The Insulin Injustice

By: Muqadas Jawad, Biological Science, 2027

On May 3, 1922, a physician and scientist made a discovery that had the potential to change the lives of many people who suffered from type 1 and type 2 diabetes. That discovery was of insulin. The significance of insulin as a treatment became evident when Leonard Thompson, a type 1 diabetic, received his first insulin injection. His blood sugar dropped just 24 hours after injection. In 1923, Sir Frederick G. Banting, the recipient of the patents on insulin, declared “Insulin does not belong to me, it belongs to the world” [1]. Banting advocated for equal access to insulin. Yet, 102 years later, there exists a pressing concern to address why some diabetics still struggle to afford insulin.

According to the New England Journal of Medicine, in 2019, 100 units of insulin cost $18 for uninsured persons. To put this statistic into perspective, for a person weighing 70 kg and requiring one unit per kilogram daily, 100 units would last only two days [1]. This amounts to a monthly expenditure of $270 solely on insulin. Moreover, the CDC reports that the total annual cost of diabetes stands at $327 billion, where $237 billion allocated to “direct medical costs.” Individually, Medicare beneficiaries who have type 2 diabetes spend approximately $5,876 per year annually for diabetes management [2]. Otherwise, those with diagnosed diabetes spend about $9,600 per year in relation to their diabetes, with potential expenditures amounting to $16,750 annually for additional medical expenses [3]. According to research from the Yale School of Medicine, “insulin is seven to 10 times more expensive in the U.S. compared with other countries around the world.” A vial of insulin that was priced at $21 in 1996 could now cost up to $250, despite estimates suggesting it only costs up to $4 to produce one vial [4]. The insulin production process involves profit extraction at every step, resulting in unreasonably high prices for one vial of insulin.

The affordability of insulin is especially problematic for “low-income, uninsured, and underinsured populations,” who are more likely to face challenges in purchasing a vial of insulin in an economy where income is decreasing while the cost of living is increasing. This demographic, which disproportionately consists of minority racial and ethnic groups, are also at a hightened risk of being unable to afford medication that could be vital to their lives. Alarmingly, “one in four Americans who take insulin report reducing their dose or stopping it altogether because of cost” [5]. This can present many health complications for diabetics. Moreover, racial minorities are also typically more likely to have some form of diabetes. Therefore, the limited accessibility of insulin for these minority groups exacerbate existing racial healthcare disparities.

Recent legislation, such as the Insulin Affordability and Inflation Reduction Act, attempts to address the soaring costs of insulin [6]. It is commendable that there are efforts being made to address the high cost of insulin, especially considering that 30% of the population with type 2 diabetes and all individuals with type 1 diabetes require insulin [5]. However, it is crucial to note that an act like this only provides provisions for those covered by Medicare. Additional support is imperative for the uninsured, underinsured, and low-income individuals in accessing a necessity for a condition that is fatal when left untreated. 

After enduring years of unreasonable and unjust barriers to insulin, it is time that we begin to shift healthcare in a way that insulin can be made affordable to all – to those with Medicare or other forms of insurance, and to those who are underinsured or do not have insurance. Given that insulin has the potential of being one’s only solution for diabetes management, we cannot delay action much longer. For something as vital as insulin we must take immediate steps in order to make this treatment fully accessible and affordable to all individuals in need. 

References

1. Fralick, M., & Kesselheim, A. S. (2019, November 7). The US Insulin Crisis — Rationing a Lifesaving Medication Discovered in the 1920s. The New England Journal of Medicine . https://www.nejm.org/doi/10.1056/NEJMp1909402 

2. [2] Centers for Disease Control and Prevention. (2022, December 21). Health and Economic Benefits of Diabetes Interventions. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/programs-impact/pop/diabetes.htm 

3. American Diabetes Association (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes care, 41(5), 917–928. https://doi.org/10.2337/dci18-0007

4. Lipska, K. (2023, April 27). The Price of Insulin: A Q&A with Kasia Lipska. Yale School of Medicine. https://medicine.yale.edu/news-article/the-price-of-insulin-a-qanda-with-kasia-lipska/#:~:text=Insulin%20is%20seven%20to%2010,produce%20a%20vial%20of%20insulin.

5. Peek, M. E. (2021). By any means necessary: why lowering insulin prices is relevant to racial health equity. The Lancet, 398(10313), 1783–1784. https://doi.org/10.1016/s0140-6736(21)02315-1

6. Sayed, BA, Finegold, K, Olsen, TA, De Lew, N, Sheingold, S, Ashok, K, Sommers, BD. (January 2023) Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings by State and Demographics. (Issue Brief No. HP-2023-02). Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.