2 patent, resting in its grave February 13, 2018. has been charging licence fees from then until today on the grounds that the patent is still valid in the Mumbu Yumbu tribe hunting scorpions in an oasis in the middle of the Sahara.
Guess what they did next: just threw the hardware decoder out of the Pi4, but didn't make it free:)
github.com/raspberrypi/firmwar

@art There's an open insulin project that is trying to lower the barriers of entry for small producers. They seem to be making some progress but I don't understand enough of the details to know how close they actually are.

@art A lack of regulatory pressure on drug manufacturers in the states. In Canada, even without a single payer drug program, drugs such as insulin and epinephrine are an order of magnitude less expensive.

@alexjgriffith @art

No, Canada went full circle regulator and the US only half way The US either need to go full circle or back off the regs
Many in the US don't know they can buy it OTC They also don't know the difference in brand and OTC vs Precription ( which tend to be faster metabolizing versions)

@art There are different kinds of insulin being made, some being pretty recently invented (like in the past decade I think), and the newer better ones are only being made by like one company, who knows they can jack up the price because people don't have a choice.

@art The older kinds of insulin (that are also available for cheaper) still work perfectly well for keeping you alive, but for example, being slower-acting means you have to follow a stricter schedule and plan meals and so on. The newer ones make it easier to live healthy without strictly planning everything ahead of time. It's a real quality of life improvement if you're type 1 diabetic. Anyway, I think the open insulin foundation (I think it's called that?) is making progress.

@art
Still the insulin cost thread.
First off, 5 9's of pharmacists are friendly, helpful and knowledgeable. Yes, 99.999% of them! :-)
Anyhow, I go how much for a vial of insulin? "What kind?"
Umm... "Rapid acting?" Is that good for a type 1 diabetic? "Yes, $30. Is that full price without Pharmacare? "Yes." If I wasn't a really brittle diabetic, could I get through a month with that? "Yes."
So. In a random supermarket in canada near the alaskan panhandle, a vial of insulin is $30CAD.
What are you paying down there Art? In USD is fine. I'm really curious now.

@gemlog It's my Mom who uses the insulin and I'm not sure what kinds shes on. At one point it was $400 USD per month. The US needs a NHS or something.

@art
Holy mac! At the current exchange rate, she'd need to be 16 diabetics to use that much insulin in bc, canada. More even.
Sadly, I don't hold out any hope at all for a made in the USA NHS.
Back when Canada first got theirs there was a huge lobbying and disinformation effort from the medical corporations in the USA. Also, our doctors went on strike to keep their $$ monopoly.
Tommy Douglas went to the UK and signed up hundreds of UK doctors and brought some back. The doctors caved and it later became national.
Do you think the USA med-pharma capitalists have less or more power in the USA today?
Yeah.... sorry, but that's my pessimistic view.

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