I had several eye surgeries related to my congenital cataracts as a kid, including one where I had to wear an eye patch bandage for a few weeks. I remember being given a Mickey Mouse doll with a circular band-aid over the same eye, similar to my own. I peeled it off right away. Maybe I was a cynical kid.
Because there's a push for insulin affordability, and they look really really really terrible when someone brings up a chart of the rise in the price of insulin over the past few decades.
They fear a Congressional inquiry and federal price caps. Normally, you'd expect a new medicine entering the market to get cheaper as the production ramps up, yet it's gone the opposite direction, even after the patent has expired.
But the patent on this, insulin aspart (humalog is insulin lispro, the competitor), is now expired, so the patent isn't a factor in the cost. The fact it costs 10x more than it did when it was introduced to the market in the mid-90's is just absolutely crazy.
Its middlemen. Lilly has been pretty adamant that their revenue per unit has been inline with inflation, despite the sticker price skyrocketing. Presumably that can be fact checked with their financial data. They insist that its PBMs and insurers gaming the rebate system. Unfortunately the rebate system is incredibly opaque and PBMs insist on keeping this way to protect trade secrets.
The only thing wrong here is a bit of silliness in the structure, the people who do have insurance but don't get the good negotiated price, and your made up numbers
My curiosity got the better of me, so I rang up my mother who's had type 1 since childhood.
She said 5x3ml vials of Lispro (or just about any brand) was approx. $40 in the pharmacy.
Once she's spent more than $275-ish in a calendar year, the insulin is free (well, tax funded) until December 31st.
This is in Norway, where the state presumably negotiates good deals with big pharma as they are basically a single customer buying goods for however many of a population of 5.5M need insulin (injected, that is)
I still remember one particular game in the mid-90s where there was basically a corporation of several "evil" players vs. me and another "good" player. We eventually played to a stalemate where neither side was going to get a clear victory.
As a type 1 diabetic, I feel this. It sure seems like there's a lot more money to be made from me selling insulin, testing supplies, pumps, etc, that I'll need to use for life (29 years and counting) than in finding a cure, which perhaps they can sell me once, or maybe yearly. I know there are people working hard to find a cure, but I also know that they struggle with getting funding.
Same situation, same feeling. I also don’t have high hopes for disruption from some startup, people seem to underestimate how much harder startups in biotech are compared to tech.
As they say, technically correct is the best kind of correct but also the most useless.
Parent's point is well received: it's much harder to be a startup when you need to fund laboratories, complex supply pipelines, diverse and deep know-how, interaction with government agencies etc.
From the little I've read manufacturing insulin and testing supplies doesn't seem terribly complex. I'm not too sure why there's so much profit to be made other than regulatory capture.
Different formulations of insulin offer different benefits to diabetics. Ones that are more slow acting more closely resemble the body's natural regulation of insulin, and therefore do less harm to the body. Or so I hear.
Most type 1 diabetics take 2 types of insulin (except for people on pumps). One is your bolus insulin, which is faster acting, usually used before meals or to bring down high blood sugar more quickly. The other is your basal insulin, which is slower acting, typically taken once or twice a day, which provides insulin for your body's background metabolic processes. People on pumps typically just use the bolus type insulin, since the pump can continuously supply small doses every few minutes, which allows for finer tuning more quickly.
Until about 25 years ago, the normal bolus insulin was Regular insulin, which is just like what your body makes. However, injecting it into fat makes it work more slowly, so you'd take it a half hour before eating, and it would peak a couple hours later. Currently bolus insulins are a genetically tweaked version that allows the body to absorb it more quickly, within a few minutes, with a peak in an hour or so. In the human body, there's an even faster phase 1 insulin response, but to get it as a type 1, you'd need to inject insulin into a vein. It can be done, but it is considered extremely dangerous.
Basal insulins are generally regular insulin mixed with something to delay action or modified to do the same. Older ones like NPH needed to be taken roughly every 12 hours, but had a relatively high peak, which sometimes meant you needed to time a snack to deal with that. Newer ones offer a much flatter action curve, and can often be taken just once a day.
I ripped all of my CDs to FLAC, then I was able to convert those to Ogg Vorbis at the time for my portable player. Later I converted the FLACs to mp3s, and used Apple's iTunes Match, so I have access to them on various devices for $25/year.
“Them”. I tried this when it launched, and so many of my unique recordings were clobbered: Artists incorrectly identified, live recordings replaced with studio recordings, etc. I threw the idea out and never looked back.
What we need is an oil barrel subscription service. For just $20/mo, they'll deliver a barrel of oil to your house or business. For $25/mo, they'll throw in a bucket of coal. Makes a great holiday gift.
Wouldn't it be better if I store the oil for you and give you a certificate instead? You could buy it instantly and you could just email or whatsapp your christmas gift of coal...
Even better if the certificates are cryptographically signed in a chain and their custody is verified though a solution of the Byzantine generals problem.
