Dr. Marc Siegel: Diabetes and America – We can't afford more deaths because of rising insulin prices

More than 30 million Americans – over 9 percent of the U.S. population – have diabetes. Over 7 million of them use insulin, which is skyrocketing in price and creating a public health crisis that will lead to needless deaths and billions of dollars of avoidable health care costs.

Out-of-control diabetes causes devastating problems to every organ in the body – including the eyes, the nerves, the kidneys and the heart.

And now some people using insulin are suffering devastating financial problems as well.

GLOBAL DIABETES EPIDEMIC DRIVES SURGE IN INSULIN DEMAND

As insulin continues to become more and more expensive, many people with diabetes who require it can’t afford it and find they have to ration its use. Tragically, news reports say some people have even died because they’ve reduced their expensive insulin dose to save money.

According to the Centers for Disease Control, in addition to the over 30 million diabetics in the U.S., another 84 million Americans have pre-diabetes, a condition that can lead to diabetes in five years.

Of the 30 million diabetics in the U.S., only about 1.25 million have Type 1 diabetes – an immune system disorder in which your pancreas doesn’t produce enough insulin. For people with this type of diabetes, insulin is lifesaving – they would die without it.

Type 2 diabetes is far more common, affecting the other 29 million people in the U.S. with the disease. If you have Type 2 diabetes, your body produces more insulin than do people with Type 1 – but the cells in your body are resistant to the insulin you make.

As insulin continues to become more and more expensive, many people with diabetes who require it can’t afford it and find they have to ration its use. Tragically, news reports say some people have even died because they’ve reduced their expensive insulin dose to save money.  

According to CDC, 14 percent of Type 2 diabetics use insulin, 13 percent use insulin plus oral medication, 57 percent use oral medicines alone, and 16 percent control their blood sugar with diet and exercise.

Do the math – the vast majority of our insulin supply is used by Type 2 diabetics, not Type 1. Since there are 25 times more Type 2 diabetics than people with Type 1, this means that six times more Type 2 diabetics are taking insulin than are Type 1 diabetics.

But here’s something many people don’t realize: not all Type 2 diabetics who are taking insulin really need it.

Many Type 2 diabetics could manage the disease effectively with newer oral medications, including Januvia or Metformin. And many more could decrease or eliminate the requirement for insulin altogether by improving their diet or increasing exercise.

Weight loss leads directly to lower insulin requirements. Since two-thirds of all Americans are overweight, this is a major cause of excess insulin use.

We Americans like our bright shiny objects and are drawn to the latest technology or treatments. Older and cheaper insulins are too often overlooked and passed over when they can be just as effective as the newer insulins with prices soaring well out of the affordable range.

According to IBM Watson Health, insulin list prices have tripled in the past 10 years. The three main insulin makers are Eli Lilly, Sanofi and Novo Nordisk.

Eli Lilly’s Humalog cost $21 per vial in 1996 when it first came out – but has skyrocketed to $275 per vial now.

Sanofi’s Lantus was $35 a vial in 2001 when it was first on the market – but is now $270.

Novo Nordisk’s Novolog was $40 in 2001 and rose to $289 in 2018.

All three of these are very popular insulins that many of my patients take regularly.

Many insurers continue to cover the expensive insulins and negotiate lower prices, as do pharmacy benefit managers that take a profit and pass the price hikes along to the consumer in terms of higher co-pays.

Health and Human Services Secretary Alex Azar has focused on improving price transparency so that the consumer knows the true list prices of drugs. He is also working towards having more of the negotiated discounts passed along to consumers.

Federal officials are also putting a new focus on more choice and generic alternatives for drugs.

Food and Drug Administration Commissioner Dr. Scott Gottlieb told me in an exclusive statement that “we’ve outlined a pathway by which we’re transitioning the insulin products … to make it possible to create Biosimilar copies of these products once patents and other exclusivities have lapsed. We think this will open up many more opportunities to develop low-cost copies of the existing insulins, helping promote competition and access.”

In the meantime, it’s wise for prescribing physicians to consider older and less costly options. After all, insulin has been used to treat diabetes for almost 100 years, since it was first isolated in Canada in 1921.

The available tried-and-true insulins are still quite useful, says Dr. Mayer Davidson, renowned endocrinologist and diabetes specialist who is co-founder of Mellitus Health.

Mellitus Health has developed an algorithm to guide doctors, nurse practitioners, physician’s assistants and clinical pharmacists in prescribing insulin quickly and more effectively.

Now, less experienced practitioners who are fearful of giving patients an insulin dose that will cause their blood sugar levels to plummet to dangerously low levels will have a proper guide.

And Dr. Davidson told me that he believes “over half of people with diabetes can be successfully treated with non-insulin medications.”

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But even if both doctors and patients use the current outrageous prices of our newest insulins as a motivation to use insulin more sparingly and efficiently – while focusing more on diet and weight loss – there will still be millions of diabetics who will always need insulin.

The FDA’s plan to flood the market with cheaper alternatives to the expensive insulins is a great step in the right direction. But in the meantime, we can’t afford to see any more people die because they can’t afford the price. The Health and Human Services Department needs to bring all its powers to bear to stop this from happening.

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