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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

#161

> 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…

IANAL, but they may not be ignoring those laws; they may be planning to fight them. That cannot happen without standing, which may be easiest to obtain by trying to move forward with this plan. I suspect they would be breaking federal laws, so I believe consideration of the State's 10th Amendment rights applies here. That would be wonderful and hope that this case brings that topic into the spotlight, because I see 9…

We already have precedent for a state outright saying "fuck copyright": Blackbeard's Law[0]. North Carolina copied a photographer's images and then passed a law saying the images were part of the public record and thus not copyrightable. The photographer sued to get the law repealed but SCOTUS decided that sovereign immunity meant there was no standing to overturn the law.

An interesting wrinkle is that Congress already foresaw this and passed a law decades ago waiving state sovereign immunity for patent and copyright claims. But then SCOTUS overturned the patent prong of this federal waiver on the grounds that Congress hadn't proven that states had a pattern of telling patent holders to go fuck themselves. And SCOTUS's reasoning for striking down the suit about Blackbeard's Law was that this also held true for the copyright prong of that law... despite being handed a brazen example of a state nullifying copyright law for their own gain on a silver platter.

What this technically means is that your state could, tomorrow, run their own pirate streaming site and not get sued for it[1]. The only way to stop it legally would be to sue end users, which would be difficult to do for a direct download service[2].

As for antitrust and cartels, since copyright and patents are legal, government-granted monopolies, most courts are very loathe to attack them even when they are used in ways that violate antitrust law. You can see this in FTC v. Qualcomm, where an appeals court smacked down an antitrust ruling for this reason. Compounding this is the fact that a very large contingent of judges have been slowly nullifying antitrust since the 1980s under the "consumer welfare" theory that every tech company is built to maximally exploit.

I could see California getting away with bloodying Eli Lily & Co's nose. But I would not count on this becoming a future model for evading (ab)use of the patent system. Remember, all the states are still part of a federal government that is very much in favor of the patent system as currently constituted, and there are still things they can do to block California.

[0] https://nsglc.olemiss.edu/blog/2020/apr/2/index.html

[1] Assuming your state had not already waived sovereign immunity for copyright

[2] It's commonly believed that you can't sue for downloads, only uploads. This isn't quite true. At least one court has outright said that both are illegal but infringe on different exclusive rights. I don't remember which court.

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

#163
post #156
post #94

Earlier quoted context omitted.

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?

Jokes on them. I can buy raw semaglutide powder two steps off a Google search at 10% of retail.

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

#165

Earlier quoted context omitted.

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.

Which is what the conversation should be, and how it should be framed.

The press writing "life saving insulin" headlines takes away from the ability to discuss that: within the last decade or two, modern improvements made the process of managing diabetes significantly easier and else stressful. The drug companies gave everybody a taste of an easier life, and then jacked up the price, saying "pay us more or go back to the old way." At what level should the government step in and subsidize or control this quality of life improvement? At what level should its creators be rewarded?

I am old enough to remember when the entire world took traditional insulin. It wasn't pretty.

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

#166
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…

Hey Eric, somewhat tangential question -- why is it that seemingly all precursor manufacturing is done in China or India? Is it just a low-cost game or are regulations making it too expensive to do in the U.S. or something else?

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

#167
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.

Novolin 70/30 ReliOn vial (10 mL; 100 iU/mL) has had a flat price since 2014. The Novolin 70/30 ReliOn FlexPen (3 mL; 100 iU/mL) pen has been the same price as the vial since mid 2018 when it came out.

The price of these drugs NEVER went up.

Framing it as only "more hassle" or "purely convenience" really downplays the difference in the quality of life improvement the last decade has brought everyone.

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

#168

Earlier quoted context omitted.

> has been shown to be effective at controlling costs That has never happened. What does happen is the cost is borne by the taxpayer rather than the user of the service. The "warping" of the profit motive in the insulin case is entirely caused by government interference and regulation (by making it nearly impossible for competitors to spin up and make insulin).

There are many cases where the government can produce things at cost and bankrupt for profit companies. It's not always effective but the situation is quite dire at this point

> There are many cases where the government can produce things at cost

Yes, and the costs are always higher than that of a for profit company.

> the situation is quite dire at this point

Right. The solution is to remove the regulatory and legal barriers that add $190 in cost to a dose.

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

#169

Earlier quoted context omitted.

> has been shown to be effective at controlling costs That has never happened. What does happen is the cost is borne by the taxpayer rather than the user of the service. The "warping" of the profit motive in the insulin case is entirely caused by government interference and regulation (by making it nearly impossible for competitors to spin up and make insulin).

Not really. The internet is an example of what happens when you suck margin out of high margin businesses like content creators. India is an example for pharmaceuticals. If the state takes a commodity and sells it on a cost plus or cost basis, it’s going to kill investment in the spaces and collapse the margin. At this point, we’re killing people and bankrupting states and employees with out of control costs. Making…

> Making an example out of insulin would fix that

No it won't. It will just shift the cost to the taxpayers.

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

#170

Earlier quoted context omitted.

> has been shown to be effective at controlling costs That has never happened. What does happen is the cost is borne by the taxpayer rather than the user of the service. The "warping" of the profit motive in the insulin case is entirely caused by government interference and regulation (by making it nearly impossible for competitors to spin up and make insulin).

In this case the regulation is certainly being pushed by the pharma companies themselves as they wish to use regulation as a means of eliminating their competition so they can charge monopoly prices. So less regulation is not going to help, rather, the political influence of the corporations is the problem. Doing an end run around the whole mess by simply producing your own insulin will rapidly cause collapse in pric…

> So less regulation is not going to help

Yes it will. The government is far, far more powerful than the corporations.

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