Fight the Big Three

For a country that claims to promote capitalism and prioritize the health of its citizens, the price of insulin is unacceptable.

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By Ivy Jiang

Insulin prices have risen dramatically over the past two decades, causing the drug to become inaccessible to the seven million Americans who depend on it to live. A vial of insulin cost about $30 in 2001, while one today can set you back around $250. Large pharmaceutical companies manipulate the artificial market for insulin and gouge prices under false guises to make profit. Meanwhile, Americans who cannot afford such steep prices are forced to ration their insulin at the expense of their health. For a country that claims to prioritize the health of its citizens, this situation is unacceptable. The price of insulin must decrease.

People diagnosed with Type I or Type II diabetes need to take insulin regularly to keep their blood sugar levels stable. Without insulin, a diabetic could suffer from serious diabetic ketoacidosis, which causes the blood to turn acidic and the victim to suffer from dehydration, shortly followed by death. Diabetics who cannot afford to pay the price of their needed dosage of insulin are forced to ration their intake. Combined with the fact that approximately 88 million Americans have prediabetes, American citizens are pressed with a massive issue.

Insulin was never meant to be so expensive. The first insulin was invented by Frederick Banting in the 1900s. After realizing that the drug would save millions of lives, Banting sold the patent to the University of Toronto for $1, believing it was immoral to profit off such a vital product. He hoped that his actions would make the drug accessible to those who needed it. His invention has evolved into the synthetic insulin sold today.

Nowadays, the “big three” drug companies—Eli Lilly, Novo Nordisk, and Sanofi—control nearly the entire United States insulin market. With their domination, these companies have collaboratively manipulated insulin prices and established a fixed market. Using patent evergreening, these organizations renew their patents after making just miniscule tweaks to the medication. This strategy allows the company to keep their hold on insulin for as long as possible. For example, Sanofi has filed 74 patents on their insulin Lantus, which has secured an uncontested market for the next four decades. The big three use this unchecked market to increase insulin prices annually, garnering profit by claiming high costs for research and development and causing prices to multiply 10 times over the course of 20 years. However, insulin has not had major formula changes in the last two decades and instead has been continuously rebranded and tweaked for convenience, enabling patent evergreening.

What’s especially upsetting is that small, emerging companies occasionally do come up with patents to introduce insulin into the market at lower costs. However, the big three quickly shut them down by intimidating them with their extensive resources and buying them out or suing them in court, exhausting the opposition with a lengthy process and excessive legal fees. The attempted exclusion of small companies from the industry also hampers the progress of developing insulin. Smaller companies are more likely to take risks to achieve an edge in the industry, while the big three are profit-driven and less likely to spend money trying to achieve a breakthrough.

Large pharmaceutical companies are also heavily involved in lobbying favorable politicians or donating millions to legislatures in exchange for them turning a blind eye. In fact, members of the big three and the government often overlap—former Eli Lilly executive Alex Azar sat as the United States Health and Human Services Secretary from 2018-2021. During his tenure, Azar helped increase the price of insulin by rejecting cheaper imported insulin from Canada, opposing the notion for Medicare to negotiate lower drug prices and undermining the Affordable Care Act. Azar simply used his position to continue pursuing the interests of Eli Lilly, which he still had a financial stake in.

We must counter this problem by lobbying our politicians to implement insulin price limits and resolve patent loopholes. Showing widespread concern and dismay toward unfair drug policies puts pressure on legislatures. In fact, 13 states have created insulin price controls limiting the monthly out-of-pocket cost to $100. While these cost limits are a step in the right direction, they only apply to commercially insured diabetics living in those 13 states. Self-employed or unemployed citizens, as well as those on Medicare, have to pay the exorbitant full price, despite these groups needing financial assistance the most. Senator Elizabeth Warren has introduced and supported bills like the Medicare Drug Price Negotiation Act and the Medicare for All Act of 2019 that would help those on Medicare to afford insulin, but unfortunately, they did not pass.

More importantly, we must fix patent evergreening and allow the importation of insulin from other countries. Insulin price gouging is not nearly as bad in European countries and Canada because the governments directly negotiate the price of insulin down. Legislation like the Affordable and Safe Prescription Drug Importation Act would facilitate this process. In addition, we need to support the production of biosimilar insulins from different companies to loosen the big three’s leveraging power. Recently, the FDA approved a biosimilar insulin created by Mylan Pharmaceuticals called Semglee, which is interchangeable with Sanofi’s Lantus but is 65 percent cheaper.

We need to act on the potential to create affordable insulin. E-mailing and writing letters to our representatives is a great way to show engagement and bring awareness to this pressing issue. A unified response can finally inhibit drug price gouging and hinder the big three’s grip on the insulin market, relieving the financial and health burdens of diabetics.