Becca Hamberg BA ’24
HHS Competencies: Ethics and judgment; Social and structural proficiency
‘“The cost, I’m getting it for so cheap it’s like water,”’ Trump remarked in a September presidential debate falsely claiming that he had significantly reduced the cost of insulin for diabetic Americans (Guarino). Yet insulin costs between $270 and $289 per vial. Type 1 diabetics typically require two or three vials a month while type 2 diabetics can require 6 or more vials (Tridgell). This means spending between $540 and $1734 or more every month for survival. There are people that are unable to afford these high costs and are forced to figure out a way to stay alive. One strategy is to ration their insulin as a staggering “1 in 4 Americans” do or sacrifice other expenses in their life such as buying groceries or paying bills (Guarino). Rationing insulin can lead to life-threatening and even more costly complications such as kidney failure, blindness, amputation, heart attacks, and in the worst scenarios, death (Tridgell). People with diabetes are forced to make impossible decisions of whether to buy enough to eat or to take their medication. However, this has not always been the case. Insulin prices have increased by 555 percent, adjusted for inflation, in just 14 years (Donovan-Smith).
Insulin prices have increased at a rate faster than any technological improvements to medication warrant. Nevertheless, this argument that the companies use to justify this price hike falls through when there is an analysis of the improvements mapped next to the price increases. The most significant improvements were in the 60s and 70s when insulin began to be synthesized and then manufactured through genetic engineering but the major price increases did not happen until the 2000s. “A few decades ago, people could pay about $20 a month for insulin,” while people now, unless covered by Medicare, must pay hundreds of dollars for insulin each month (Guarino).
These price increases were driven by the greediness of three companies: Novo Nordisk, Sanofi, and Eli Lilly – not because the improvements required more capital to manufacture. They have a monopolistic oligopoly hold on the market. Typically, this kind of inelastic pricing is reserved for monopolies where there is no competition and therefore no price ceiling. The inelasticity of the price is also driven by the inherent need for insulin because it is necessary for survival. People will pay as high a price as they can afford because without it they will die. Normally, with the competition between these three companies, prices would be driven down to appeal to consumers. However, these companies have realized that insulin can be priced extremely high because it is a life-saving drug. Pharmaceutical companies have even had lawsuits filed against them with accusations of “price collusion for allegedly raising insulin prices repeatedly and in lockstep to match their competitors” over the past two decades (Tridgell). While some remedies have been put in place in an attempt to make insulin more affordable, the remedies often create other expenses or are simply not widespread enough to benefit the diabetic population as a whole.
The manufacturing of prescription medications within the United States healthcare system is convoluted and has many different complex mechanisms that create these high drug prices. Insurance guidelines for how patients are able to access and use their insulin such as quantity limits, the way that Medicare interacts with these drug companies, advertising for prescription medications, and pharmacy benefit managers are just a few of the reasons why drug prices are so marked up in the United States. Ultimately, this confusing system of drug manufacturing in the United States harms patients. David Tridgell, an endocrinologist working in the United States, discusses how he and other doctors have to sacrifice the best care practices because patients are unable to afford them, “sometimes I have no choice: It’s either cheaper insulin or no insulin” (Tridgell). He recognizes the brokenness that exists in the healthcare system but has little power when prescribing patients insulin and has to make decisions not solely based on his medical expertise. He must factor in the affordability of the medication and his patient’s ability to pay for these expensive medications. Patient’s health is unable to be prioritized because insulin companies have raised the prices beyond affordability. Unfortunately, this issue is most common in the United States because of the structure of the economy and the healthcare system. “A box of Lantus exceeds $1,000 in the United States… ‘yet that same box lists under $100 at any Canadian pharmacy without a prescription,’” (Guarino). Insulin companies are able to have higher prices in the United States compared to other countries. Many medication and healthcare businesses in the United States operate on this same principle; putting the highest price on human life.
The healthcare system in the United States is inherently neglectful of the population that cannot afford life-saving healthcare or medications. Businesses profit off of people’s need for these life-saving interventions. Ultimately, these companies and the people that operate them decided that high profits are more important than the health of the population and the individuals that live in the United States. The emphasis on capitalism in the United States perpetuates these moral failings as people lack the sympathy to run their companies to serve the population in an ethical manner. Insulin companies are just one of the sectors in the healthcare system that manipulate the population to make a profit. Recently, OxyContin manufacturer Purdue Pharma pleaded guilty in a settlement deal that seeks to hold the company responsible for its role in the opioid epidemic (Balsamo). Prescription medication companies and the healthcare system as an entity must be held accountable for their roles in harming the United States population’s health. Patients should not have to compromise their health as a result of affordability and inequality present throughout the healthcare system in the United States.