The high cost of insulin is preventing a vast number of American diabetes patients from getting their blood sugar stable, Jeremy Greene, MD, PhD, professor of medicine and history of medicine at Johns Hopkins University, explained in a recent paper published in the New England Journal of Medicine. Dr. Greene told National Public Radio (NPR) that his patients’ blood sugar can be so out of control that “you can’t even record the number on their glucometer.”
This lack of diabetes management is largely due to the fact that there are no low-cost or generic insulin options in the United States, NPR reported in a March 19, 2015 article.
Insulin has been around for 90 years, a truth that shocked Dr. Greene and his colleagues since it can cost diabetics up to $400 a month despite its age.
Insulin’s Animal Beginnings
Insulin goes back to the 1800s, when scientists were beginning to understand the relationship between diabetes and damaged cells in the pancreas. But it wasn’t until the 1920s in Toronto, Canada that they extracted insulin from cattle pancreases and found they helped patients in a trial experience a speedy remission of symptoms. With these discoveries, cattle and pig pancreas extract was soon being sold on a large scale to diabetics throughout the world.
But this animal-based insulin wasn’t the best form for everyone. Many needed multiple injections daily and experienced minor allergic reactions. Over the following decades, researchers began to make purer forms of the drug with better quality ingredients to stem the negative reactions and to reduce the number of injections required every day.
In the 1970s, a new technique of creating insulin was pioneered using recombinant DNA technology, which put the human gene for insulin into bacteria and allowed for mass production of the hormone.
Once this new mechanism was implemented, Greene relates, “The older [animal] insulin, rather than remaining around on the market as a cheaper, older alternative, disappeared from market.”
Marketing the New, Trashing the Old
The disappearance of the older insulin may have been because pharmaceutical companies thought it would no longer be profitable in the wake of this new medical phenomenon. New insulin marketing had a lot to do with it too. Doctors bought into thinking that because this insulin was newer, it was better, Kevin Riggs, MD, MPH, co-author of the study, explained to NPR.
The new form of insulin was made by the company Humulin, and it intensely targeted its marketing to both patients and doctors.
Newer Insulin Not Always Better
But, as studies have often found, just because a drug is newer does not mean it’s better. “In government-funded studies that have compared older drugs to newer drugs, often older drugs come out looking better or equal to newer drugs,” says Adriane Fugh-Berman, MD, professor of medicine and pharmacology at Georgetown University. She argues that some people have better outcomes from animal-derived insulin because they experience less variability in blood sugar and fewer instances of hypoglycemia.
But this old form is no longer even offered in the United States, though it is in other countries. With no lower-cost option, many of the estimated 29 million people with diabetes in the United States can’t afford insulin treatment.
So what will bring the older form back? Dr. Fugh-Berman explains that “In Canada, there actually is still an animal-derived insulin on the market, and that was really due to the efforts of consumer advocates.” Is consumer advocacy and lobbying the answer?
Alternatives to Expensive Insulin
Some analysts anticipate the price of the newer form of insulin will drop soon as insulin patents have expired, allowing more competition into the market. The U.S. Food and Drug Administration (FDA) has also recently approved the creation of biosimilar versions of insulin, which will be coming to market soon, hopefully.
But biosimilar versions of insulin, which provide most of the same effects of insulin without being identical to it, are not going to bring down the prices as much as patients need. “Rather than reducing costs by 80 percent, as many generics have done, they might reduce costs by 40 percent,” Dr. Riggs told NPR.
The market needs to provide a less-expensive insulin to ensure the health of our American diabetes patients. Will it come from reintroducing animal-based insulin, offering generic newer insulin, or creating biosimilar versions of insulin? We have yet to see.
Or maybe we should all just move.