For the last several years, I’ve thrown an odd, quiet party on July 27. I don’t buy any cake, for a reason that will become very clear, and I don’t invite anybody to the party. Instead, I take a moment to be grateful that on July 27, 1921 — not even a century ago — a handful of doctors discovered insulin in a lab.
As a Type 1 diabetic from childhood, I have an appreciation for that little hormone to which so many people have never given two entire thoughts. Without it, I would have died many years ago. I know this is true because this is precisely what Type 1 diabetics did for millennia before insulin was discovered and then synthesized. Diabetes was a mysterious, debilitating, and uniformly fatal disease. Yet, because of a small glass vial of a clear liquid, I’ve lived through many years and numerous, regular medical appointments with a disease that, according to one ancient Greek physician, made life “short, disgusting, and painful.”
A couple years ago, I happened to be picking up my insulin prescription on July 27. To be clear, this is not part of my little celebration — I’m not quite that odd. Rather, it was just one of a number of errands. Indeed, I am fortunate enough to live in a time in history when acquiring a substance that allows me to survive is just an errand. Because I had recently changed insurance, I was expecting some minor hiccups when picking it up. The look on the pharmacy tech’s face was alarmingly grave though when I gave her my name and birthdate.
“You know how much it costs?” she asked me with an anxious tinge in her voice.
“Oh, I suspect it’s more than usual,” I admitted as I gave her one of the myriad shopper loyalty cards affixed to my keyring. “I just switched insurance and I’m nowhere near my deductible.”
Unconvinced, she shook her head and said, “No, I mean do you think you can pay for it today? It’s $851.19.” As an afterthought, she added, “How long will it last you?” Staggered by the cost and doing my own quick financial calculations, I mumbled that it would likely last me about a month. She continued to shake her head and asked me a question I’ve puzzled over since:
“Do you still want it?”
I was struck then, and I’m struck now, by the dismal uniqueness of that question. Did I want the thing without which I would literally die in relatively short order? Sure, some Type 2 diabetics may be able to control blood sugar with diet and exercise, but as a Type 1 diabetic I could be an ultra-marathon running vegan and I’d still need insulin every single day for the rest of my life. So, did I want to keep on living, the pharmacy tech seemed to be asking me.
But, of course, the real question was: can you afford to keep living in a world where this hormone gets more and more expensive every year? Can you afford to buy this miraculous, nearly-century-old hormone that has increased in price by more than 17% per year since 2012? Can you afford to keep on living?
In my case, my family and I were able to move some money around and scrimp and save until we met our deductible. But there are many for whom that solution is untenable. While three companies control 90% of the global market for insulin and continue to inhibit competition with “pay-for-delay” schemes and lobbying that prevents competitors from feasibly producing “biosimilars” (the equivalent of a generic drug), people around the country are forced to ask themselves if they can afford to keep on living with a disease that was once a dreadful and mysterious terror.
As companies continue to find ways to extend their patents on this nearly-century-old hormone — with the willing cooperation of our elected leaders —in order to inhibit competition and enable further price-fixing, people are discovering that their life may well have a price they cannot afford.
Because of the synthesis of insulin, life with diabetes no longer needs to be “short, disgusting, and painful” as it was once described. But unless we do something about its soaring costs and the people that profit excessively from this miracle, it certainly could be again for so very many of our neighbors, loved ones, and friends.