The authors of the new study, published in the Annals of Internal Medicine,
analyzed data from the 2021 National Health Interview Survey, examining a
sample representative of 1.4 million U.S. adults with type 1 diabetes and 5.8
million with type 2 diabetes.
The results indicate that 16.5% of all adult insulin
users across the U.S. rationed insulin in some way in the past year, with
rationing more common among those with type 1 diabetes than type 2.
"Universal access to insulin, without cost
barriers, is urgently needed," Adam Gaffney, an ICU doctor at
the Cambridge Health Alliance and the lead author of the study, told NBC News. "We have
allowed pharmaceutical companies to set the agenda, and that is coming at the
cost to our patients."
Gaffney, an outspoken advocate of Medicare for All, said he has personally "cared for patients who have life-threatening complications of diabetes because they couldn’t afford this life-saving drug."
The high price of insulin has long been a scandal in
the U.S., where the list costs of the cheap-to-produce medicine are often up to
10 times higher than in other countries.
Sen. Bernie Sanders (I-Vt.) has famously led caravans of people with diabetes into
neighboring Canada to spotlight the shocking price of insulin in the U.S.,
which does little to regulate the pharmaceutical industry's price-setting
power.
One recent report by Human Rights Watch (HRW)
described insulin access in the U.S. as "a privilege that many cannot
afford," noting that "soaring medicine prices and inadequate health
insurance coverage can result in unaffordable out-of-pocket costs that
undermine the right to health, drive people into financial distress and debt,
and disproportionately impact people who are socially and economically marginalized,
reinforcing existing forms of structural discrimination."
The new study, co-authored by David Himmelstein and
Steffie Woolhandler, echoed those findings, pointing out that people without
health insurance "had the highest rate of rationing... followed by those
with private insurance." People on Medicaid and Medicare reported the
lowest rate of insulin rationing.
"Several factors likely underlie our
findings," the authors note. "Insulin prices in the United States are
far higher than in other nations. Moreover, pharmaceutical firms have increased
insulin prices year upon year, even for products that remain unchanged."
According to public data spotlighted by HRW, Eli Lilly
has hiked the list price of the commonly used insulin product Humalog by an
inflation-adjusted 680% since it started selling the drug in 1996.
Gaffney, Himmelstein, and Woolhandler note that the
recently enacted Inflation Reduction Act includes a provision limiting insulin
copays to $35 per month for those on Medicare, a change that "may improve
insulin access for seniors, who experienced substantial rationing in our
study."
But they lament that Senate Republicans stripped out an insulin copay cap for
those with private insurance.
"Further reform," the trio writes,
"could improve access to insulin for all Americans."
In July, California Gov. Gavin Newsom announced that the state would soon move
to produce its own insulin in an effort to provide a lower-cost alternative to
Big Pharma's products.
At the national level, HRW has called on Congress to
"consider legislation to provide insulin to all insulin-dependent
individuals in the country free-of-cost."
"People who need insulin shouldn't have to break
the bank just to survive," said Matt McConnell, economic justice and
rights researcher at HRW, "but in the U.S. they often do."
