Why treating diabetes keeps getting more expensive • Hacker News Board

Re: Why treating diabetes keeps getting more expensive

#31

Post by soneca » Tue, Jan 23, 2018, 12:45 PM UTC

bruxis wrote: post #9

As a type-1 diabetic of 17 years now, I can confirm that the price of Insulin has been steadily rising over the years. I can also state that the majority of my medical expenses go to insulin pump supplies, not insulin itself. On average, I'm paying roughly $250/mo out of pocket, after 90% insurance coverage for the whole diabetic kit-and-kaboodle. I would be quite troubled if I were to lose my job and/or medical insu…

I think the reason the other comment about the effect of increased type-2 diagnosis on price was downvoted was that it stated a simple and direct causation between growing demand and prices.

I agree that type-2 patients should receive better orientation in terms of dietary treatment, but this growth in demand could (should?) also lead to an economy of scale, especially for pump supplies, and a price drop. I have the impression that it is not the free market (through demand growth) that is increasing the prices, but rather a lack of free market (through cartel).

Re: Why treating diabetes keeps getting more expensive

#32

Post by theorique » Tue, Jan 23, 2018, 1:02 PM UTC

Kayou wrote: post #22

bruxis wrote: post #21

Earlier quoted context omitted.

Just to add a bit of a positive spin on this: even type-1 diabetics could take measures to both improve their health and reduce the amount of insulin they require. I consider myself moderately overweight at this point (maybe 10-15kg). If I lost weight, I could reduce the baseline amount of insulin I need every day, thus reducing the amount of insulin overall that I need to pay for. I also fully acknowledge that, upon…

You still need to have carbs in your diet, it wouldn't be healthy otherwise. Especially if you practice a sport. I eat whatever I want (mostly pasta usually) and I need 20 units a day at most. (100 units/ml dosage).

There's no dietary or metabolic need for carbohydrate. The human body can survive and thrive perfectly well with only fat and protein as macronutrients. Practically speaking, doing that is challenging and complicated because most foods are a mix of all three macronutrients.

Re: Why treating diabetes keeps getting more expensive

#33

Post by rbultje » Tue, Jan 23, 2018, 1:04 PM UTC

“I don’t think it takes a cynic such as myself to see most of these drugs are being developed to preserve patent protection,” said David Nathan, a Harvard Medical School professor. “The truth is they are marginally different, and the clinical benefits of them over the older drugs have been zero.” -- quote from article

And there you have it. I have seen this myself. One year ago, the insulin I was on was removed from the pharmacy, and coverage by my insurance company was also voided. My only choice, I was told, was to switch to a new insulin (which - as article states - was only marginally better, if at all), but which had a fresh patent and thus ensures new profits for another 20 years to come.

And so the wheel keeps churning. Patients are not given a choice, because we are not humans. We are merely a commodity to pharmaceutical companies' profits and shareholder value.

Re: Why treating diabetes keeps getting more expensive

#34

Post by mschuster91 » Tue, Jan 23, 2018, 1:18 PM UTC

loverofthings wrote: post #15

michaelmrose wrote: post #8

Earlier quoted context omitted.

Demand has gone up it hasn't risen exponentially. The manufacturers have colluded to raise the price. There is no reason for it to ever come down.

We live in the age of globalization and capitalism. There's bunch of cheap stuff coming from all over the world. Collusion on that scale is not possible. There's just more people suffering from diabetes T2 than ever before. Someone is just profiting off of large demand.

> There's bunch of cheap stuff coming from all over the world.

Said cheap stuff from everywhere cannot be legally mass-imported into Western countries (and that for good reason).

> Collusion on that scale is not possible

Oh it certainly is. The "old" insulin may be produced as a generic but the new varieties (as described by the article) are patented by a few companies.

In addition insulin production is extremely expensive compared to simple pill pressing as you need bioreactors and GMOs to produce it. Many generics vendors opt out of that complexity.

Re: Why treating diabetes keeps getting more expensive

#35

Post by marvin » Tue, Jan 23, 2018, 1:20 PM UTC

rbultje wrote: post #33

“I don’t think it takes a cynic such as myself to see most of these drugs are being developed to preserve patent protection,” said David Nathan, a Harvard Medical School professor. “The truth is they are marginally different, and the clinical benefits of them over the older drugs have been zero.” -- quote from article And there you have it. I have seen this myself. One year ago, the insulin I was on was removed from…

I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper.

What is different for diabetes, or the United States, to cause this to not be an option? Seems almost like a human rights violation, or at least deeply unethical.

Re: Why treating diabetes keeps getting more expensive

#36

Post by strebler » Tue, Jan 23, 2018, 1:22 PM UTC

kakoni wrote: post #16

Whats up with those US prices, Humalog more than $250 per vial? In Europe (Finland) non-subsidized price is $34.

That's incredible. Humalog is a quite similar low price in Canada. It's strange that it'd actually be economical for many American diabetics to just book a (yearly) flight to Canada and buy 12 months worth of insulin.

Re: Why treating diabetes keeps getting more expensive

#37

Post by glassesquestion » Tue, Jan 23, 2018, 1:27 PM UTC

From the article:

> There have been few efforts to create a cheaper insulin. Walmart, for instance, sells Novo Nordisk's human insulin under the name ReliOn for $25 a vial. Eli Lilly is expected to release the first copycat insulin analog, a chemically altered form of insulin, at the end of this year.

You can buy this product right now, it is the same formulation you would have taken if you were diabetic in the 1990s. https://www.walmart.com/ip/Pharmacy-Relion-Humulin-Insulin/1...

I am amazed by how many diabetics and GPs don't know this exists.

Re: Why treating diabetes keeps getting more expensive

#38

Post by benaduggan » Tue, Jan 23, 2018, 1:32 PM UTC

Kayou wrote: post #30

nunb wrote: post #26

Earlier quoted context omitted.

Doctors Phinney and Volek would disagree on the carbs/sport connection.

Then they should come with an explanation as to why I want to throw up and can't do anything when doing sport with no insulin to use my carbs.

I think the reasoning goes because you are used to using carbs as your energy source most of the time, your body doesn't know what to do at first when it doesn't have any available. The body adapts surprisingly well to different energy sources, so if you drop all carbs, your body will burn fat for energy and create ketones.

It kinda sounds crazy, and I used to think it was, but I'm currently low carb to lose weight (lost 28 pounds in 3 months with it so far!). It just takes a couple weeks of training while on the diet to get your body to catch on and be back to your usual performance.

There are actually a surprising number of world records set by athletes on low carb diets who destroyed previous records that claim their diet is the main reason they were able to accomplish their goals

Re: Why treating diabetes keeps getting more expensive

#39

Post by pja » Tue, Jan 23, 2018, 1:32 PM UTC

marvin wrote: post #35

rbultje wrote: post #33

“I don’t think it takes a cynic such as myself to see most of these drugs are being developed to preserve patent protection,” said David Nathan, a Harvard Medical School professor. “The truth is they are marginally different, and the clinical benefits of them over the older drugs have been zero.” -- quote from article And there you have it. I have seen this myself. One year ago, the insulin I was on was removed from…

I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper. What is different for diabetes, or the United S…

Generics still require FDA approval, which costs on the order of single digit $millions to obtain. Plus you’ve got to set up the plant to create the drug, which costs more $. Would you invest $millions in a product when a competitor (who probably already has plant capacity from when they made the drug while it was under patent) could come in and undercut you at a moments notice?

Obviously not - so the system ends up in a metastable state where one monopoly producer can charge high prices for a drug & no competitor will enter the market because they know the producer can and will undercut them the moment they try and do so.

This one of the reasons why the health care system in the US is completely borked.

Re: Why treating diabetes keeps getting more expensive

#40

Post by shadowtree » Tue, Jan 23, 2018, 1:33 PM UTC

marvin wrote: post #35

rbultje wrote: post #33

“I don’t think it takes a cynic such as myself to see most of these drugs are being developed to preserve patent protection,” said David Nathan, a Harvard Medical School professor. “The truth is they are marginally different, and the clinical benefits of them over the older drugs have been zero.” -- quote from article And there you have it. I have seen this myself. One year ago, the insulin I was on was removed from…

I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper. What is different for diabetes, or the United S…

Insulin is being “grown” genetically modified organisms in vats. It is not a simple molecule you get by mixing chemicals together.

The very first application of the human genome project.

The whole process of production is non-trivial, every step heavily patented and secured. Also pretty expensive.

There are new biotechs currently working on CURING diabetes, but no one is doing trials on humans yet. Means we’re at least 10 years away from a cure.

And no, those are not crazy 18 year olds in a garage. Spark Therapeutics now has an injection to cure macular degeneration, Moderna is building a whole RNA modification platform with 19(!) individual drugs in the pipeline.

It is very likely that we’ll see a major shift of medicine to curing, rather than treating in the next 20-25 years. Hep-C now has a cure. Still so, so amazing. The Human Genome project will turn out to be one of the most live-saving accomplishments of humanity, next to the green revolution in farming.