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Thursday, July 9, 2020

Trump’s insulin plan – yet another trick on senior citizens

Don’t hold your breath waiting for your “savings”
By Will Collette

3272 Best Trump images in 2020 | Trump, Politics, Anti trumpAs a seventy year old diabetic on insulin, I was very interested in Donald Trump’s May 26 announcement that he had negotiated a terrific deal to “cap” the cost of insulin for people on Medicare at $35 a month.

He said he had worked out a fabulous deal with Big Pharma, insurance companies and Medicare. 

Now he is bestowing the fruits of his deal-making skills on older people, a major part of Trump’s 2016 voting bloc, but according to polls, are now abandoning him in droves.

In his announcement, Trump said:  
"If you don’t take insulin, I just wrote this down, you go blind, stroke, amputation, kidney failure and other things. So we’re getting it out…I hope the seniors are going to remember it, because Biden was the one who put us into the jam because they didn’t know what they were doing. They were incompetent….I don’t use insulin. Should I be? Huh? I never thought about it, but I know a lot of people are very badly affected.”
And why not: after all, Trump took hydroxychloroquine to prevent COVID-19 when medical experts and scientists said hydroxychloroquine not only doesn’t prevent COVID-19 but was also a dangerous and ineffective treatment for the disease. Maybe injecting a few hundred units of insulin would be just the thing to clear the fog out of his brain.

Surgeon General Dr. Jerome Adams had to come up to answer continuing questions to Trump about why he thought he should take insulin:
“Your body, Mr. President, actually makes insulin endogenously and people such as you and I, we make our own insulin. So yes we do utilize insulin, but we make it ourselves.”
But this little display of Trump’s medical acuity was just a sideshow. The real question is whether his announcement has any substance to reduce the brutally high cost of insulin - due in large part to actions by Trump's Health and Human Services Secretary Alex Azar, who ran leading insulin producer, Eli Lilly (see graphic, above left). 

Spoiler alert: this plan is too little, too late.


Insulin prices have been a national scandal as blood-sucking Big Pharma companies have jacked up prices of many life-critical medications. Insulin price hikes resemble the 2015-2017 Epi-Pen scandal where their manufacturer raised the price of this life-saving device from $50 to $300 each with no justification.

The Epi-Pen scandal was, in turn, compared to rat-faced pharma CEO Martin Shkreli who, according to the LA Times, “shamelessly raised the price of a six-decade-old anti-infection drug called Daraprim from $13.50 to $750 a pill.” He is now in prison for related crimes though he has asked to be released so he could go to work on a COVID-19 cure.

So what about insulin?

Insulin generally comes in an injection pen very similar to the EPI-Pen. You can get insulin in a long-acting and short-acting form. Diabetes patients and their doctors have to work together to try to figure out the best way to balance drugs, diet and exercise to control the disease.

In the past few years, insulin prices have gone up so much that this balancing act has been disrupted as patients have had to ration their insulin due to cost. Some died.

One of the most popular fast–acting insulins is Humalog which cost $21 a month when it was first introduced in 1996. Today, that same drug costs around $300 a month. In Canada, it only costs $32. 

Go figure.

The price hikes for long-acting insulin injector pens have been even steeper.

So what will Trump’s insulin plan actually do?

It won’t happen for at least a year
Knowing Trump and all his grandiose plans, this may NEVER happen. Since May 26, neither HHS nor the Trump campaign has said a word on this issue. Trump has moved, making defense of the Confederacy a higher priority. What we do know for sure is that you won’t be able to opt in to this deal until next year. 

That’s when….

You must buy pricier prescription drug supplemental insurance
All Medicare recipients are required to buy what’s called Medicare Part D coverage to pay for approved prescription drugs. You will need a “participating enhanced” Part D plan to qualify for the $35 insulin price cap. 

This is the way the insurance companies get their slice of this “deal” and your actual savings go down. The head of Medicare give a low-ball estimate of $17 a month in increased premiums, which is, in my opinion, wishful thinking.

Big Pharma will not have to decrease their costs
They will simply pass on their costs for this “plan” on to Medicare and the insurers. If the insurers find the deal isn’t working for them, you can count on them to drop out.

Both the insurers and Big Pharma stand to get a lot of public relations mileage out of this plan. Vanderbilt health policy researcher Stacie Dusetzina put it this way: "If I were in the industry and didn't want to see a larger reform package, this is one way to take some heat off."

Max Richtman, head of the National Committee to Save Social Security and Medicare, calls Trump’s insulin plan “a nickel solution to a billion-dollar problem.” This shaky “deal” does nothing to address the core problems behind the price-gouging.

Among the many flaws in Trump’s May 26 announcement is how few people this would actually help. Prescription price-gouging and out-of-control medical inflation affects just about everybody. 

This plan only offers some relief to a sub-set of diabetes patients – those who are over 65, on insulin and holding “participating enhanced” drug insurance.

Big Pharma says price hikes are driven by the complications involved in getting paid under our complex public-private coverage system. 

Further driving prices up are the complicated systems of rebates and discounts. Big Pharma uses coupons and deals to combat adverse publicity on its price-gouging - they crank up the price by two hundred bucks and give a $100 coupon to some people who qualify.  

This is not the way to run a medical system that literally means life or death to all of us.

Let’s go back to the cost difference for Canadian diabetes patients and Americans. Canadians pay one-tenth the price for the same insulin Americans use.

Why is that? What is it that Canada has that the US doesn’t? The answer is Canada has a single-payer national health care system.

The Medicare-for-all plans released during the primaries by Senators Elizabeth Warren and Bernie Sanders  came with very high price tags. But both argued that Medicare-for-all would actually be billions cheaper than Americans’ current cost for health care.

This new, though transitory, interest in insulin prices by our Dear Leader really adds to the evidence supporting Medicare-for-all. Even after Trump’s insulin $35 price cap happens, Canadians will still be paying less for insulin under their national health care system.