Origins of the insulin crisis: how a century of price-fixing controversies affects the cost of care today

Strodel, Rachel J.; Greene, Jeremy A.

doi:10.1016/s0140-6736(21)02402-8

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…However, "financial toxicity" medicalizes a problem that is fundamentally socioeconomic-the development of a system that distributes health care as a discretionary consumer good, subject to the laws of supply and demand. When insulin prices skyrocketed, causing numerous avoidable deaths in patients with diabetes who were unable to afford it, 6 it was not caused by any change in the toxicity profile of the drug. Labeling this price-gouging as a "toxicity" obscures the intentionality of actions by pharmaceutical companies to increase profits.…”

Section: Language and Cognitionmentioning

confidence: 99%

Words Matter: Unintended Side Effects of “Financial Toxicity”

Blackstone,

Daly

2023

Journal of the National Comprehensive Cancer Network

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H igh out-of-pocket costs of treatment in the United States are a major driver of health disparities. The financial burdens associated with medical care are frequently referred to in the literature as "financial toxicity." This term was popularized after articles by Zafar and Abernethy in 2013 highlighted the growing out-of-pocket costs borne by patients with cancer. 1,2 They describe financial toxicity as consisting of both "objective financial burden" and the subjective distress resulting from that burden. The authors attribute increasing costs to 4 factors: "an aging populace, more patients with access to treatment, innovation, and overutilization."Since 2013, the concept of financial toxicity has gained significant popularity in the oncology literature and has been adopted in other specialties, such as neurology. 3 The reasons for this are understandable. Clinicians are familiar with the notion of unintended and sometimes serious noxious side effects of treatments. Chemotherapeutic agents powerful enough to slow or eradicate cancerous cells often are just as powerful in damaging healthy tissue. Thus, explanation of potential toxicity is routinely included in discussions with patients about recommended treatment. "Financial toxicity" is a useful idiom that encourages clinicians to screen for, identify, and attempt to manage treatment-induced financial problems just as they do for other treatment-related toxicities. However, this choice of language may obscure rather than illuminate causes of the problem and our responsibility to work toward solutions.

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Section: Language and Cognitionmentioning

confidence: 99%

Words Matter: Unintended Side Effects of “Financial Toxicity”

Blackstone,

Daly

2023

Journal of the National Comprehensive Cancer Network

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“…Without insulin, a person living with type 1 diabetes (T1D) cannot survive ( 1 ). Despite its discoverers’ intent that insulin be accessible to all who need it ( 1 – 3 ) and their desire to prevent its exploitation by monopolies ( 4 , 5 ), it has become a commercial product, grossing huge profits over recent decades ( 2 , 5 , 6 ). More than 100 years after its discovery, many people with T1D die because they cannot access or afford insulin and other essential diabetes supplies ( 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Others face extreme financial burdens, paying 20-100% or more of monthly income towards diabetes management ( 10 , 11 ). T1International ( https://www.t1international.com/ ), a non-profit advocating for the rights of people with T1D worldwide, and others have documented the countless deaths resulting from insulin rationing ( 5 , 12 , 13 ), and called for international declarations prioritizing insulin access ( 14 ). Market dominance by three insulin manufacturers ( 5 , 7 , 15 ), patent evergreening ( 16 ), price discrimination ( 6 ), and supply-chain inefficiencies ( 17 , 18 ) have been cited as contributors to high prices in the absence of governmental regulation ( 7 , 19 ).…”

Section: Introductionmentioning

confidence: 99%

“…T1International ( https://www.t1international.com/ ), a non-profit advocating for the rights of people with T1D worldwide, and others have documented the countless deaths resulting from insulin rationing ( 5 , 12 , 13 ), and called for international declarations prioritizing insulin access ( 14 ). Market dominance by three insulin manufacturers ( 5 , 7 , 15 ), patent evergreening ( 16 ), price discrimination ( 6 ), and supply-chain inefficiencies ( 17 , 18 ) have been cited as contributors to high prices in the absence of governmental regulation ( 7 , 19 ). In many countries, healthcare systems lack or leave gaps in coverage for diabetes treatment ( 20 – 22 ), contributing to rationing of insulin and supplies ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

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Out-of-pocket expenses and rationing of insulin and diabetes supplies: findings from the 2022 T1International cross-sectional web-based survey

Souris,

Pfiester,

Thieffry

et al. 2024

Front. Clin. Diabetes Healthc.

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IntroductionContinue investigating Out-of-Pocket Expenses (OoPEs) and rationing of insulin and diabetes supplies, including impacts of the COVID-19 pandemic, for people with type 1 diabetes (T1D).MethodsA cross-sectional web-based survey was conducted in English and advertised by T1International’s global network of patient advocates from May through September 2022. Participants provided monthly OoPEs and rationing frequency for insulin and supplies, impacts of the COVID-19 pandemic, and open-ended comments.ResultsIn the seven most represented countries, mean monthly OoPEs were highest in the United States, followed by Panama, Canada, and India, and were much lower in the United Kingdom, Germany, and Sweden. OoPEs were highest for participants with partial healthcare coverage, followed by those with no healthcare coverage. The COVID-19 pandemic negatively impacted access and/or affordability of insulin and/or supplies for over half of participants. Globally, 19.5% reported insulin rationing and 36.6% reported rationing glucose testing supplies. Qualitative analysis of open-ended responses identified themes such as ‘mental health impacts’ and ‘limits to life choices.’DiscussionHigh OoPEs lead to rationing of insulin and supplies for many people with T1D globally. Healthcare systems improvements and price reductions of insulin and supplies are needed to ensure adequate, equitable access for all.

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“…Free intellectual property made insulin a 'gentleman's market', and companies vied to make it available. The first vials marketed for around Canadian (CAD)$1, equivalent to ~CAD$12 in 2006, but the price soon came down [5] with insulin produced by Eli Lilly sold for 3.5% of its initial price in the 1930s [6].…”

Section: Introductionmentioning

confidence: 99%