The Impotent Ignorance of U.S. Legislators

"The Canadian medicine supply is not sufficient to support both Canadian and U.S. consumers. The supply simply does not, and will not, exist within Canada to meet such demands."
"Hospital and community pharmacies in Canada are resourced to serve the Canadian public. they are not equipped to support the needs of a country ten times its size without creating important access or quality issues."
Warning communication to Canada's Minister of Health

Quinn Nystrom holds insulin she purchased in Canada after travelling over the border for more affordable medication. (Lorenda Reddekopp/CBC)

It is grossly inconceivable that people with diabetes, requiring the hormone insulin to manage their chronic disease, ensure quality of life and life itself, are faced in the United States -- where pharmaceutical companies who manufacture human-type insulin for broad consumption nationwide value the free enterprise system over adequate profits with the assurance that their product prolongs lives -- with steeply unaffordable costs for vials of insulin. There are times, and none more urgent than this one, when government intervention should be required to correct such a dire situation.

It belies belief that a free enterprise system can be so bereft of human values beyond profit that it can without conscience raise the cost of an elemental, vital drug from $30 to $300, placing it beyond the reach of people desperate to continue a difficult-enough therapeutic mode sustaining and prolonging life. That drug manufacturers can and do raise prices to such impossible levels is breath-takingly incongruous given that drugs manufacturing has a purpose and that purpose is now interrupted by greed.

Federal and state legislators in the United States, in recognition of the plight of people with diabetes without health insurance either through employment or independent means, whose incomes are modest and strained beyond acceptability by sky-rocketing costs of medication, have turned not to enacting needed legislation to curtail manufacturing greed, or to supplement the costs of such vital drugs through public subscription, but to allowing Americans to purchase their drugs abroad where they are available at a tenth of the cost.

Laws permitting residents of various states to import drugs from Canada represents no kind of a workable solution to the crisis inflicted upon American diabetics. It is beyond ludicrous that someone like Senator Bernie Sanders plans to highlight the issue by accompanying Americans with diabetes to Canada on an insulin-buying trip. That people with diabetes in the United States must organize trips to Canada to enable them to buy a drug that sustains their lives is beyond incredible.

The very country known for its manufacturing of drugs and their wide distribution -- and the greed of those involved in manufacturing -- sees a situation now where diabetics ration their medication, fearful of not having enough to maintain a balance of wellness. In so doing they risk hastening the onset of complications that ensue from diabetes such as neuropathy, blindness, kidney failure, heart conditions. The issue represents a country-wide medical emergency.

As for Canada; recent years have seen Canadian pharmaceutical manufacturers reporting thousands of shortages of their own, often linked to manufacturing issues but to increased demand as well. Over 27 different bills have been introduced in the U.S. Congress and state legislation over the past year -- according to data from the National Academy for State Health Policy -- which allow Americans to buy their drugs from Canadian sources.

This evades the source of the problem and it exports the problem to a neighbour's vulnerable population, threatening them with a potential precarious position in drug availability. What kind of solution does that signify?  Canada ensures the regulation of drug prices through the federal Patented Medicine Prices Review Board, with its mandate to ensure that the cost of medications is "not excessive".

"We have got to do better in our country."
"People are where we need to be on it, regular folks. It’s our political leaders lack the courage to do the right thing."
John Kennedy, who travelled to Canada from Ohio

Lija Greenseid prepares to draw insulin at her home in St. Paul, Minn. Greenseid, whose daughter has Type 1 diabetes, is organizing a group trip to Canada to buy insulin at one-tenth the U.S. cost.  Photo: Jenn Ackeerman, The Washington Post

Pricing Insulin out of Reach of Diabetics in the United States

"Our survey confirms that globally, rationing insulin is all too common. It also confirms what many already know: respondents from the U.S.A., one of the wealthiest countries in the world, had the highest degree of rationing of insulin and supplies compared to other high-income countries."
Elizabeth Pfiester, head, T1 International

When Professor Frederick Banting and his assistant Charles Best completed their research in insulin in 1921 at their University of Toronto laboratory -- a lifeline was thrown to the millions of people around the world whose inability to produce insulin naturally spelled a gruesome and swift death sentence -- the world sat up and took notice. Dr. Banting and his supervisor, J.R. McLeod were recognized as Nobel recipients, an award that Dr. Banting shared with his colleague, Dr. Best. 

Dr. Charles Best (left) Sir Frederick Banting (right)

The University of Toronto, acknowledging the vital importance of the discovery of insulin in saving the lives of millions and for its future usefulness in saving untold numbers of peoples' lives, made the decision that the patent was priceless. That being the case, it was 'sold' for the princely sum of $1. The formula for producing insulin was made widely available to ensure that it could be accessed wherever people required it, at a low and reasonable cost as one of the most important advances in medical science of the time.

In Canada, insulin is available to insulin-dependent diabetics at a reasonable price. Insulin itself must have a mode of delivery, so there is the added cost of hypodermic syringes. And to ensure that people with diabetes know how much long- and short-acting insulin they require at any given time, blood-testing strips as well as a 'reader' are also required. None of this paraphernalia supporting diabetes management is inexpensive; added together the monthly costs are substantial.

A woman fills a syringe to give herself an injection of insulin.  (Reed Saxon/The Associated Press)

In the United States, it appears that the most basic element of diabetes therapy, insulin, is now sold at an astronomical price. In Canada a vial of insulin is roughly $30. In the United States people with diabetes are charged over ten times as much for the very same insulin. What irony. Canadians have traditionally travelled across the border to the United States for purchases of all manner of goods whose cost has always been less in the U.S. than in Canada. Now, when it comes to pharmaceuticals, and particularly insulin, the trend has reversed.

Diabetes is a particularly pernicious chronic condition; it must be carefully monitored and dealt with. Managing diabetes properly equates with a total lifestyle overhaul. Diet, exercise, proper footwear, precise insulin measurements to match blood-sugar levels ascertained through monitoring must be adhered to. Diabetic neuropathy, retinopathy, heart problems are all conditions associated with long-term and/or improperly managed diabetes.

A new survey in the U.S. has found that too many people must struggle financially to be able to afford this vital medication, that while 18 percent of people with diabetes worldwide take to rationing insulin because of cost; bad enough. Worse is that close to 26 percent of people living with diabetes in the United States are forced through financial difficulties to ration their insulin. Half-measures, in other words, where carefully calibrated amounts of insulin are required for maximum outcomes in health.

Of those interviewed, 70 percent reported some cost coverage while two-thirds had no financial support for their out-of-pocket costs. In the U.S. 89 percent of diabetics did have health care coverage while 79 percent had no other assistance, and 5.5 percent received assistance from government. The problem here is that in the U.S. there are no longer any vials of insulin available for $30. In high-income countries other than the U.S. rationing was reported by 6.5 percent of people living with diabetes; 11 percent in low- or middle-income countries.

Over 29 million Americans (9.3 percent of the population) have some form of diabetes, according to the American Diabetes Association -- in a country where the free enterprise system was born and pharmaceutical companies charge to the hilt for their prescription formulas. Between 2002 and 2013, the average list price for insulin tripled; where 15 years ago a 20-milliliter vial of Humulin R U-500 had a price tag of $175.57, currently the cost is a staggering $1,487.

In excess of 1,400 patients and caregivers over 90 countries responded to answers in the survey by T1 International, a patient advocacy group focusing on Type 1 (formerly called Juvenile-Onset) diabetes. Without insurance, the costs associated with insulin are financially ruinous for a great many people; even those with some level of insurance are hard put to pay their out-of-pocket costs. And since insulin sells for one-tenth the price in Canada, Americans are increasingly heading north for their insulin needs.

According to one study, the estimated cost in production of a vial of human insulin ranges between $2.28 and $3.42. Most analog insulin production costs are between $3.69 and $6.16. As a result of rising prices and a growing contingent of patients, Medicare Part D costs in diabetes treatment rose 840 percent between 2007 and 2017, from $1.4 billion to $13.9 billion, while average costs per person increased by 358 percent in the same period, from $862 to $3,949.

A group of about 25 Americans from Minneapolis headed to London, Ontario this past week to buy their non-prescription insulin. Quinn Nystrom, one of the group's organizers, paid $21 a vial for insulin when she was diagnosed with Type1 diabetes two decades earlier; now it costs $445. Canada regulates drug prices through a review board to ensure that this kind of industrial-level gouging is prevented. It's past-time for the wealthiest nation on earth to do the same for its citizens.