[hjk05]

There isn’t a monopoly. It doesn’t take decades to get a generic on the market. Insulin is available in wallmart for 25$ per vial.

There is a definite problem in the US with drug pricing, and middlemen gauging the market, but it’s a straw man to claim new insulin products don’t bring any change. If you ask the patients there’s a world of difference between the cheap genetics and the main brand products, which is why they want the newer products and not the generics. But of cause patients also want the newer products at the same price as the generics which will never happen, even if the government fixes the drug pricing market.

[ng12]

> If you ask the patients there’s a world of difference between the cheap genetics and the main brand products

The main problem is the $25 insulin is R and not fast-acting. It's not the difference between generic and name-brand, it's about using an insulin that takes over twice as long to be absorbed by your body.

[hjk05]

It really boggles my mind that every article on insulin goes through this cycle: “the producers are scammers it the same product put out a hundred years ago but they have new patents!!!” “It’s cheaply available in the old form” “but that’s not the same product!!”

You can’t have it both ways. Cheap alternatives are available. But yes newer main brand products are better in tons of ways, which is not surprising as they are culmination of decades of research. You can’t both claim there are no differences and than want those differences in the cheaper generics.

[rland]

The patent is expired on the “new version,” Humalog. It expired sometime in the early 2010s. However, because it is produced biologically (altering RNA in bacteria) instead of chemically, additional regulations prevent a genetics from entering the market.

It is this additional regulation that should be subject to scrutiny, since the price of humalog has continued to rise, even after its patent expired. A vial of humalog costs~$5-10 to manufacture, while its list price is nearly $300 and rising quickly. I’m guessing because pharmas want to milk their golden cow while these regulations are still in place. We could drop the price of Humalog 90% within a matter of days by simply cutting regulation against import, as it is already being manufactured safely abroad.

By the way, when Humalog was under patent, on day one, the list price was something like $30 per vial.

Using cheaper alternatives is also strongly correlated with worse outcomes, including amputations and death.

In a word, yes, it literally is exactly as unconscionable and greedy as it looks on the tin.

[hjk05]

> I’m guessing because pharmas want to milk their golden cow

It’s a wired definition of milking a product to lower your take home year after year. The PBMs have rebates close to 70% they are literally making more on the drugs than both the companies producing them and the companies providing them through insurance. List prices are high because the people who own the consumer side of the market don’t care how high the prices go as long as they can set up rebates that increase their own profits.

[ng12]

I agree that the reporting is sub-par but that's not really what's going on. Insulin R and rapid-acting insulin are two separate medications. All insulin manufacturers produce both types and a generic is only available for NPH, despite the fact that the overwhelming majority of Type 1 diabetics are prescribed fast-acting. Additionally most diabetics are prescribed to take a long-lasting insulin as well since the body needs insulin 24-hours a day, there is no generic for this variant either.

[lostmymind66]

If the generics are $25, then I don't see a problem. It's cheaply available and this article is wrong.

[erinaceousjones]

Not all insulin is created equal, as the Vox article posted in this thread shows - https://www.vox.com/science-and-health/2019/4/10/18302238/in... - different formulations vary in their effectiveness person-to-person regarding regulating blood sugar levels. For one person, the cheap ReliOn insulin from Walmart might allow them to manage their T1 diabetes, but for another person it might cause more incidences of hypo/hypergylcaemia.

The expensive, newer, patent-covered formulations like Lantus are what are prescribed over here in the UK - lucky that the NHS shields us from the ridiculous prices!

[tomatotomato37]

I don't get it. If the generic unimproved versions... unimprovedness is riskier, and an improved version is researched and created that removes that risk, than why should the new formula of the new version not be under patent?

[dunstad]

If you think about the rules of our current system, your conclusion makes perfect sense. I and others don't think the rules of the current system are very good if they're preventing us from giving people better quality of life.

[themaninthedark]

I purchased an OS 8 years ago, if I want to buy the same modern OS from the maker it now cost more money.

I purchased a car from a manufacturer, the base price was 20,000. Now the same model car has the base price 25,000. Sure, they added side impact airbags, backup cameras and lane assist but why can't I buy it for 20,000?

If you and others who think like you dislike the current system and want to improve everyone's quality of life, you are quite welcome to invest the time and capital to start a drug research lab, invent new and novel medicine, patent it, get it FDA approved then license it to anyone who wants to make and sell it.

Volvo was committed to the idea of safety that when they developed a seatbelt system they did just that.

The idea of taking someone's work with out paying them fair compensation is akin to slavery. The only difference it that slavery is forcing someone to do something and this is promising someone compensation then withholding it.

Now, if we believe that this new formulation is so revolutionary and would be such a great benefit then why not just buy the patent from the maker? Put together a company, raise the funds. Anything can be bought and sold. The only question is price. Trying to force the government to use a version of eminent domain by lying about the situation to the public to spark outrage is scummy.

[dunstad]

I'm not going to try to persuade you that the negatives of capitalism outweigh the positives, but if you're interested in learning why I believe what I do I'd be happy to direct you to where you can find out.

[rland]

The new version is not under patent, the patent expired on it several years ago.

[jablongo2]

The problem is that the generics are equivalent to insulin from the 70's, when complications of type-1 diabetes were considered almost unavoidable. You can be super diligent and figure out how to manage your diet to make it work with the cheaper stuff, but that takes years of practice and conditioning. If you have to switch from something like humalog and an insulin pump, to injections of Regular insulin a two times a day or so, you are gonna be screwed.

[wishinghand]

The generic insulin is very low quality. Yes it could save my life, but it would incredibly hard to manage a healthy one.

[consp]

Most people will not be healthy with the generic insulin. There are wide verieties of treatment methods for vastly different people and medicine has come a long way. This "generic" human insulin replacement is a 40 year setback in treatment and will likely cause more secondary costs due to bad treatment.

[WalterBright]

Since patents expire after 20 years, it would be max a 20 year setback.

[tschwimmer]

Do you have some more information about this? It's interesting to me and I'd like to learn more.

[IG_Semmelweiss]

http://www.econtalk.org/robin-feldman-on-drugs-money-and-sec...