Illinois set to approve insulin price cap of $100 for month supply
The move reflects a broader nationwide effort to lower prices of the life-saving drug.
- Some 30 million Americans have diabetes and must take insulin, but about 25 percent of them can't routinely afford the drug.
- In recent decades, the cost of insulin has skyrocketed, partly because only three companies make insulin in the U.S.
- There's some indication that recent efforts to make insulin more affordable are picking up steam.
Illinois is set to pass a measure to cap out-of-pocket insulin costs at $100 for a 30-day supply, a move that reflects a broader effort to lower costs of the hormone across the nation.
The bill is currently in the hands of Illinois Gov. J.B. Pritzker, who has expressed support for capping insulin prices, saying the rising costs are "an enormous burden for too many Illinois families," and that Illinois sees health care as "a right and not a privilege," according to the Chicago Tribune.
The cap applies only to commercial insurance plans, and it was modeled after a bill in Colorado, which became the first state to cap insulin prices earlier this year. If passed, the Illinois bill would take effect Jan. 1, 2021.
"For over a million Illinois residents, insulin is an absolute necessity," said State Sen. Andy Manar (D-Bunker Hill), who sponsored the bill. "Without it, they will die. Pharmaceutical companies are leveraging that fact in order to maximize profits. It's time we hold them accountable."
"Insulin belongs to the world, not to me"
Insulin is an essential and naturally occurring hormone that regulates blood sugar. About 30 million Americans have diabetes and must take insulin because they either don't produce enough of the hormone or don't respond to its effects. Before the discovery of insulin in the 1920s, a diagnosis for Type 1 diabetes was often considered a death sentence.
In 1923, Frederick Banting, James Collip, and Charles Best sold the first insulin patent to the University of Toronto for $1 each. They believed the drug — which meant Type 1 diabetes was no longer a death sentence — shouldn't be kept from the public for the sake of profit.
"Insulin belongs to the world, not to me," Banting reportedly said at the time.
But a century after their discovery, insulin is one of the most expensive liquids in the world, and it remains prohibitively expensive for millions of diabetes patients worldwide, many of whom risk facing blindness, strokes, foot amputations or premature death without access to the drug.
"You don't know if you will have enough of a freaking liquid that your whole life depends on," Marina Tsaplina, who has diabetes, told Business Insider. "You don't know if you have enough life. That's what being not sure if you can afford your insulin means."
The sixth most expensive liquid in the world? Insulin in the US.— Andy Slavitt (@Andy Slavitt)1566761450.0
The insulin crisis
The soaring prices of insulin have sparked outrage. In 2016, the average monthly cost of insulin was about $450, but nearly 25 percent of Americans with diabetes are unable to routinely afford these prices, and so they resort to rationing, skipping doses or even obtaining insulin illegally.
What's driving up prices? One explanation lies in the fact that there are only three major insulin makers in the U.S.: Eli Lilly, Novo Nordisk and Sanofi, each of which is able to negotiate drug prices with private insurers. These "big three" insulin makers have also been accused of price fixing in several lawsuits.
Typically, competing drug companies would be able to make generic versions of insulin, which would help lower prices. But no such generic insulin currently exists. That's in part because insulin makers have made incremental changes to insulin drugs over the decades, which allow them to keep their designs protected by patent laws. Some of these changes have resulted in improved diabetes care. But others seem designed to extend patent protection.
The result is that it's hardly profitable for alternative manufacturers to produce older versions of insulin.
"Older insulins have been successively replaced with newer, incrementally improved products covered by numerous additional patents," states a 2017 Lancet paper on insulin price increases.
What's more, navigating the patent laws is difficult and potentially dangerous for competing companies, as David Gaugh, senior vice president of sciences and regulatory affairs for the Association for Accessible Medicines, told STAT.
"There's all types of patents that are involved," Gaugh said. "Whether it be process patents, manufacturing patents, device patents É packaging patents, labeling patents and trademarks, all those are different methods used to prevent [competition]."
Patents aren't the only factor preventing a generic insulin from entering the market. In fact, a true generic — or even biosimilar — insulin is impossible to create, according to U.S. law. That's because generic drugs are derived from chemical-based medications, whereas insulin is a biologic-based drug. As such, any "generic" insulin is more complicated to manufacture and more difficult to get approved by the Food and Drug Administration.
More affordable insulin
In 2018, the American Diabetes Association recommended several steps U.S. lawmakers can take to make insulin more affordable:
- Streamlining the biosimilar process
- Increasing pricing transparency throughout the insulin supply chain
- Lowering or removing patient cost-sharing for insulin
- Increasing access to healthcare coverage
Earlier this year, members of Congress pressured the "big three" insulin makers, along with pharmacy benefit managers, to start lowering the costs of insulin. In November, the World Health Organization announced it would begin testing and approving generic versions of insulin, a process designed to make it easier for United Nations agencies and organizations like Doctors Without Borders to bring the drug to developing countries where it's in short supply.
"Four hundred million people are living with diabetes, the amount of insulin available is too low and the price is too high, so we really need to do something," Emer Cooke, the W.H.O.'s head of regulation of medicines and health technologies, said.
The director of the Affordable Insulin Now campaign, Rosemary Enobakhare, said in November that the W.H.O. move is "a good first step toward affordable insulin for all around the world," but that it wouldn't help diabetes patients in the U.S. To make a difference in the U.S., she said, would require "Congress to grant Medicare the power to negotiate drug prices" instead of leaving it up to insulin makers.
What would happen if you tripled the US population? Join Matthew Yglesias and Charles Duhigg at 1pm ET on Monday, September 28.
The idea of 'absolute time' is an illusion. Physics and subjective experience reveal why.
- Since Einstein posited his theory of general relativity, we've understood that gravity has the power to warp space and time.
- This "time dilation" effect occurs even at small levels.
- Outside of physics, we experience distortions in how we perceive time — sometimes to a startling extent.
Physics without time<p>In his book "The Order of Time," Italian theoretical physicist Carlo Rovelli suggests that our perception of time — our sense that time is forever flowing forward — could be a highly subjective projection. After all, when you look at reality on the smallest scale (using equations of quantum gravity, at least), time vanishes.</p><p style="margin-left: 20px;">"If I observe the microscopic state of things," writes Rovelli, "then the difference between past and future vanishes … in the elementary grammar of things, there is no distinction between 'cause' and 'effect.'"</p><p>So, why do we perceive time as flowing <em>forward</em>? Rovelli notes that, although time disappears on extremely small scales, we still obviously perceive events occur sequentially in reality. In other words, we observe entropy: Order changing into disorder; an egg cracking and getting scrambled.</p><p>Rovelli says key aspects of time are described by the second law of thermodynamics, which states that heat always passes from hot to cold. This is a one-way street. For example, an ice cube melts into a hot cup of tea, never the reverse. Rovelli suggests a similar phenomenon might explain why we're only able to perceive the past and not the future.</p><p style="margin-left: 20px;">"Any time the future is definitely distinguishable from the past, there is something like heat involved," Rovelli wrote for the <a href="https://www.ft.com/content/ce6ef7b8-429a-11e8-93cf-67ac3a6482fd" target="_blank"><em>Financial Times</em></a>. "Thermodynamics traces the direction of time to something called the 'low entropy of the past', a still mysterious phenomenon on which discussions rage."</p>
The strange subjectivity of time<p>Time moves differently atop a mountain than it does on a beach. But you don't need to travel any distance at all to experience strange distortions in your perception of time. In moments of life-or-death fear, for example, your brain would release large amounts of adrenaline, which would speed up your internal clock, causing you to perceive the outside world as moving slowly.<br></p><p>Another common distortion occurs when we focus our attention in particular ways.</p><p style="margin-left: 20px;">"If you're thinking about how time is <em>currently</em> passing by, the biggest factor influencing your time perception is attention," Aaron Sackett, associate professor of marketing at the University of St. Thomas, told <em><a href="https://gizmodo.com/why-does-time-slow-down-and-speed-up-1840133782" target="_blank">Gizmodo</a></em>.<em> "</em>The more attention you give to the passage of time, the slower it tends to go. As you become distracted from time's passing—perhaps by something interesting happening nearby, or a good daydreaming session—you're more likely to lose track of time, giving you the feeling that it's slipping by more quickly than before. "Time flies when you're having fun," they say, but really, it's more like "time flies when you're thinking about other things." That's why time will also often fly by when you're definitely <em>not</em> having fun—like when you're having a heated argument or are terrified about an upcoming presentation."</p><p>One of the most mysterious ways people experience time-perception distortions is through psychedelic drugs. In an interview with <a href="https://www.theguardian.com/books/2018/apr/14/carlo-rovelli-exploding-commonsense-notions-order-of-time-interview" target="_blank"><em>The Guardian</em></a>, Rovelli described a time he experimented with LSD.</p><p style="margin-left: 20px;">"It was an extraordinarily strong experience that touched me also intellectually," he said. "Among the strange phenomena was the sense of time stopping. Things were happening in my mind but the clock was not going ahead; the flow of time was not passing any more. It was a total subversion of the structure of reality."<br></p><p>It seems few scientists or philosophers believe time is completely an illusion.</p><p style="margin-left: 20px;">"What we call <em>time</em> is a rich, stratified concept; it has many layers," Rovelli told <em><a href="https://physicstoday.scitation.org/do/10.1063/PT.6.4.20190219a/full/" target="_blank">Physics Today</a>.</em> "Some of time's layers apply only at limited scales within limited domains. This does not make them illusions."</p>What <em>is</em> an illusion is the idea that time flows at an absolute rate. The river of time might be flowing forever forward, but it moves at different speeds, between people, and even within your own mind.
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