Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why you shouldn’t be happy with $137 insulin

Elisabeth Rosenthal, MD
Meds
June 13, 2019
Share
Tweet
Share

Eli Lilly and Co. recently announced with some fanfare that it was manufacturing a generic version of its own best-selling insulin brand, Humalog, which it would sell for half off — $137.35 versus about $275.

David Ricks, the chief executive of Lilly, said the company was making this seemingly beneficent gesture because “many patients are struggling to afford their insulin.”

But they’re struggling, in large part, because since 2001 Lilly has raised the price of a vial of Humalog to about $275, from $35. Other insulin makers have raised prices similarly.

In Germany, the list price of a vial of Humalog is about $55 — or $45 if you buy five at a time — and that includes some taxes and markup fees. Why not just reduce the price in the United States to address said suffering?

Instead, Lilly decided to come out with a new offering, a so-called authorized generic. This type of product is made by or under an agreement from the brand manufacturer. The medicines are exactly the same as the brand-name drug — often made in the same factory with the same equipment to the same formula. Only the name and the packaging are different.

It is, perhaps, a sign of how desperate Americans are for something — anything — to counteract the escalating price of drugs that Lilly’s move was greeted with praise rather than a collective “Huh?”

Imagine if Apple sold a $500 iPhone for $250 if it was called, say, a yPhone, and simply lacked the elaborate white box and the little Apple logo on the back. That would be patently absurd. An iPhone in a brown paper bag is still an iPhone. And Humalog with a new name isn’t a generic — except according to the bizarre logic of the pharmaceutical industry. Like so many parts of our health care system, its existence has more to do with convoluted business arrangements than health.

Generics, as traditionally understood, are copies of brand-name drugs made by competing manufacturers once the original patent protection has expired. To be approved by the Food and Drug Administration, they must have the same active chemical ingredients as the brand drug and be absorbed equally into the blood, though they could look different and contain different inactive additives.

Historically and in practice they tend also to be far cheaper, because the advent of generics often introduces robust competition into the market. That is why brand manufacturers sometimes produce an authorized generic once they lose patent protection. That way, they can compete at the lower price point, while preserving the original for those with extreme label loyalty.

More recently, authorized generics like Lilly’s stem largely from a different strategy — based on the perverse ways money flows through our health system and who keeps the cash.

Over the past 20 years, drugmakers have continuously raised the price of some essential medicines in the United States because, well, they can in a country that doesn’t set drug prices. And they do — until the bad publicity catches up with them.

Mylan got hauled before Congress in 2016 for raising the price of an EpiPen. Now it’s insulin’s turn. The other two major makers of brand-name insulin products — Novo Nordisk and Sanofi — have raised prices in lockstep with Lilly. But they are based in Europe, so the Indiana-based Lilly has been the primary focus of angry protests here.

Part of insulin’s price rise in the United States is because of the middlemen who buy the drugs on behalf of insurers and hospitals and negotiate discounts off the list price for their clients. So Lilly often doesn’t make the full $275 a vial (though, since rebates are secret, we don’t know how much less).

ADVERTISEMENT

By selling an authorized generic, rather than merely lowering the brand’s price, Lilly is essentially doing an end run around those middlemen and giving patients who don’t purchase through an insurer another option.

It is also making sure that if and when cheaper versions of Humalog emerge, it will have an offering to compete.

In fact, a “biosimilar” version of Humalog already exists. It was introduced to the United States last year. And yet it costs around the same price as the brand-name drug. Why? It is made by Sanofi, which has no interest in starting a price war to lower costs.

Finally, Lilly has generated a few positive headlines. “Eli Lilly Will Sell Half-Price Version of Humalog, Its Best-Selling Insulin,” this paper reported.

Mylan effectively calmed its EpiPen PR crisis by introducing a cheaper authorized generic. Now Lilly, following a similar playbook, is hoping for a similar result.

Will it work? Politicians and patients will decide.

But they might well keep these two thoughts in mind: If the product being sold were electricity or gas for your car, a price rise of more than 600 percent over 15 years would be regarded as price gouging and wouldn’t be tolerated. And in Germany and many other developed countries, there is no need for a $137.35 vial of “authorized generic” for Humalog. At around $50 a vial, Humalog as Humalog costs far less.

Elisabeth Rosenthal is editor in chief, Kaiser Health News.

Image credit: Shutterstock.com

Prev

OB/GYNs are getting old and tired. Who's going to be left to deliver your children?  

June 13, 2019 Kevin 25
…
Next

How failing Step 1 helped me pass the boards. Twice.

June 13, 2019 Kevin 4
…

Tagged as: Diabetes, Endocrinology

Post navigation

< Previous Post
OB/GYNs are getting old and tired. Who's going to be left to deliver your children?  
Next Post >
How failing Step 1 helped me pass the boards. Twice.

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Elisabeth Rosenthal, MD

  • I was a teenage rifle owner, then an ER doctor

    Elisabeth Rosenthal, MD
  • I’ll reward businesses that are seriously implementing recommended COVID-19 precautionary guidelines

    Elisabeth Rosenthal, MD
  • How many people have coronavirus? We don’t really know.

    Elisabeth Rosenthal, MD

Related Posts

  • Happy National Grateful Patient Day!

    R. Lynn Barnett
  • The obscene price of insulin: This is what happens when health care is for profit

    Therese Zink, MD, MPH
  • We need to be happy with what we have now, and not rely on delayed gratification

    Omar Bukhari, DO
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 45-year-old woman with type 2 diabetes mellitus

    mksap
  • Type 1 diabetes is no fun

    Ryan Ritchie
  • When should you prescribe statins for older adults?

    Kenneth Lin, MD

More in Meds

  • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

    Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO
  • A world without antidepressants: What could possibly go wrong?

    Tomi Mitchell, MD
  • The truth about GLP-1 medications for weight loss: What every patient should know

    Nisha Kuruvadi, DO
  • The hidden bias in how we treat chronic pain

    Richard A. Lawhern, PhD
  • Biologics are not small molecules: the case for pre-allergy testing in an era of immune-based therapies

    Robert Trent
  • The anesthesia spectrum: Guiding patients through comfort options in oral surgery

    Dexter Mattox, MD, DMD
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why young doctors in South Korea feel broken before they even begin

      Anonymous | Education
    • Measles is back: Why vaccination is more vital than ever

      American College of Physicians | Conditions
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why young doctors in South Korea feel broken before they even begin

      Anonymous | Education
    • Measles is back: Why vaccination is more vital than ever

      American College of Physicians | Conditions
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...