Josh Wilkerson had type 1 diabetes and depended on regular insulin injections to manage his blood glucose levels. Without them, he risked long-term complications from his condition or slipping into a diabetic coma. When he turned 27, he was no longer covered under his stepfather’s insurance. His employer-provided health insurance did not cover insulin treatments. Without coverage, Josh found himself paying nearly $1,200 a month for insulin, a burdensome expense for someone earning $16.50 an hour.
To make financial ends meet, Josh switched to another insulin named ReliOn. ReliOn is available without a prescription at many pharmacies and some national retailers such as Walmart and CVS. More importantly, it is often considerably cheaper than most prescription insulins. A vial of ReliOn (about a month’s supply) costs about $25. A vial of Humalog, a comparable kind of insulin, typically costs $275.
But ReliOn’s lower price is not without its tradeoffs. Older insulins, such as ReliOn, have more variable rates of absorption compared to more recently developed ones. This leaves patients more susceptible to blood glucose fluctuations. Unfortunately, Josh struggled to keep his blood sugars under control once he switched. After his fiancé found him unconscious, he was taken to the emergency room. Tragically, he passed away five days later.
Josh’s heartbreaking story has received widespread attention and is provoking many to call for action. Popular press headlines demanding action be taken to include “Walmart insulins are not the answer,” “Drug prices are killing diabetics,” and “A man who switched to affordable insulin died.” Others raise questions such as “Is over the counter, cheap insulin safe?”
Frustration over skyrocketing insulin prices and the challenges they pose to many diabetics is undoubtedly justified. Unfortunately, many have erroneously declared retailers like Walmart have failed and task government to step in and make insulin cheaper. As a piece in the Washington Post states:
Much to the relief of insulin affordability advocates, who have been raising awareness about costs and pushing for policy changes, the public is increasingly aware of this crisis. But instead of working with advocates to rectify the situation, too many people are simply promoting older, cheaper insulin…Such gestures come from a good place, but they put insulin-dependent people at greater risk and threaten to exacerbate the larger problem.
Such claims are fallacious at best.
Is true that ReliOn and other “older cheaper, insulins” are not a solution? Yes. However, no insulin is a solution. Diabetes management requires strict dieting, healthy lifestyle choices, regular physician visits, consistent sleep schedules, and a personal commitment to regularly testing blood glucose levels. Although modern insulins have their advantages, they hardly constitute a “solution” for a demanding and taxing life-long condition.
Further, medical studies indicate personal choices are far more likely to lead to premature death and diabetic-related complications than the kind of insulin used. A 2008 study published in the peer-reviewed journal Diabetes Care found that consequences of mismanaged diabetes in Demark (where insulin is significantly cheaper) were due to dietary and lifestyle choices. These findings, coupled with medical testimony that ReliOn is safe and effective, undermine claims that such insulins “threaten to exacerbate the larger problem.”
Most importantly, we should hesitate to call on further policies to make insulin affordable. As I have argued before, the primary reason insulin is so expensive in the United States is because of poorly designed policies that allow insulin producers to charge high prices. Under the FDA’s regulatory system, insulin is considered a biological compound rather than a pharmaceutical. Biological compounds can have their patents extended as long as their chemical composition is modified. This regulatory policy has allowed three insulin producers to encompass 99 percent of the insulin market for nearly one-hundred years, stifling competition and keeping their prices high. In that time, advocacy groups and government panels have failed to find any solution to the insulin problem.
In contrast, retailers like Walmart have done what policymakers, advocacy groups, and government panels could not: make life-saving medication widely available and affordable. In doing so, they have undoubtedly saved lives and provided financial relieve for numerous patients in dire situations.
We should be extremely hesitant to chastise retailers for making cheaper insulins available. Their critics’ talk, unlike their solutions, is cheap.