Pharmaceutical perils
The life-or-death struggles of diabetics in the US
A Humalog insulin bottle is held up to the sky in Bellingham, Wash. on July 22, 2022. The price for this 10ml bottle averages at $274.70 without insurance // Photo by Lily Webster
Written by Jasper Summy
James Klumker sits on his porch with a cold Miller High Life in his hand, relaxing with his work boots still strapped on his feet.
His phone vibrates, but it’s not a text message or phone call; it’s a notification that his blood sugar level is high.
Unlike non-diabetics, Klumker’s pancreas doesn’t produce insulin, the hormone that allows sugar in the bloodstream to be used as energy. Without the proper insulin regimen, diabetics like Klumker could face serious and life-threatening health problems.
“It’s literally my life juice. I need it to stay alive, yet, I’ve gone over 24 hours without insulin simply because I couldn’t afford a refill. That could put me in a coma,” Klumker said.
Acquiring insulin is a burden that has become increasingly more unaffordable in the United States over the years.
Insulin rationing, or using less than the required dose or skipping it, is becoming a more common practice for diabetics, especially in the United States. A 2018 survey conducted by T1International found that 25% of American respondents had rationed their insulin during the prior year.
Earlier this year, Klumker went to the hospital for diabetic ketoacidosis, a condition that can be life-threatening if left untreated.
Diabetic ketoacidosis has several causes, including illness, missing an insulin dosage, or using the wrong amount. Low insulin means that the body relies on fats broken down by the liver for energy instead of sugar. Acids called ketones are produced too quickly in the bloodstream during this process. As these compounds build up, the bloodstream becomes acidic.
Klumker, 23, lives in Bellingham. He was diagnosed with type 1 diabetes when he was five years old. Unfortunately for him, the United States is one of the worst places to be diabetic.
According to Mayo Clinic, the most common forms of analog insulin can cost 10 times more in the United States than any developed country. Diagnosed diabetics also have more than twice the amount of average medical costs than non-diabetics per the Centers for Disease Control and Prevention.
There’s a variety of factors that contribute to the failure of the insulin market to provide affordable prices.
In economic terms, the demand for insulin for most users could be considered highly inelastic, meaning that most users will be willing to buy the same quantity regardless of a change in price. This allows manufacturers to have control over prices of insulin.
“I think it’s run by a bunch of able-bodied rich people who don’t have to think about the things that not as wealthy, very sick people have to think about, and as a result, there is no consideration for differences in access or equity within the healthcare system,” said Zoe Harper, a 21-year-old Western Washington University student with type 1 diabetes.
On top of that, it doesn’t help that there isn’t much price regulation in the industry, and it’s highly non-competitive. If you purchase insulin, there’s a good chance it’s made by either Eli Lilly, Novo Nordisk or Sanofi — three different insulin manufacturers.
Technological advancements in recent years have made it easier for diabetics to regulate and monitor their blood sugar, but these devices can be expensive. Klumker said his Medtronic insulin pump, which automatically adjusts his insulin throughout the day, costs $7,000 with no insurance.
“It definitely has taken a very long time for me to come to terms with the fact that I just have to deal with this and suck it up,” Klumker said.
Today, various organizations exist in hopes that every diabetic has access to the supplies they need.
T1International is a patient-led, nonprofit organization that spreads awareness of issues facing type 1 diabetics through community collaboration, campaigning and advocacy training.
The Embrace Foundation is an organization that redistributes supplies to diabetics in need, who only have to pay a $10 shipping fee.
“When artificial insulin was invented by Frederick Banting, he sold the patent for a literal dollar in hopes that everyone would be able to access it. It’s gone so far away from that and it’s become such a monopoly by Eli Lilly and all these other corporations,” Harper said.
In March 2022, Congress passed the Affordable Insulin Now Act. If passed into law, this legislation would cap the out-of-pocket cost of a month’s supply of insulin to $35 for patients insured privately or through Medicare.
The price of insulin causes an unnecessary financial and emotional burden for those who need it to survive. It’s sickening to think that Eli Lilly — one of the leading insulin manufacturers in the world — is on track to pay out nearly $1 billion in dividends to its shareholders per quarter this year, according to Yahoo! Finance. Yet, so many are struggling to acquire this life-saving product.
Klumker believes no one should pay to stay alive.
“There’s too much money being made at other people’s expense,” he said.