Drugs & Updates

Analysing the Skyrocketing Price of Insulin

Nearly a century ago, Canadian surgeon Frederick Banting and his assistant Charles Best isolated the hormone insulin under the directorship of John Macleod at the University of Toronto. A medical discovery that can be considered equivalent to that of the steam engine. It revolutionised the lives of those plagued by this ailment. A disease that was previously considered fatal suddenly had a cure. Once word got out about their brilliant discovery, the demand for this drug skyrocketed. On January 23rd,1923 Banting and Best, along with chemist James Collip were awarded the American patents for their discovery which they sold to the University of Toronto for $1 each.

On this occasion, Banting famously said “Insulin does not belong to me, it belongs to the world.”

Fast forward to 2022, Insulin’s out-of-pocket (OOP) costs have skyrocketed. With a majority of diabetics in India seeking care under the private sector, getting regular access to Insulin has become an expensive affair.

A 2013 study by Abhishek Sharma et al, conducted in New Delhi found that the lowest-paid unskilled government worker in Delhi would work about 1.5 and 8.6 days, respectively, to be able to pay OOP for a monthly supply of human phial and analogue cartridge insulin. On average, private-sector consumers were found to be paying 2.62 times the price that the government pays to purchase insulin, regardless of insulin type or place of manufacture. Improving the reach of the common man to insulin is a major public health concern.

The Insulin Cartels

The bulk of global insulin manufacturing and supply lies in the hands of 3 companies – Eli Lilly, Sanofi, and Novo Nordisk. While Indian companies Biocon and Wockhardt have also gotten into the game, the lack of trust in the domestic products makes them weak competitors to their global counterparts, despite having lower prices. The majority of the research and development is geared towards wealthy nations, neglecting the needs

of low- and middle-income countries, which have seen a boom in the prevalence of diabetes, much higher as compared to their developed counterparts.

The Situation in Government Centres

The rising costs and difficulty in access prompted the filing of a public interest litigation petition in 2018 in the Madras High Court which urged the State government to provide insulin free of cost to diabetic patients at government hospitals and include complete treatment for diabetes under the Chief Minister’s Comprehensive Health Insurance Scheme. When it comes to government centres, the administration finds it difficult to accommodate the growing burden of diabetic patients, and often only have older, more ineffective versions of regular insulin. They often need to ration the insulin for those in an emergency setting and may even run out of it completely.

WHO Steps In

The World Health Organisation (WHO) published a report on 12th November 2021, commemorating the 100 year anniversary of the discovery of insulin. On this occasion, WHO Director-General, Dr. Tedros Adhanom addressed the cost crisis and said “The scientists who discovered insulin 100 years ago refused to profit from their discovery and sold the patent for just one dollar. Unfortunately, that gesture of solidarity has been overtaken by a multi-billion-dollar business that has created vast access gaps. WHO is working with countries and manufacturers to close these gaps and expand access to this life-saving medicine for everyone who needs it.”

WHO has tried to address some of the barriers to the availability of insulin and related medicines and health technologies through a series of dialogues with business associations and manufacturers of these products and managed to secure commitments to a number of actions from the industry.

NPPA Takes Action

In October 2021, the National Pharmaceutical Pricing Authority (NPPA) had issued a notice which fixed the price of 81 medicines, including off-patent anti-diabetic drugs. NPPA has fixed the retail price of ‘insulin human injection, 200IU/ml’ and ‘70% isophane insulin human suspension + 30% insulin human injection 200IU/ml’ produced by Wockhardt Ltd at ₹106.65 per ml each (excluding GST). These prices came into effect from April 1st, 2021.

Hope For The Future

Owing to the public outcry over the exorbitant out-of-pocket cost of Insulin, Eli Lilly and Company announced in September 2021 that it will lower the list price of Insulin Lispro Injection in the US by another 40 percent. From January 1, 2022, the new list price will be $82.41 for individual vials and $159.12 for a pack of five pens.

Major changes need to be made on a global and national level in order to improve affordability and access to insulin. Possible solutions include improving the confidence of doctors and patients in domestically produced Insulin through effective trials, developing more affordable human insulin, increasing competition through the use of more affordable Insulin analogs or biosimilars, strengthening the supply chain for manufacturing and distribution, and further negotiating lower prices from manufacturers in India.

Author

Rupali Sachdev

Rupali Sachdev is an intern doctor at Grant Medical College and Sir JJ Group of Hospitals in Mumbai. With experience in writing, design, medical technology, public speaking, and social service, she believes that doctors need to broaden their horizons and look at patient care more holistically.

 

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