By Bram Sable-Smith
NPR, September 1, 2018
Diabetic ketoacidosis is a terrible way to die. It’s what happens when you don’t have enough insulin. Your blood sugar gets so high that your blood becomes highly acidic, your cells dehydrate, and your body stops functioning.
Diabetic ketoacidosis is how Nicole Smith-Holt lost her son. Three days before his payday. Because he couldn’t afford his insulin.
“It shouldn’t have happened,” Smith-Holt says looking at her son’s death certificate on her dining room table in Richfield, Minn. “That cause of death of diabetic ketoacidosis should have never happened.”
The price of insulin in the U.S. has more than doubled since 2012. That has put the life-saving hormone out of reach for some people with diabetes, like Smith-Holt’s son Alec Raeshawn Smith. It has left others scrambling for solutions to afford the one thing they need to live. I’m one of those scrambling.
My first vial of insulin cost $24.56 in 2011, after insurance. Seven years later, I pay more than $80. That’s nothing compared with what Alec was up against when he turned 26 and aged off his mother’s insurance plan.
Smith-Holt says she and Alec started reviewing his options in February 2017, three months before his birthday on May 20. Alec’s pharmacist told him his diabetes supplies would cost $1,300 a month without insurance — most of that for insulin. His options with insurance weren’t much better.
Alec’s yearly salary as a restaurant manager was about $35,000. Too high to qualify for Medicaid and, Smith-Holt says, too high to qualify for subsidies in Minnesota’s health insurance marketplace. The plan they found had a $450 premium each month and an annual deductible of $7,600.
“At first, he didn’t realize what a deductible was,” Smith-Holt says. She says Alec figured he could pick up a part-time job to help cover the $450 per month.
Then Smith-Holt explained it.
“You have to pay the $7,600 out of pocket before your insurance is even going to kick in,” she remembers telling him. Alec decided going uninsured would be more manageable. Although there might have been cheaper alternatives for his insulin supply that Alec could have worked out with his doctor, he never made it that far.
He died less than one month after going off of his mother’s insurance. His family thinks he was rationing his insulin — using less than he needed — to try to make it last until he could afford to buy more. He died alone in his apartment three days before payday. The insulin pen he used to give himself shots was empty.
A miracle discovery
Insulin is an unlikely symbol of America’s problem with rising prescription costs.
Before the early 1920s, Type 1 diabetes was a death sentence for patients. Then, researchers at the University of Toronto — notably Frederick Banting, Charles Best and J.J.R. Macleod — discovered a method of extracting and purifying insulin that could be used to treat the condition. Banting and Macleod were awarded a Nobel Prize for the discovery in 1923.
For patients, it was nothing short of a miracle. The patent for the discovery was sold to the University of Toronto for only $1 so that live-saving insulin would be available to everyone who needed it.
Today, however, the list price for a single vial of insulin is more than $250. Most patients use two to four vials per month (I personally use two). Without insurance or other forms of medical assistance, those prices can get out of hand quickly, as they did for Alec.
Depending on whom you ask, you’ll get a different response for why insulin prices have risen so high. Some blame middlemen — such as pharmacy benefit managers, like Express Scripts and CVS Health — for negotiating lower prices with pharmaceutical companies without passing savings on to customers. Others say patents on incremental changes to insulin have kept cheaper generic versions out of the market.
For Nicole Holt-Smith, as well as a growing number of online activists who tweet under the hashtag #insulin4all, much of the blame should fall on the three main manufacturers of insulin today: Sanofi of France, Novo Nordisk of Denmark and Eli Lilly and Co. in the U.S.
Remarks on Drug Pricing Blueprint
By HHS Secretary Alex M. Azar II
HHS.gov, May 14, 2018
You’ve probably heard before that Medicare could save tons of money by negotiating directly for drugs. This just isn’t true, and you don’t have to take my word for it.
The only way that direct negotiation saves money is by doing something this administration does not believe in: denying access to certain medicines for all Medicare beneficiaries, or setting prices for drugs by government fiat.
We don’t believe either of these proposals would put American patients first. They would move us toward the kind of socialized medicine systems that have such a notorious reputation for poor quality and access.
By Don McCanne, M.D.
There could not be a more glaring example of our policy failures in the design of our health care financing system. The tragic, premature death of 26 year old Alec Raeshawn Smith would have never happened with a well designed, single payer, improved Medicare for All. You can read through his story and pick out each of the policy defects that should be completely unacceptable in the most expensive health care financing system in the world.
There are now a plethora of reports about the outrageous pricing of our pharmaceutical products, including many tragic stories about the gouging of diabetic patients for their life-saving insulin. Yet we have as HHS Secretary, Alex Azar, the former president of the U.S. subsidiary of Eli Lilly – a major producer of insulin – under whose reign Lilly’s prices skyrocketed.
So what does Alex Azar have to say about the outrageous pricing of these products? He says, “this administration does not believe in… setting prices for drugs by government fiat.” He says, this “would move us toward the kind of socialized medicine systems that have such a notorious reputation for poor quality and access.”
With that kind of uncaring, cruel attitude, it seems that it is time to nationalize our health care financing system. We already have the tools to do that in a civil manner: replace our current politicians with ones that will enact an improved Medicare for All.
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