
A Government Guide to Keeping Insulin Unaffordable - henvic
https://fee.org/articles/a-government-guide-to-keeping-insulin-unaffordable-3-easy-steps-on-how-to-hogtie-a-market/
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jablongo2
As a type-1 diabetic and user of Lilly and Novo Nordisk insulins, this article
is spot on. People are literally dying in some cases due to this dysfunction.

One thing that is not mentioned is that the dynamics of prescription-writing
in the first place is anti-competitive in terms of price. Fiasp and Humalog
are equivalent fast acting insulins from Novo-Nordisk and Lilly - competition
will only happen when patients can decide which one to take instead of their
doctors, who are not sensitive to small price differences (and in most cases
are not themselves taking the drug).

~~~
rayiner
> s a type-1 diabetic and user of Lilly and Novo Nordisk insulins, this
> article is spot on. People are literally dying in some cases due to this
> dysfunction

How many people would be dying if there wasn’t the same level of incentives to
research these drugs in the first place?

Diabetes is a common health problem around the world. Nothing stopped say a
non-profit or government from beating Lilly and Novo Nordisk to the punch
developing these drugs. But profit seeking corporations are simply better at
innovation than governments and non-profits.

~~~
pasquinelli
The basic science behind insulin-the-drug wasn't innovated by profit seeking
corporations. Applying that basic science to make a usable drug wasn't
innovated by profit seeking corporations either. A cursory glance at the
wikipedia page for insulin tells me the innovation was done be german,
american, and canadian scientists at public universities, starting in the
1880s and not developing into a usable drug until the 1920s.

I don't think a profit seeking corporation would've done that.

~~~
rayiner
If the basic science was the hard part, why did it take 40 years to go from
basic science to “usable drug?”

~~~
kshacker
Remember this was before the era of Facebook, even email and fedex now that I
think of it, and they might have also been fighting the world war.

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deogeo
> Even though insulin treatment itself can’t be patented, improvements in
> delivery mechanisms can be. These incremental improvements, no matter how
> small, can be used to extend the 20-year patent on a drug, a process called
> “patent evergreening.”

I'm confused - wouldn't the new patent only cover the improved method, and the
patent on the original, un-improved version would still expire?

~~~
rayiner
“Evergreening” is a term made up by journalists that has no basis in patent
law, and is also actively misleading.

The real issue is that nobody has an incentive to prescribe the older, less
good but still acceptable drug. (In the case of insulin, note, it’s not only
the delivery mechanisms that have improved, but the insulin itself.) the
insurance company, in particular, under the ACA, have no incentive to cut
costs to improve profits.

~~~
pessimizer
Or, in the case of albuterol inhalers, the companies can actively lobby to
prevent the older version from being distributed anymore.

Evergreening is absolutely a thing, and absolutely planned and executed by the
companies that profit from it.

~~~
pg_bot
The older albuterol inhalers are no longer sold because they used CFCs as a
propellant. CFC usage was banned internationally by the Montreal protocol in
1987. The propellant could not be immediately replaced due to strict FDA
safety guarantees so they carved out a temporary exemption for medical usage.
Research and development was done to find a replacement (HFAs) and that work
is now being paid for by the patents granted from that process (more expensive
inhalers). Whether this was a valid trade-off is a separate discussion but
company lobbying is not the reason why they are no longer distributed.

[https://www.fda.gov/drugs/questions-answers/transition-
cfc-p...](https://www.fda.gov/drugs/questions-answers/transition-cfc-
propelled-albuterol-inhalers-hfa-propelled-albuterol-inhalers-questions-and-
answers)

------
henvic
By the way, you can do business without IP...

I recommend the following book: Against Intellectual Property by Stephan
Kinsella.

[https://mises.org/library/against-intellectual-
property-0](https://mises.org/library/against-intellectual-property-0)

------
TomMckenny
If campaign contributions are called free speech and legislators are happy
making laws blatantly favoring contributors, you're going to have a pretty
tight loop.

------
mnm1
How big is the insulin market? It sounds fairly big considering how many
people have diabetes. So where are the Mexican cartels or similar black market
organizations when you need them? If we're going to wait for the government,
or worse, the industry itself to fix this problem it'll never be fixed. What
we need is a proper black market. Is insulin available on the dark web drug
markets? If not someone should make it available and cash in while still
providing massive savings. That's how you solve a problem like this when your
fucking government has stopped working like the US government has.

~~~
henvic
Proper black market is exactly a part of the industry that the state fights.

One of the things I always wanted was to create a black market for electronics
in my home country (Brazil) because taxation here is really high.

You should also know that the government with its patents system is the root
cause of this price spike.

I wish black market organizations doing legit and good stuff (like selling
medicine that is pricey due to state granted monopolies) was the norm and I
hope someday it will be. However, we are not there yet.

------
BurningFrog
Obligatory link to essay explaining the issues in pedagogical detail. Section
II is on insulin:

[https://slatestarcodex.com/2019/04/30/buspirone-shortage-
in-...](https://slatestarcodex.com/2019/04/30/buspirone-shortage-in-
healthcaristan-ssr/)

------
lostmymind66
It's unaffordable because there is a monopoly on Insulin. Why is there a
monopoly? Because it takes decades of work and close to a billion dollars to
get a new drug through FDA approval.

We need to work on bringing these costs down, so more companies can actually
compete. Government regulation schemes will only reduce the amount of
companies willing to go through the process and give us less choice in the
end.

~~~
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.

~~~
lostmymind66
If the generics are $25, then I don't see a problem. It's cheaply available
and this article is wrong.

~~~
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.

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

