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Insulin is way too expensive. California has a solution: Make its own

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Re: Insulin is way too expensive. California has a solution: Make its own

#151

Post by hertzdog »

ProjectInsulin wrote: post #87
rayiner wrote: post #73

Earlier quoted context omitted.

> I don't understand. My understanding of why insulin is so expensive: intellectual property laws are enforced by the government preventing businesses without that intellectual property to compete in the space. That’s not an accurate understanding of intellectual property specifically. Insulin isn’t like a pill, where once you have a chemical formula you can make millions of them very cheaply. It’s a biologic, an art…

Hi Rayiner, you are spot on with your analysis. My name is Eric, and my non-profit, Project Insulin, is tackling this problem head-on as well. We are developing a biosimilar insulin and will distribute it directly to patients at cost. The drug development process is still expensive but much cheaper because of the Biologics Act that was passed in 2020. When going through the FDA approval process, biosimilar insulin ma…

Hi Eric, my name is Francesco. In the last three years we industrialized a novel method for producing biosimilar insulin (in Italy). We are an international team and I really would like to contact you. Can you write to the email you find on my profile?

Re: Insulin is way too expensive. California has a solution: Make its own

#152

Post by zaroth »

basch wrote: post #128
olliej wrote: post #76

Earlier quoted context omitted.

You know developing insulin doesn't require violating patents, right? And the price of insulin in the US is entirely an artifact of monopoly behavior by a small number of pharmaceutical companies? The ability to mass produce insulin at negligible cost has been around for decades, they guy who discovered it made it patent free even. Only in the US do companies get away with this kind of price gouging, and only because…

Insulin is cheap. Long acting insulin is not. They are different products, and the formers patent being free has nothing to do with the later innovations being locked down.

Even the modern rapid acting insulin that doctors are prescribing (Humalog, Basaglar, etc.) can be very expensive.

CVS filled a month supply for me after my insurance number had changed and when I went to pick it up they kindly asked for $1300 before I gave them the new insurance info.

Re: Insulin is way too expensive. California has a solution: Make its own

#153

Post by roenxi »

r3trohack3r wrote: post #69

> Though insulin generally costs less than $10 per dose to produce, some versions of the drug have a list price above $200. This is in part because, in the US, a warped market has allowed three companies to dominate the insulin business. > With California leading the way, a handful of states are considering trying to disrupt the market for essential medications, starting with insulin. The plan would be to manufacture…

Not knowing anything about the specifics of California, but bad law here seems to follow a rough process:

1. Centralise power in a regulatory body that will raise costs every time something goes wrong.

2. The barrier to getting things done rises until there is a crisis.

3. The barrier is so high only someone behaving like a financial illiterate would enter the market, so legislators task government with entering the market or underwriting someone who can.

So I'd assume that legal ability that was ever the problem. Usually it is regulatory requirements implying a minimum size of the actor needed to take on the risk. I see a few comments that this time around the technical term implementing this for insulin is "bioequivalence" but the broader pattern applies in a few markets and should be called out.

Re: Insulin is way too expensive. California has a solution: Make its own

#154

Post by cloudfifty »

bombcar wrote: post #141
basch wrote: post #115

Earlier quoted context omitted.

People dont want insulin (traditional insulin.) They want fancy insulin (modern insulin), because it is convenient. They want modern rapid and long acting insulin. They want pens. Maybe people want the inhalable powder. Those innovations exist outside the original insulin patent. They are also mixing other drugs with the insulin. >Average retail prices of Novolin and Humulin (traditional short- and intermediate-actin…

Yeah, you can do some quite easy motte-and-bailey with it. Everyone will agree that (cheap, out of patent) insulin should be available to all; it's literally lifesaving. But then switching that to the (modern, convenient) insulin should be available to all is a bit of a slight of hand, especially when it is NOT a "you will die without this" but a "you will have more hassle taking medication to not die" scenario.

[dead]

Re: Insulin is way too expensive. California has a solution: Make its own

#155

Post by basch »

zaroth wrote: post #146
basch wrote: post #127

Earlier quoted context omitted.

Long acting insulin is exactly what this entire debate has always been about. Generic standard insulin has been cheap at walmart forever. They even sell cheap rapid acting ReliOn. People want long acting insulin cheap. (short-, intermediate-, rapid-, and long-acting, ultra-long-acting (42h) insulin are the main categories.) Long acting insulin was the product that had a price jump at the end of 2017. I am pretty symp…

T1D patients use both types if they are self-injecting. The long acting covers your basal rate (baseline) and the fast acting covers carbs you eat. Or if you have a pod or pump then you can use only the rapid acting and the software will drip it slowly to cover your basal need over the 24h. Trying to use just the fast acting with self-injections doesn’t work because you go high overnight while you’re sleeping, and ev…

Which would be covered by traditional mixed, short and intermediate insulin, right? The price of Novolin 70/30 (mixed), Novolin R (rapid) and Novolin N (intermediate) insulin have remained flat since 2014. (Short acting and Rapid are two different things, the former being the old kind of insulin that takes 30 minutes, the latter being modern tech that takes minutes.)

It's when you want something better, that lasts longer than Novolin N that price starts to go up. (Novolin N is typically injected underneath the skin (subcutaneously) once or twice per day.)

Obviously, if you have insurance, I would expect you to be being prescribed something better, because that's how the world works. Then you can jump from traditional insulin to rapid and long lasting, and pens.

Re: Insulin is way too expensive. California has a solution: Make its own

#156

Post by pkaye »

coldpie wrote: post #94
ProjectInsulin wrote: post #87

Earlier quoted context omitted.

Hi Rayiner, you are spot on with your analysis. My name is Eric, and my non-profit, Project Insulin, is tackling this problem head-on as well. We are developing a biosimilar insulin and will distribute it directly to patients at cost. The drug development process is still expensive but much cheaper because of the Biologics Act that was passed in 2020. When going through the FDA approval process, biosimilar insulin ma…

Hi Eric! I'm a T1D and so super interested in this space. Can you comment on whether it is the case that "modern" insulins (Lantus and Humalog/Novolog, in my case) are both covered by current patents, and also considerably better for patient outcomes (faster acting, more predictable -> lower A1c) than non-covered insulins? That is my understanding for why cheap, high quality insulins are not available, but I'd love t…

I think Humalog/Novalog patents expired a while back. These companies will probably focus on other newer drugs for profitability like Semaglutide which is useful for dealing T2D and obesity.

Another thing that needs to be investigated is how much the PBMs (Pharmacy Benefits Managers) prpfit from the spread of drug pricing. Are they marking these drugs up a lot? Do they need to be tightly regulated?

Re: Insulin is way too expensive. California has a solution: Make its own

#158

Post by basch »

zaroth wrote: post #152
basch wrote: post #128

Earlier quoted context omitted.

Insulin is cheap. Long acting insulin is not. They are different products, and the formers patent being free has nothing to do with the later innovations being locked down.

Even the modern rapid acting insulin that doctors are prescribing (Humalog, Basaglar, etc.) can be very expensive. CVS filled a month supply for me after my insurance number had changed and when I went to pick it up they kindly asked for $1300 before I gave them the new insurance info.

Rapid (minutes) being modern insulin. Short acting (takes 30 minutes) being traditional insulin. Rapid for the most part being an additional technology and convenience over short acting traditional.

But yes, I didn't leave a complete comment.

Re: Insulin is way too expensive. California has a solution: Make its own

#159

Post by qclibre22 »

mhb wrote: post #134
bhawks wrote: post #110

Earlier quoted context omitted.

1.4 million people in the us alone would disagree with you. Type 1 diabetes has nothing to do with diet it is an autoimmune disease with genetic and possible environmental antecedents. If you're interested in learning more about type 1 diabetes please check out: https://www.jdrf.org/t1d-resources/about/facts

"More than 37 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them have type 2 diabetes." https://www.cdc.gov/diabetes/basics/type2.html

And it's often treatable through diet and vigorous exercise.

"A weight loss of ~15 kg, achieved by calorie restriction as part of an intensive management programme, can lead to remission of T2DM in ~80% of patients with obesity and T2DM." [ https://pubmed.ncbi.nlm.nih.gov/32690918/ ]

"A novel HIIT-protocol recruiting lower and upper body muscles efficiently improves insulin sensitivity, VO2max and body composition with intact responses in obesity and type 2 diabetes. " [ https://pubmed.ncbi.nlm.nih.gov/36387850/ ]

The caveat, is of course, "long-term weight loss maintenance is challenging."

Re: Insulin is way too expensive. California has a solution: Make its own

#160

Post by spiznnx »

bombcar wrote: post #141
basch wrote: post #115

Earlier quoted context omitted.

People dont want insulin (traditional insulin.) They want fancy insulin (modern insulin), because it is convenient. They want modern rapid and long acting insulin. They want pens. Maybe people want the inhalable powder. Those innovations exist outside the original insulin patent. They are also mixing other drugs with the insulin. >Average retail prices of Novolin and Humulin (traditional short- and intermediate-actin…

Yeah, you can do some quite easy motte-and-bailey with it. Everyone will agree that (cheap, out of patent) insulin should be available to all; it's literally lifesaving. But then switching that to the (modern, convenient) insulin should be available to all is a bit of a slight of hand, especially when it is NOT a "you will die without this" but a "you will have more hassle taking medication to not die" scenario.

I do want to bring up that insulin management is extremely taxing to individuals, and hard to get right. See https://news.ycombinator.com/item?id=30376777 for previous discussion.

Obviously the costs involved in implementing these technologies should be part of the discussion, but I don't think it's unreasonable to want to make anything that eases management of diabetes way more affordable.

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