> Though insulin generally costs less than $10 per dose to produce, some versions of the drug have a list price above $200. This is in part because, in the US, a warped market has allowed three companies to dominate the insulin business.<p>> With California leading the way, a handful of states are considering trying to disrupt the market for essential medications, starting with insulin. The plan would be to manufacture and sell insulin themselves for a price that is roughly equivalent to the cost of production.<p>I feel like I'm missing something here. My understanding of why insulin is so expensive: laws are created and enforced by the government preventing people from competing in the space.<p>If you try to make your own insulin, and you take it to market with 3rd party analysis and certification of it being medical grade (and safe) insulin, you'll start seeing an escalation of the state against you. First angry letters from lawyers and eventually, if you continue head strong and ignore everyone telling you to stop, government officials (possibly with guns) will come and forcibly shut you down.<p>Is California just going to ignore these laws? How will the state not be liable for damages when individuals are?<p>I'm all in favor of revoking the legal structures that pick the winners in this market. It seems like there are plenty of people passionate in this space that would/could make insulin at near-cost if permitted to.<p>It's just that, by my understanding, it's the government that doesn't permit them to. It's weird that people in the government (at the state level) are stepping in to do what people in the government (at the federal, but possibly also the state level?) won't let people in the market do.<p>Edit: substituting “intellectual property laws” with “laws” as it seems there’s more to it than just IP.
This is great news. Honestly, I hope to see more nationalization of widely used services (or whatever the equivalent word for nationalization is at state or municipal levels.)<p>Municipal broadband, power, roads, schools, post, housing, and healthcare? It's long overdue, and with an appropriate amount of funding has been shown to be effective at controlling costs and delivering moderately good quality in most cases.<p>A lot of things get so warped by profit motive. And there are places I <i>want</i> a profit motive, but insulin (and healthcare generally) isn't one.
I listened to the Vox The Weeds podcast interviewing the same author and was frustrated that his many explanations seemed disconnected. Since old insulin patents have expired, is it that you are <i>allowed</i> to buy generic insulin but there are no manufacturers, or that you <i>not allowed</i> to buy generic insulin because recent advancements are so good that doctors won’t prescribe the old stuff anymore? And no one will make generic insulin because the brand-name companies will undercut them and there are so many kinds you need to make, but basically a $100 million donation to the world by California will fix all that?
> States have become more ambitious in their policies for tackling the insulin affordability crisis because the scale of the problem continues to grow and the federal government seems capable of taking only limited action to address it.<p>As if the federal government isn't the one causing the shortage in the first place.
> The state is taking a two-phase approach. In the short term, California has put out a request for proposals from existing enterprises that could produce generic insulin for the state as a subcontractor in the next few years in order to try to deliver relief as soon as possible.<p>[...]<p>> But in the long term, the plan is for a government factory operated by government workers producing government-owned medication. The state would have its own public production facilities, staffed by civil workers, which would sell generic insulin for the same cost needed to produce it, plus perhaps a small percentage to cover auxiliary costs for the program.<p>> The $100 million in funding is split evenly between the short and long term. But that long-term vision will take time. Even if the state were to retrofit an existing factory for insulin production, that construction work could take years, as would hiring a workforce to oversee it. Once production is up and running, California would need to hit more targets — most importantly producing a product that the FDA says is interchangeable with existing insulin medications.<p>That second phase is certainly ambitious. Putting it out for bid would be the more normal government process. It will be interesting to see what happens.
Don't believe in Gavin Newsom's new bullshit.
Last I heard about this, a Vial of generic insulin was going to be $35.
Walmart sells the same insulin (regular or suspended varieties) for $25
It is just a publicity ploy.
Even at $25/vial, Walmart insulin has a very nice mark-up. Why buy it from state of CA for a more expensive price tag?
To boot all of this, if you do not have health insurance, Walmart sells the insulin to you without prescription. CA? Not so much.
I am sick and tired of this quasi-populist sounding stories from California nad other liberal inundated locations.
Walmart now sells Novo Nordisk produced insulin for $17 per pen[0]. I have a hard time believing California will do it cheaper than that.<p>[0] <a href="https://www.walmart.com/cp/relion-diabetic-care/3769564" rel="nofollow">https://www.walmart.com/cp/relion-diabetic-care/3769564</a>
California governor Newsom announced this plan seven months ago:<p><a href="https://news.ycombinator.com/item?id=32021868" rel="nofollow">https://news.ycombinator.com/item?id=32021868</a> (216 comments)<p>I clicked on the Vox link, hoping to see an update. There wasn't one, although I'm guessing that the 2022 announcement was about the budget being approved and now in 2023, they just started writing an RFP.
Reflecting a common theme in our healthcare system, the problem of insulin costs is very unevenly distributed: <a href="https://www.healthsystemtracker.org/brief/out-of-pocket-spending-on-insulin-among-people-with-private-insurance" rel="nofollow">https://www.healthsystemtracker.org/brief/out-of-pocket-spen...</a>.<p>About 3 in 4 enrollees in ACA plans that use insulin pay $35/month or less out of pocket. For people with private insurance, 4 in 5 pay $35/month or less.<p>The biggest problem seems to be too many plans, too many choices, and too many ways to fall through the cracks.
Seems to be a weirdly US specific problem:<p><a href="https://worldpopulationreview.com/country-rankings/cost-of-insulin-by-country" rel="nofollow">https://worldpopulationreview.com/country-rankings/cost-of-i...</a>
Big pharma has totally pwnd the regulations the government enforces on the prescription drug market ensuring they have monopoly pricing power. Why wait for CA to spin up it's own insulin manufacturing industry - just do not prosecute the import/manufacturing and resale of insulin - like it did for medical marijuana in the 90s?
Reading these comments, I learned about human analog insulin and how it's considered more modern than older, off-patent versions. I was wondering about human analog insulin's patent status, and from here [1] I learned about the practice of patent ever-greening.[2]<p>TL;DR: "Evergreening is any of various legal, business, and technological strategies by which producers (often pharmaceutical companies) extend the lifetime of their patents that are about to expire in order to retain revenues from them. Often the practice includes taking out new patents (for example over associated delivery systems or new pharmaceutical mixtures), or by buying out or frustrating competitors, for longer periods of time than would normally be permissible under the law."<p>A relevant quote from the Wikipedia article: "In one study of the prescription drug market, Feldman found that 78% of new patents associated with prescription drugs were for existing drugs."<p>Depressing AF...<p>1. <a href="https://www.t1international.com/blog/2019/01/20/why-insulin-so-expensive" rel="nofollow">https://www.t1international.com/blog/2019/01/20/why-insulin-...</a><p>2. <a href="https://en.wikipedia.org/wiki/Evergreening" rel="nofollow">https://en.wikipedia.org/wiki/Evergreening</a>
There’s a better solution; regulate, fine and breakup unscrupulous drug companies.<p>Hang on, isn’t insulin pricing the exact sort of thing anti-cartel/anti-competitive laws are meant to prevent?
„Alec Smith, died in 2017 because he could not afford the $1,300 out-of-pocket price for his prescription once he was dropped from his parents’ health insurance when he turned 26“<p>What a reality. I‘m glad that I don’t have a life threatening diseases, but I would do everything that is possible to survive. Steal, rob, fraud to come at least up with the money to survive.<p>I‘m shocked that simply surviving a manageable sickness in a first world country is not a human right.
> because of the Senate’s arcane rules, they could not establish the same cap for private insurance<p>It looks like one party tried to get this done in reconciliation. If so, blaming “arcane rules” is slanted and makes me wonder what other information the author is twisting.
This is a failure of the free market. When companies get too big, and no longer compete, they should be regulated. The free market only works when there's a ... free ... market.
Insulin is expensive for the same reasons that epi pens are expensive[1] and why Martin Shkreli could increase the price of Daraprim by 50x without worrying about losing market share[2]. The FDA restricts the manufacture and importation of these drugs. Often there is only one manufacturer who has managed to jump through all the bureaucratic hoops, giving them a monopoly on the drug.<p>1. <a href="https://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/" rel="nofollow">https://slatestarcodex.com/2016/08/29/reverse-voxsplaining-d...</a><p>2. <a href="https://slatestarcodex.com/2015/09/24/the-problems-with-generic-medications-go-deeper-than-one-company/" rel="nofollow">https://slatestarcodex.com/2015/09/24/the-problems-with-gene...</a>
What exactly is California planning to make? The generic version is already available for $25-$30. Why does the state need to get into the manufacturing business?
America's reluctance to "socialize" things has created a nightmare with our infrastructure + social utility system.<p>I hope this is done well.
Or just abolish the FDA?
They're the ones keeping competitively priced insulin out of the market.<p><a href="https://mises.org/wire/patents-legal-monopolies-and-high-prices-drugs" rel="nofollow">https://mises.org/wire/patents-legal-monopolies-and-high-pri...</a>
My fiancée was close to death from a missed diagnosis of Type 1 diabetes. We were extremely lucky that she actually got a diagnosis; A nurse at the oncology ward had a hunch. (Overburdened medical personnel miss diagnoses.)<p>Her HbA1c long-term blood sugar measurement was literally off the charts. Off the chart on the wall on the hospital, right through the red “DANGER” section. She had lost 17% of her bodyweight and half of her hair.<p>We have learned the following:<p>You want a continuous glucose monitor (CGM), and an insulin pump, with rapid-acting insulin.<p>You do not want long-acting insulin. Especially not insulin glargine. It is a dangerous form of insulin: It is injected as a blob of insulin (“bolus”) under the skin. It’s supposed to stay in the place and slowly fritter and diffuse into the bloodstream. This effect is due to crystallization of the modified insulin amino acid chain in the pH level inside the body. It’s clever. However, if insulin glargine happens to go into a blood vessel, it works pretty much instantly. Then it is not long-acting at all. The subcutaneous environment is… living tissue. There are capillaries. It can and will go into directly into the bloodstream at some point. For some reason. At injection time, or due to bumps and jostles and physical pressure. Then there are no brakes on it. 24 hours’ worth of active insulin can go into the bloodstream. Then every cell in the body is signaled hard to pull glucose from the blood – all the flesh in the body rips the sugar out of your blood, leaving too little for the brain. People start losing consciousness in minutes, csn pass out, and may die.<p>Insulin degludec is another long-acting insulin, one which is acceptable in this regard. The bolus stays glommed together due to polymerization of the insulin so it’s more robust. It also has molecular brakes on it kind of – if it does go into the bloodstream, it attaches to albumin in blood plasma and doesn’t become active all at once.<p>However, using rapid-acting insulin in a pump is strictly better because this replicates the insulin oscillation of the pancreas. <i>“[The pancreas’] basal insulin level is not stable. It oscillates with a regular period of 3-6 min. After a meal the amplitude of these oscillations increases but the periodicity remains constant. The oscillations are believed to be important for insulin sensitivity by preventing downregulation of insulin receptors in target cells. Such downregulation underlies insulin resistance, which is common in type 2 diabetes.”</i>—<a href="https://en.wikipedia.org/wiki/Insulin_oscillation" rel="nofollow">https://en.wikipedia.org/wiki/Insulin_oscillation</a><p>The insulin pumps work this way. They pump the insulin with a rhythm. It’s easier to control the blood sugar and you need less insulin. It’s crucially different and much better for long-term health and quality of life.<p>The most important things are a good blood sugar sensor (continuous glucose meter or CGM), and a good pump with a good user interface. We haven’t tried one of the closed-loop automatically controlled pumps that reads from the sensor and autoadjusts, but it’s clear from the problems people have with badly designed pump that a good “semiautomatic” pump is better than a poor and unpredictable sensor-feedback-controlled automatic one. These have issues like sometimes cutting out without giving clear warning if blood sugar is high, and the blood sugar target range can’t be adjusted low enough (liability issues afaik) so people tend to stay at too high blood sugar levels which do long-term harm. I do assume that a good automatic pump is magic.<p>Also, glucose metabolism and inflammation are intimately related, which ties into the vascular system. There is <i>a lot</i> more actionable science out on this than most doctors are aware of. (Overburdened medical personnel are unable to keep abreast of scientific developments.)
For context: the patent on insulin was sold in 1923 to the university of Toronto for one dollar because the inventor felt it was unethical to use this invention to make egregious profits off people who had no alternative. This is 100 year old technology. It's not a manufacturing, regulatory, or technological issue. It's just monopoly pricing and greed.