[jerf]

If you can only charge $100, but it costs $110, what happens isn't that it gets sold at $100 anyhow. What happens is that it doesn't get sold.

Nobody has an obligation to manufacture insulin.

I'm not saying the costs are $110. I don't know. I'm just explaining why this can result in lost insulin.

[pjc50]

https://www.businessinsider.com/insulin-prices-could-be-much... : a year’s supply of human insulin could be $48 to $71 a person and between $78 and $133 for analog insulins.

That's well below the $1,200 a year cap.

[EpicEng]

You're making a hypothetical argument when you don't need to. Since we're specifically talking about insulin, and not placing an arbitrary cap on any drug, there's no need.

We know what it costs to manufacture insulin, and it's literally a few bucks per vial [1]. You're framing this as if it represents the larger debate between fixing medical costs and the free market, but it's not that at all, and no one is going to lose their insulin.

[1]: https://www.businessinsider.com/insulin-prices-could-be-much...

[lightbyte]

That's not really a relevant argument here as insulin costs <$5 to manufacture.

[UnpossibleJim]

Which insulins? Not all insulins are equal or cost the same to produce.

[EpicEng]

https://www.businessinsider.com/insulin-prices-could-be-much...

If you can find any variant that even approaches $100, please link a source.

[UnpossibleJim]

I'm not arguing that they cost $100 to produce, but even in this article they cost more than the stated "<$5 to make". And this doesn't include any recoup of research cost. I'm not arguing for higher insulin cost, even though it seems like I am. I have to buy the stuff and take it or die. On the other hand, a consistent supply and further research into better fast acting and long acting insulins also matter to me, as they make a HUGE difference in the quality of life. It's a double edge sword, unfortunately. Until such time as profit motive is replaced (and I would be ecstatic if it were), those of us with type I diabetes have to thread that needle very carefully =\

[JMTQp8lwXL]

It sells in Europe for much cheaper. There is absolutely a market for insulin for under $100/mo in many western countries.

[ogre_codes]

In most of the world people can get a month's supply of insulin for less than $100/ month. It's not more expensive to manufacture here, there is just more profit-taking.

[theandrewbailey]

Manufacturers that can't (or won't) sell a month's worth of insulin for $100 will be replaced by those who can.

[jerf]

You misunderstand. I'm not saying "If the manufacturers decide it costs $110". I mean, if it costs $110. You can't force someone to create things at $110 and sell them at $100... or at least, you can't for very long.

Others are observing that the current prices are not currently anywhere near $100. That's completely unrelated to what I'm explaining.

I'd also point out that is a temporary fact, not a permanent fact. If, let's say, in two months the Coronavirus has mutated into a mark 2.0 and is sweeping through Illinois [1], getting insulin may become much more expensive due to all the measures needed to prevent spread of infection. If it becomes more than $100 worth of expensive, it's going to be difficult to distribute. There can be supply disruptions due to source contamination, whoknows what else. Even if today this seems like a generous cap, an inflexible cap can still be a problem tomorrow.

Of course, the last few years being what they are in online discourse, a large number of you will be inclined to read this as a defense of high prices, rather than what it actually is, which is an observation that price fixing has certain effects and that we don't know the future very reliably. Screwing around with insulin prices just because you can is evil and should be the grounds of a presumptive collusion, oligarchy, or monopoly investigation. But that doesn't mean that fixing the price is a good idea, or going to fix it. Personally I'd suggest getting a few state attorney's together and digging into why the price is so high, with an eye towards criminal charges or anti-trust action, would be much more effective. You might even find that "feels better" than mere price caps. Remove the incentives for people thinking they can get away with this sort of thing scott-free, rather than trying to treat the symptoms far down the pipeline from the root cause.

(Downvoters are invited to consider my replacement suggestion of criminal charges or significant antitrust action before deciding that I'm "defending" anything. This is a silly papering over of the problems by people who ought to have the power to do a lot more.)

[1]: A totally absurd, impossible scenario, of course. https://chicago.cbslocal.com/2020/01/24/first-case-of-corona...

[shadowgovt]

An inflexible cap can always be suspended via state of emergency declaration in the scenarios you're positing.

Hell, via state of emergency declaration the state can use tax money to buy the insulin.

[ceejayoz]

> That's completely unrelated to what I'm explaining.

Then this is a https://en.wiktionary.org/wiki/if_my_aunt_had_balls,_she%27d... scenario.

If IL were capping below cost, that'd be a problem. They're not, though.

[jerf]

The topic is price fixing; the discussion is about the efficaciousness of price fixing.

Why cap when they ought to have the power to look at the root problems? Why fix this one particular thing in a dangerous and probably-ultimately-ineffective way when they ought to be able to address the whole issue of price-gouging medicines more systematically?

(Other than the possibility of this being a band-aid while they do that, but I wouldn't trust a politician's word on that even if they were promising it.)

[EpicEng]

>The topic is price fixing; the discussion is about the efficaciousness of price fixing.

No it's not. This is specifically about price fixing as it relates to insulin.

[JackRabbitSlim]

Except they can't. You have to get FDA approval and jump through regulatory capture hoops. Even for drugs already approved on on the market. See Martin Skrelli's case of a generic medication easily made in science class. Sure it was cheap and easy to make but only his company had the FDA approval to sell it and the cost for a competitor to get approval was significantly higher than any potential profit.

People will die, that's the system we have. The only question is do we relent and give in to what amounts to terrorist demands?

[ceejayoz]

It doesn't cost anywhere near $100 to produce a month's supply.

https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-expe...

> The US is a global outlier on money spent on the drug, representing only 15 percent of the global insulin market and generating almost half of the pharmaceutical industry’s insulin revenue. According to a recent study in JAMA Internal Medicine, in the 1990s Medicaid paid between $2.36 and $4.43 per unit of insulin; by 2014, those prices more than tripled, depending on the formulation.

[RHSeeger]

> Why Americans ration a drug discovered in the 1920s.

The current top-shelf insulins were not discovered in the 1920s and are considerably better than the ones that were. The older insulins (going back to R, L, N sold in the 80s) are fairly inexpensive; on the order of $25 per bottle (and I believe can be bought over the counter). The newer insulins sell for on the order of $275 per bottle.

The numbers I see say it should cost about $300 for a years supply for me (given my current usage) if everything was optimal (non-greedy, short supply chain). Then assume it goes through 3 hands to get to me (original manufacturer, distributor, plan manager; I'm ignoring the pharmacy since I assume they're at least partially altruistic) and add 50% each time for a total of 1012.50 (300 * 1.5. * 1.5 * 1.5). So even then, it's still less than 100 per month expected cost. Though that's for only the short acting insulin, not the 24hour.

What it would really cost without insurance right now is thousands per month. They're making bank on it.

[EpicEng]

Where are you getting those numbers from? Estimates I found place the cost to produce a vial, including the entire supply chain, at $3-$6.

[JumpCrisscross]

> It doesn't cost anywhere near $100 to produce a month's supply

Is the $100 indexed to inflation?

Separately, this is a supply-side problem. Why can’t I start a business that manufactures insulin while selling it at a reduced—but profitable—margin? Those barriers to entry are a fundamental issue.

[jeltz]

> (g) On January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor.

Yes.

[ceejayoz]

"Is the $100 indexed to inflation?"

> In 2009, the list price for a 10-milliliter vial of Humalog, a fast-acting insulin made by Eli Lilly, was about $93. Today it costs closer to $275. Similarly, Novo Nordisk's fast-acting insulin Novolog cost almost $93 for a 10-milliliter vial in 2009. Today, it costs about $290. - https://www.businessinsider.com/insulin-price-increased-last...

If you've got any evidence that the inflation rate between 2009 and 2019 was 300%, I'd love to see it.

[jldugger]

I seem to recall from an Economist podcast a few years ago (and a brief glance at wikipedia confirm) that humalog was a human biologic, instead of the more common insulin extracted from pig pancreas. The option to take animal or human insulin is likely welcome to folks with adverse reactions or maybe a religious prohibition.

As you can imagine, we don't just extract humalog from human pancreases. They instead modify plants to generate the exact molecule humans would. This is somewhat common these days, but it does take some effort and innovation to cultivate, versus the naturally occurring substances previously used.

I don't know if human insulin is any more effective (wikipedia citations suggest no but...), but the impression I got from the podcast was not really, and that the drug was considered a net loss for its developers.

What I did learn today is that in 2006, we restricted the supply of products competing with Humalog (https://en.wikipedia.org/wiki/Insulin_(medication)#Principle...):

> Since January 2006, all insulins distributed in the U.S. and some other countries are synthetic "human" insulins or their analogues.

If we truly cared about affordability, why ban additional supply? Even if not everyone can use it, forcing people who need the human insulin to compete with those who could choose seems likely to drive up prices.

tl;dr: Humalog was an alternative to an already existing treatment, and by 2009 it already was enjoying 3 years of import protections from the treatment it intended to replace.

[save_ferris]

Look at what other countries pay for insulin and you’ll see why this argument holds no water. What’s going on in the US is captive market price gouging, plain and simple.

[rjmunro]

Under this law, what happens is the insurance provider picks up the extra $10 and shares it with everyone else's premiums.

[ptah]

at $100 a month they would still be making 10x markup