Marvin Malek, MD MPH, is an internist who works at Springfield Hospital in Vermont, and a member of the Executive Committee of Physicians for a National Health Program.
Congress is working on a bill to help reduce the high price of insulin in the U.S.
Those of us who treat diabetes have all known patients who skimp on their dosing or skip doses entirely due to the high cost. The long-term outcomes with poorly controlled diabetes are much worse than they would otherwise be, and taking insufficient amounts of insulin can even lead to ketoacidosis and other short-term crises. So such an intervention would be enormously welcome news to the thousands of Americans who are obliged to use insulin. Unfortunately, the proposed legislation applies to only 20% of diabetic patients.
Turns out that most of the recommended drugs to treat the far more common Type 2 diabetes are also extremely expensive. Perhaps they could be addressed next.
But the cost of treating several forms of leukemia is also extremely expensive and add tremendous stress to patients who are already facing a potentially life-threatening illness. The most common medication used to treat multiple sclerosis costs $110,400 per year. And despite the fact that every type of inhaled therapy for asthmatics and COPD patients were first marketed two decades ago, the cost of every one of these inhalers appears to become ever more expensive with each passing year
Ovarian cancer and breast cancer patients face this same problem. This is also the case for patients with the majority of the rheumatologic illnesses, who face high prices for the biologic-derivative drugs they take. This list goes on and on, since the “your money or your life” extortion of pharmaceutical companies and their partners in greed, the pharmacy benefit managers (Optum Rx, CVS Caremark, etc.) is hardly confined to one class of drugs.
If Congress can manage to plow through one additional drug each month, we’ll have much to cheer about: The prescription drug affordability problem will have been solved by 2060, perhaps even a year or two sooner. But, regrettably, the insulin bill is all that’s left of the comprehensive pharma price control legislation proposed by progressive Democrats last autumn.
It’s laughably inadequate.
The price of brand-name drugs is not determined by the companies’ need to do research since the industry spends only 21% of their revenue on research (including market research), and the basic research that underlies major innovation is driven by the National Institutes of Health and similar agencies abroad. Nor is it determined by competitive market forces since all brand-name drugs are either controlled by a cartel or by a single company.
Instead, the price of drugs is determined politically.
Every other developed nation pays vastly less than we do here in the U.S. (45% less is the OECD average) because each of their governments use the power of single payer systems to negotiate vs. pharma.
Only in the U.S. do individuals with each of thousands of diseases need to form a lobby hoping they can persuade Congress to provide relief to them.
We desperately need Medicare for All legislation in the U.S. Until then, the financial distress and subpar medical care will persist. It’s tragic for many Americans. But if the insulin bill does make it through the Senate, at least some of our diabetic population will face a little less financial stress. A tiny bandaid on a very sick health care system.
