ADA Resolution Asks Congress to Investigate Insulin Prices

The American Diabetes Association (ADA) Board of Directors on Thursday passed a resolution asking Congress to investigate soaring insulin prices, which tripled between 2002 and 2013 and are blamed by experts for rising rates of diabetic ketoacidosis.

Specifically, the ADA is asking Congress to call in every piece of the supply chain—from the drug companies on down to the pharmacy—and to reveal how prices are set, to find out why they have climbed so high, and to make sure that patients who need insulin can get it.

As the ADA resolution states, insulin prices are 6 times higher in the United States than in Europe, and as a result, “a growing number people with diabetes (are) telling their healthcare providers they are unable to afford their insulin prescribed for them, thus exposing them to serious long- and short-term health consequences.”

“People with diabetes who use insulin need this medication every day of their lives in order to live,” the resolution states. All people with type 1 diabetes (T1D) and those with advanced type 2 diabetes (T2D) use insulin to manage their blood sugar levels and avoid both long-term and short-term complications, which can include blindness, loss of limbs, kidney failure, heart disease, stroke, and dementia.

Many predicted that in the aftermath of the uproar over the price of EpiPens, insulin would be the next life-saving medical product that would catch the attention of lawmakers. The difference with insulin, advocates note, is that while a patient without an EpiPen might be at risk, a person with T1D needs insulin to survive.

On November 4, 2016, US Senator Bernie Sanders (I-Vermont) and US Representative Elijah Cummings (D-Maryland) asked the US Justice Department and the Federal Trade Commission to investigate whether the 3 major insulin manufacturers—Novo Nordisk, Eli Lilly, and Sanofi—are coordinating their pricing.

Their letter cited prices that rose from an average of $231 to $731 per year per patient between 2002 and 2013, as well as instances of “shadow pricing,” in which price increases closely follow one another.

Robert A. Gabbay, MD, PhD, FACP, chief medical officer at the Joslin Diabetes Center and editor-in-chief of Evidence-Based Diabetes Management, a publication of The American Journal of Managed Care, wrote in his September editor’s letter that the reasons behind the rising prices are complex, with no one party completely at fault, which makes solutions difficult.

But the outcome for patients, he said, is not complicated: high insulin prices have bad consequences. While the Affordable Care Act once offered persons with T1D the prospect of not having to worry about being excluded from health coverage for a preexisting condition, a different problem has emerged. Instead, Gabbay wrote, persons with T1D “find themselves struggling each month to scrape together ever-increasing out-of-pocket costs for insulin—a drug discovered nearly a century ago.”

The ADA resolution calls upon “all the entities in the insulin supply chain,” including the drug manufacturers, the wholesalers, the pharmacy benefit managers, payers, and pharmacies to increase transparency, and to ensure that no patient is denied access.