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Old 06-18-2019, 08:12 AM
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The High Price of Insulin Is Killing US Citizens


Note the title. Note the "US Citizens". That's very important, because it's not happening in the UK or France or Britain or Australia or really anywhere else even slightly modern/technological.

The price of insulin has skyrocketed in the last few decades, doubling between 2012 and 2016. This has resulted in people losing access to insulin, to having to choose between rent and insulin, to people suffering side effects like kidney problems, blindness, and even death because they rationed their limited supplies too much. Go to GoFundMe and type "insulin" into the search engine and you'll get more than 7000 hits of people essentially begging for help to purchase the medicine that keeps them alive. Americans near international borders cross them to purchase insulin in another country because it's cheaper to travel to a foreign country to pay cash on the counter than what they can get though the jacked up health "coverage" system in the US.

It's more than sad, it's disgusting. Of the three people who developed insulin to treat diabetes one refused any compensation and the other two sold their discovery for a mere $1 because they wanted this live-saving substance to be easily accessible to all. That was back in 1923 - insulin is NOT a new drug. Humalin has been on the market since 1982, it's not new, either.

The drug companies keep coming out with new tweaks and new formulas to justify keeping this under patent and jacking up the costs but really, basic insulin should be made and available to all who need it as a cost that can actually be met without destitution and ruin. There is no reason this can't be done other than greed and callous indifference to suffering, disability, and death.

I'm frustrated because I know people this is affecting. I know a young man who only uses insulin every other day, and even that supply is unsteady. I suspect he's selling illicit drugs to get the money to pay for his insulin as his low-level retail job isn't sufficient. By which I mean the cost of his insulin per month exceeds his GROSS income. He lives at home with his parents, who cover his food costs, he has no car, no rent, etc. His entire income is insufficient to cover the cost of the insulin necessary to keep him alive. This has been the case since he hit 26 and was no longer covered by his parents insurance. Due to untreated diabetes he is not in good physical health which makes holding down even a part time job difficult. He is slowly dying.

I'm frustrated and angry because a co-worker of mine, although in a financially better situation with a full time job and some health coverage is still stretched to the limit and terrified a day is approaching when she, too, can not afford the medicine that keeps her alive. This is a woman who works full time, has health coverage, and usually skips lunch in order to scrape together a few more pennies to buy insulin. The mental stress of only being sure she has enough to keep herself alive for a month or even as little as a week at a time is frightening to see.

A local acquaintance died from this - first she started to have kidney problems, then her vision deteriorated, then she had to have a toe amputated, then a foot... one day she was found dead in her apartment with no food in the refrigerator and no insulin. She had run out, could not get more, and simply fell into a coma and died. Her landlord found her - he'd come to ask about the rent months past due. Apparently the utilities had been shut off as well. In other words, literally every cent this woman had went to trying to buy insulin - not to shelter, not to food, not to anything but trying to get her medicine. And it wasn't enough.

That's just three of the people I know/knew.

This is happening every goddamned day in the US. And no one seems to give a fuck. Or at least, not anyone with the power to change things. The drug companies are charging what the market will bear, and then some. I dunno, maybe they assume people will pay ANYTHING to survive, which is true up to a point... but at some point best effort still isn't good enough. Of course, the poor are hardest hit and least cared about, but it's getting bad enough to affect the middle class now - and such middle class folks will soon become poor.

I'm mad as hell - but can't do a goddamned thing about it. Oh, I suppose I could kick a few bucks to the folks I know personally - although how much that's going to help with these people needing $1000+ a month (for the ones with insurance!) is debatable at best. I don't report people bending/breaking laws to stay alive. No way in hell I'd admit to wrong-doing myself in a public forum but let's just say that I put saving a life above a lot of other things I would normally adhere to. More than willing to drive people to doctor visits or hospitals even as I gnash my teeth over peoples' bodies being destroyed by something we've been able to treat for nearly a century now.

Really makes me want to scream.

If I won a really big lottery prize I'd set up a charity to cover these cost for people. I'd buy a few Congresspeople and Senators to change the laws. I'd set up a company to manufacture a generic in direct competition to the current assholes. Fuck, I don't know.
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Old 06-18-2019, 08:23 AM
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This is how gangster capitalism works: use leverage - patient desperation and the legal system - to jack up prices. And if people die because they can't pay, well, too bad.

I personally do not necessarily think that Medicare-for-all is necessarily the best route to reform our healthcare system, but the problem we have is that Big Medicine and the Republican party are so fucking corrupt that there will eventually be a political tidal wave against the system. Bernie-care might be the end result, whether I or anyone else thinks it's the best alternative or not.

I'm sorry your friend(s) are suffering.
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Old 06-18-2019, 08:49 AM
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It's not whether or not "Bernie-care" is the best system or not, it's whether or not it's better than the one we currently have.

On top of that - as I noted, this is killing people even WITH medical coverage. Those with Medicaid/Medicare/private insurance are affected as well - my coworker has private insurance, the person who died had Medicare. It still wasn't enough.

Last edited by Broomstick; 06-18-2019 at 08:51 AM.
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Old 06-18-2019, 08:51 AM
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Originally Posted by Broomstick View Post
Note the title. Note the "US Citizens". That's very important, because it's not happening in the UK or France or Britain or Australia or really anywhere else even slightly modern/technological.
You forgot Canada, which is perhaps even more relevant, because Americans are coming to Canada to buy insulin and probably breaking American laws in the process:
https://www.cbc.ca/news/canada/nova-...ulin-1.5125988

As the article notes, a vial of NovoLog which costs USD $300 in the US is $30 in Canada. Same with most other patented (non-generic) drugs. The blood thinner Brilinta costs about CAD $100 per 60 tablets here in Ontario, though mine are covered by the Ontario Seniors Drug Benefit so they cost me $4 (the dispensing fee). In the US it ranges from the low 400s to nearly USD $500 for the same thing.

The reason for these differences is that Canada has the Patent Medicine Prices Review Board, while the US has a Congress owned by corporate interests.
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Old 06-18-2019, 09:00 AM
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There are ways to get Humulin and Novalog pretty cheaply. The problem is that everyone (understandably) wants to take newer long-acting insulins, which cost a ton.
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Old 06-18-2019, 09:29 AM
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It's easier to mess up and die on the other stuff. The longer acting stuff helps you live a normal life.

One of my best friends has been a T1 diabetic for 30 years. Her whole adult life has basically been working to pay for insulin. Her and her husband work their asses off with little to show for it and no way to get ahead, because of all the money she has to shell out just to stay alive.

Diabetics aren't the only ones that have to go through this with medication but it's such a SIMPLE thing...it's mind-boggling that this is crippling so many Americans.

There was recently a hearing with drug companies about insulin prices. Sooooo much finger pointing between drugmakers and insurance companies and pharmacies. Drug makers are all like "we give them coupons!" They give a very small percentage of people very small coupons. It's not helping. Colorado just passed a law that caps insulin co-pays at $100. I hope other states follow suit, because capitalism isn't working.
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Old 06-18-2019, 09:49 AM
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Originally Posted by wolfpup View Post
You forgot Canada, which is perhaps even more relevant, because Americans are coming to Canada to buy insulin and probably breaking American laws in the process:
https://www.cbc.ca/news/canada/nova-...ulin-1.5125988
She mentions it later, along with Mexico. Americans cross to both in order to buy medication which is available much more cheaply.
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Old 06-18-2019, 10:08 AM
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I agree with the outrage. These people should be in prison.

But I am a little confused as well.

I am a T1 Diabetic. Been taking insulin for 33 years. I take two types by prescription (insulin pens, very convenient), plus have a backup vial and syringes. I still pay $25 for each prescription (copays). One script last about a month, the other about 2 weeks. This is through my work insurance.

The back up vial, I buy at the Walmart here in Sacramento area. It still costs me $25 and it does NOT go through insurance. I wonder if these are vials that Walmart had before the price explosion and I will get shocked when I but my next one. I did buy my last one after this story broke.
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Old 06-18-2019, 10:17 AM
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There are ways to get Humulin and Novalog pretty cheaply. The problem is that everyone (understandably) wants to take newer long-acting insulins, which cost a ton.
That article shows Novolog costing about $341 per vial. How is that cheaper? The article I linked says it costs around $300, and about $30 in Canada, which is why this caravan of Americans came up here to buy it, along with other types.
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Old 06-18-2019, 10:41 AM
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The back up vial, I buy at the Walmart here in Sacramento area. It still costs me $25 and it does NOT go through insurance. I wonder if these are vials that Walmart had before the price explosion and I will get shocked when I but my next one. I did buy my last one after this story broke.
As far as I know the $25 Wal Mart vials are still a thing. But no one wants to use them as their primary insulin.
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Old 06-18-2019, 10:47 AM
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That article shows Novolog costing about $341 per vial. How is that cheaper?
Sorry, Novalin, not Novolog.
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Old 06-18-2019, 11:11 AM
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Bloody hell.

In the UK, you normally have to pay a small amount for any prescription via the NHS- £9 currently. Some classes of people are exempt from this charge, including children, people on some income related benefits, pregnant women, and insulin dependent diabetics.

Yeah, not only do you not pay for insulin here, if you *need* insulin you don't pay for any medicine.
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Old 06-18-2019, 11:16 AM
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Death penalty for drunk drivers? No.

Death penalty for pedophiles? No.

Death penalty for drug company execs? Definitely yes.
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Old 06-18-2019, 11:34 AM
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It's not whether or not "Bernie-care" is the best system or not, it's whether or not it's better than the one we currently have.

On top of that - as I noted, this is killing people even WITH medical coverage. Those with Medicaid/Medicare/private insurance are affected as well - my coworker has private insurance, the person who died had Medicare. It still wasn't enough.
If you're on Medicare, you can apply for extra help for your prescriptions through Social Security. I only pay $8.50 a month for my insulin. Yeah, I know it's small comfort if you don't have Medicare. I've been in the same boat where I've had to beg my doctor for samples.
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Old 06-18-2019, 12:02 PM
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Let's be careful with the consumer direct payment vs what the drug company is getting paid. IIRC the UK price for insulin is ~£400/year, not paid by the consumer directly.

It's harder to make and get biosimilars approved compared to small molecule generics, hence the decreased competition.

People who are unable to manage their diabetes are less likely to be productive. So from a cold-hearted economic growth point of view, the current situation situation appears suboptimal. Never mind the, you know, suffering and death thing.

Re: Walmart, this is the 1980s "human" (synthetic, as opposed to animal) insulin. Not the modified insulin analogues first introduced by Lily in I think '96 and now off-patent for the early ones. Nobody may want to manage their blood sugar with this stuff, but pretty much everyone did when I was growing up because it was the only option. That said, I think something like <3% of diabetics use human insulin now. Re: productivity, this stuff does not maximize it.
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Old 06-18-2019, 12:06 PM
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As far as I know the $25 Wal Mart vials are still a thing. But no one wants to use them as their primary insulin.
Just to be clear, it's not generic 'Equate' brand insulin. It's Novolin.
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Old 06-18-2019, 12:16 PM
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People who are unable to manage their diabetes are less likely to be productive. So from a cold-hearted economic growth point of view, the current situation situation appears suboptimal. Never mind the, you know, suffering and death thing.
That was actually sort of already figured out by the kind of 19th century industrialists whose workers owed their soul to the company store: those who built schools and clinics, either out of the goodness of their heart or because there was a need for a place to store little children and sick people so their mothers/relatives could go to work, got better results than those who did not.

Thing is, in most countries, this ended up in diverse variations of univeral-ish healthcare; the intent is to have universal healthcare, but the path there may still have a ways to go. In the US, it stayed as a job-related benefit and one which often deserves scare quotes. Even ACA is often treated as an addendum or bridging mechanism in between... uh. In between jobs with decent medical benefits.

That "uh" is because I just thought of that adage about how "in America, a poor person is just a temporarily embarrased millionaire" or words to that effect. Apparently the assumption behind a lot of the usual discourse is that "in America, someone without decent medical coverage is just between good policies".
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Last edited by Nava; 06-18-2019 at 12:17 PM.
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Old 06-18-2019, 12:32 PM
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Death penalty for drunk drivers? No.

Death penalty for pedophiles? No.

Death penalty for drug company execs? Definitely yes.
Death penalty for poor people with diabetes? Apparently so.
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Old 06-18-2019, 01:55 PM
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the person who died had Medicare. It still wasn't enough.
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If you're on Medicare, you can apply for extra help for your prescriptions through Social Security. I only pay $8.50 a month for my insulin. Yeah, I know it's small comfort if you don't have Medicare. I've been in the same boat where I've had to beg my doctor for samples.
I don't understand this. Aren't the benefits for Medicare standard across the US? How can one person die because they can't afford it, and another person only pay $8.50 a month?

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As far as I know the $25 Wal Mart vials are still a thing. But no one wants to use them as their primary insulin.
Why don't they want to use them as their primary insulin?
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Old 06-18-2019, 02:31 PM
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Why don't they want to use them as their primary insulin?
See my post above.
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Old 06-18-2019, 02:36 PM
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Sorry, but either I'm not reading your post correctly, or I'm just not understanding it, or something else, but I don't see how what you wrote explains why people don't want to use the $25 Walmart insulin as their primary insulin. Unless it is "the $25 Walmart stuff doesn't maximize productivity". Is that it?
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Old 06-18-2019, 02:40 PM
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Sorry, but either I'm not reading your post correctly, or I'm just not understanding it, or something else, but I don't see how what you wrote explains why people don't want to use the $25 Walmart insulin as their primary insulin. Unless it is "the $25 Walmart stuff doesn't maximize productivity". Is that it?
It's human insulin, not modified insulin. Different drug, and less likely to prevent hospitalization/organ damage/death.
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Old 06-18-2019, 02:49 PM
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As to why that happens: modified insulins can include functionality such as longer lifes than human insulin, or being able to activate decreased-sensitivity insulin receptors (insulin resistance). The specific mechanisms and benefits will vary from insulin to insulin; which benefits are needed will vary from patient to patient. For someone who isn't producing enough insulin but whose receptors work just fine, human insulin works just fine; for someone with insulin resistance, it won't work well whether it's from their own pancreas or from a needle.

Last edited by Nava; 06-18-2019 at 02:50 PM.
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Old 06-18-2019, 02:49 PM
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It's human insulin, not modified insulin. Different drug, and less likely to prevent hospitalization/organ damage/death.
I'm thinking that not taking insulin because you are too poor to buy the expensive kind would be worse than using the Walmart insulin.
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Old 06-18-2019, 02:52 PM
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Colorado has a cap on how much of a co-pay can be charged for insulin. It's new.
And there are people--conservatives, natch--who deride this as a slippery slope. Oh, what will happen next? Will we all have to pay for everybody's eyeglasses? To fix their broken legs from skiing? How about plastic surgery, surely that's next!
Sheesh. I really don't know how these people function, I honestly don't.
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Old 06-18-2019, 02:55 PM
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It's not a quick (enough) fix, but the FDA are in the process of closing what amounts to a loophole that Pharma companies have been exploiting. For historical reasons insulins, which are biological drugs, have been regulated as if they were chemical drugs (because, I think, they are so damn old and predate the rules under which modern biological drugs are regulated). This has had the effect of keeping biosimilars (loosely speaking, generics) off the market.

The FDA issued a statement in April:

Quote:
.......Transitioning biological products currently regulated as drugs to being regulated as biologics will enable – for the first time – products that are biosimilar to, or interchangeable with, these products to come to market.......

.......This transition is particularly important for insulin

Although they are biologics, insulin products have historically been regulated under the FD&C Act rather than the PHS Act, which governs the FDA approval of most biologics. Biologics are typically isolated from a variety of natural sources – human, animal or microorganism – and may be produced by biotechnology methods and other cutting-edge technologies. Due in part to the complexities of these products, it has been hard to bring a substitutable generic insulin to the market under the FD&C Act.

The transition of insulin from the drug to the biologics pathway will open up these products to biosimilar competition. We’re already seeing robust activity among sponsors seeking to bring forward biosimilar copies of insulin......
So hopefully there's a medium-term partial solution. But as has been noted above, basically you need a better healthcare system.

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Old 06-18-2019, 03:20 PM
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manson1972, you can die of the Walmart insulin, too. Insulin's funny that way: if you've got too much in your system for the state of your system at that particular moment, it can kill you, even if it's also going to kill you if you get too little. And unless you're running a more or less continuous blood test, it's very difficult to be sure exactly how much you need at a given moment (for your conscious brain, anyway; a properly functioning pancreas is very good at this, but a properly functioning pancreas is what a lot of diabetics haven't got.)

If the newer versions of insulin are less susceptible to that problem, then they're a lot safer to take.

-- my father was on the old style insulin for many years when that was all that was available. We all had to be aware of early signs of insulin shock; and the accummulated damage which was part of the reason why he died at 69 was in large part due to poor control that was less drastic in the short run but did long term damage even though it didn't kill him right off. At the time, of course, that was the best that could be done.

I've had a dog on the $25 Walmart insulin -- and it was only $25 if you could get to Walmart. The local pharmacy, which is a lot closer to me than Walmart (which is in a different village entirely, and difficult for anyone who can't drive to get to) advised I go to Walmart because they had to charge $150 per vial for it; apparently Walmart had struck some sort of special deal. The dog was unlikely to live more than another couple of years in any case, so it was less crucial to have her on something with better long term results.
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Old 06-18-2019, 03:26 PM
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Oh, i get it. Newer stuff = better. I just don't get dying because you can't afford insulin when there is cheaper, but not as good, insulin you can buy.

And I still don't get how someone on Medicare dies because they can't afford insulin at the same time that someone else on Medicare gets insulin for $8.50 a month.
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Old 06-18-2019, 03:46 PM
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Oh, i get it. Newer stuff = better. I just don't get dying because you can't afford insulin when there is cheaper, but not as good, insulin you can buy.

And I still don't get how someone on Medicare dies because they can't afford insulin at the same time that someone else on Medicare gets insulin for $8.50 a month.
They may not be aware that Extra Help exists or not be eligible. There are income requirements. To be eligible in 2019, your income must be below $18,735 for an individual or $25,365 for a married couple living together.
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Old 06-18-2019, 03:57 PM
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And I still don't get how someone on Medicare dies because they can't afford insulin at the same time that someone else on Medicare gets insulin for $8.50 a month.
Medicare is done state-by-state. The federal government gives a block of money to the state and they choose how to use it. In some states, the governors have resisted Medicare Expansion, leaving the citizens of that state with less coverage than other states. You can check what type of medicare your state has at the link above.
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Old 06-18-2019, 04:01 PM
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Medicare is done state-by-state. The federal government gives a block of money to the state and they choose how to use it. In some states, the governors have resisted Medicare Expansion, leaving the citizens of that state with less coverage than other states. You can check what type of medicare your state has at the link above.
Isn't that MediCAID?
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Old 06-18-2019, 04:37 PM
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I've been told that this is all OK, because in Canada, we are all socialists, and that is bad.

You see, Insulin may cost you Americans a lot more, and some of you may die because you can't afford it, but you have FREEDOM.

And we are just damned dirty socialists.

So there ya go.
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Old 06-18-2019, 06:21 PM
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It's human insulin, not modified insulin. Different drug, and less likely to prevent hospitalization/organ damage/death.
I've been managing diabetics for decades, and am an insulin-taking diabetic myself.

NPH and Regular are very good tools for managing diabetes. The ultra-long and ultra-short acting insulins have not been shown to be significantly better for the typical diabetic's health. With usual use, they result in A1C levels about the same as with the older insulins. But those new insulins sure have been marketed like they're truly superior. THAT is a problem.

And yes, the jacking up of the price of insulin ought to be a crime.

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Old 06-18-2019, 06:28 PM
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Dayum. I pay $44 for a vial of Lantus insulin. From the Vet. For the CAT.
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Old 06-18-2019, 06:32 PM
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Oh, i get it. Newer stuff = better. I just don't get dying because you can't afford insulin when there is cheaper, but not as good, insulin you can buy.
Would they know what the dose was?

They'd have been given instructions for how much to take based on the medication the doctor ordered. A different form of insulin might need a different dose. Guessing it wrong might mean dying right now. Not taking it means dying but not as fast.

Qadgop? I might have that wrong; but I can readily imagine that thought process. (And I was told by the vet. that using a slightly different form for the dog would require recalculating her dose.) Personally, I think I'd call the doctor; but either being very broke or significantly sick can screw up your thinking. Both at once is a double whammy. (Both at once, or even one on its own, could also make it hard to get to Walmart. Will they mail order without a significant charge?)
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Old 06-18-2019, 07:44 PM
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Would they know what the dose was?

They'd have been given instructions for how much to take based on the medication the doctor ordered. A different form of insulin might need a different dose. Guessing it wrong might mean dying right now. Not taking it means dying but not as fast.
Not sure, but I'm guessing they could ask their doctor.
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Old 06-18-2019, 07:46 PM
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I completely agree with this pit. Also, if a diabetic vet hasn't considered using the VA: They suck in SO MANY ways, but they're excellent at providing insulin. Well, at least the one in Seattle is. Consider it, anyway.
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Old 06-18-2019, 08:58 PM
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Originally Posted by manson1972 View Post
Not sure, but I'm guessing they could ask their doctor.
You're assuming they have a regular doctor.

I know too many poor people who go to a clinic and get whomever happens to be there that day.

Also, for the uninsured doctor visits start around $150 in my area. It's more for a specialist like an endocrinologist who specializes in treating diabetes. Assuming said person can get an appointment in the first place.

Otherwise - it's wait until you're dying and go to the ER. Or at least hope someone gets you to an ER when you get goofy/unconscious from blood sugar problems.
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Old 06-18-2019, 09:13 PM
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Originally Posted by Broomstick View Post
You're assuming they have a regular doctor.

I know too many poor people who go to a clinic and get whomever happens to be there that day.

Also, for the uninsured doctor visits start around $150 in my area. It's more for a specialist like an endocrinologist who specializes in treating diabetes. Assuming said person can get an appointment in the first place.

Otherwise - it's wait until you're dying and go to the ER. Or at least hope someone gets you to an ER when you get goofy/unconscious from blood sugar problems.
You know poor people who go to a clinic, and the doctor there tells them "you have diabetes" and then there is no follow up or anything?
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Old 06-18-2019, 09:17 PM
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My insurance insists I am involved in a diabetic nutritional and lifestyle group. I go once a month get talked to, meal plans, monitor memory looked at. For my trouble I get some free insulin pens. And I grab all they'll give me. Along with the insulins I need there are many essentials you have to have. My latest expense is the monitor patches. Very pricey. I write big checks every month. My insurance pays. But not enough. I'm lucky, I can afford to have this disease. I've been a diabetic my whole life and I'm still shocked about the cost.

Last edited by Beckdawrek; 06-18-2019 at 09:17 PM.
  #41  
Old 06-18-2019, 09:20 PM
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My insurance insists I am involved in a diabetic nutritional and lifestyle group. I go once a month get talked to, meal plans, monitor memory looked at. For my trouble I get some free insulin pens. And I grab all they'll give me. Along with the insulins I need there are many essentials you have to have. My latest expense is the monitor patches. Very pricey. I write big checks every month. My insurance pays. But not enough. I'm lucky, I can afford to have this disease. I've been a diabetic my whole life and I'm still shocked about the cost.
What does "insists I am involved" mean? Do they take attendance? Does the group report to your insurance company on whether or not you attended?
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Old 06-18-2019, 09:29 PM
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And just by looking at this thread, you can see how varied the prices are - depending on 1) whether you have insurance or not 2) what kind of insurance you have 3) how well you know the (often very complex) rules governing your insurance in order to get the most out of your plan 4) whether there are any outside programs or discounts available depending on how much money you make, who makes the insulin you need, or where you buy your insulin. This has been true for a long time for a lot of drugs and procedures and I am continually gobsmacked that so many of us have put up with this sort of bullshit for so long. I am sure a lot of the reason is how fragmented our health care system is - there are so many variables there is no way to compare plans or prices in any meaningful way and I'm pretty sure our 'system,' such as it is, is pretty happy with keeping things that way.
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Old 06-18-2019, 09:38 PM
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What does "insists I am involved" mean? Do they take attendance? Does the group report to your insurance company on whether or not you attended?
I can't speak for Beck, but if you were talking about my insurance group, the answer would be 'hell, yes.' It's the insurance company that insists on it, because patients with chronic diseases cost them money that they'd rather keep for themselves. Anything they can do to attempt to lower their costs, they'll do.
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Old 06-18-2019, 09:48 PM
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It's disgusting.

I'll never forget the first time I ever rang up insulin. I was a 16-year-old Target cashier in 1980, and even though I was years away from deciding I wanted to be a pharmacist, I did know what that substance in the box with the $6.28 price tag was, and called the pharmacy because I just didn't believe it. I thought something like that would be, like, $300 or something.

And now it is.



It would have been one of the old animal-sourced (beef or pork) insulins, which aren't sold in this country any more, and Target closed its pharmacies not long afterwards. They reopened them in the early 1990s when the company went nationwide.

Cut to 1987, when I was volunteering in a hospital pharmacy while making up my mind about going back to school, and when I saw Humulin, I asked if they took pancreases out of dead people and extracted the insulin, because I knew that was how they got human growth hormone (ETA from donated pituitary glands). The whole E. coli genetic engineering thing was explained to me, and I thought that was pretty cool.

Last edited by nearwildheaven; 06-18-2019 at 09:51 PM.
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Old 06-18-2019, 09:56 PM
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Not sure, but I'm guessing they could ask their doctor.
See the end of my post that you quoted. I'd already addressed that.

Also, what Broomstick said. It isn't always free or easy to consult a doctor. It should be; but it isn't.
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Old 06-18-2019, 11:35 PM
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Originally Posted by Broomstick View Post
You're assuming they have a regular doctor.

I know too many poor people who go to a clinic and get whomever happens to be there that day.

Also, for the uninsured doctor visits start around $150 in my area. It's more for a specialist like an endocrinologist who specializes in treating diabetes. Assuming said person can get an appointment in the first place.

Otherwise - it's wait until you're dying and go to the ER. Or at least hope someone gets you to an ER when you get goofy/unconscious from blood sugar problems.
Anyone more advanced than a rookie Medical assistant knows insulin dosing, you don't need a dedicated doctor to help you. Insulin dosing is not an arcane formula only pharmacists and endocrinologists can understand.
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Old 06-19-2019, 03:25 AM
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Originally Posted by drachillix View Post
Anyone more advanced than a rookie Medical assistant knows insulin dosing, you don't need a dedicated doctor to help you. Insulin dosing is not an arcane formula only pharmacists and endocrinologists can understand.
In Spain you can in fact ask your pharmacist for assistance with dosage, when would be the best time to take a specific medication, interactions, etc.* Would that be possible in the US or is it one of those "I'm not touching that with a ten-foot-pole to avoid suits" things?



* Showing off: in several regions, the e-prescription system allows the pharmacist to substitute a scrip for another and to write notes to the doctors. This will normally be for very straightforward stuff such as "scrip for 500, gave 2x250 instead" or "generic instead of brand-name," but it can be more complicated when the pharmacist recognizes an interaction or allergy the doctor appears to have missed.
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Old 06-19-2019, 07:10 AM
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yes the high prices are really bad. I am type I and found that low carb diet helps me a lot to keep numbers down. I don't do Keto diet but I am close to that.
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Old 06-19-2019, 07:29 AM
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You know poor people who go to a clinic, and the doctor there tells them "you have diabetes" and then there is no follow up or anything?
Or very poor follow up. Yes.

If you don't have insurance AND money in the US you're shit out of luck unless you are actively dying. Then you go to the ER - but the ER doesn't do follow-up.

So... one possible scenario is that a person doesn't know they have diabetes. They get sick enough to wind up in the ER. The ER figures out they're diabetic. They'll give them insulin and whatever else is needed to get them out of "actively dying" then tell them to follow up with a doctor. If they don't have a regular doctor then the ER will make a referral... but that still leaves the problem of how to pay for that appointment and the subsequent medications, and that's without considering potential problems with transportation or getting time off work or whatever.
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Old 06-19-2019, 07:48 AM
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In Spain you can in fact ask your pharmacist for assistance with dosage, when would be the best time to take a specific medication, interactions, etc.* Would that be possible in the US or is it one of those "I'm not touching that with a ten-foot-pole to avoid suits" things?
Yes, US pharmacists can help with that sort of thing but the differences between the old-style insulins and the newer ones are considerable. Also, diabetics are variable. Not everyone responds the same way to the same insulin.

It is true that treating diabetes is not rocket-science in a sense - in Shaghai in WWII a English teacher taught herself how to make insulin sufficiently well to keep herself and 400 other people alive - but there's "adequate to preserve life" and then there's "optimizing results". Big Pharma pushes the new drugs/delivery systems/etc. with the argument of convenience and optimization... none of which is any good if the patient can't access such care.

There are certain substitutions pharmacists are comfortable making. There are others they are not. I could see pharmacists happily giving instructions for something specifically asked for by a doctor in a prescription but being less comfortable doing so when substituting old-style insulin for one of the newer ones with much different frequency, duration, etc. Could it be done? Yes. Should it be done with someone with limited knowledge/access to patient history and diagnosis? Um... maybe not. Unless it's an emergency.

Quote:
Originally Posted by Nava View Post
Showing off: in several regions, the e-prescription system allows the pharmacist to substitute a scrip for another and to write notes to the doctors. This will normally be for very straightforward stuff such as "scrip for 500, gave 2x250 instead" or "generic instead of brand-name," but it can be more complicated when the pharmacist recognizes an interaction or allergy the doctor appears to have missed.
They can do that in the US, too. There are a very few drugs where absolutely NO substitutions or alternations can be made in the prescription, but most of the time what you describe is permissible. As far as drug interactions or allergies, US pharmacists not only are allowed to report it they have a duty to inform the doctor and the legal right to refuse to dispense something they believe could harm the patient.

When we went through an uninsured period my spouse's meds got to be quite varied. The docs and pharmacists would put together free samples of something so a pill bottle might have three different colors of capsules in it, as an example. We still had to make choices - we kept him on the diabetes medications but dropped the statins until we get coverage again. He did wind up rationing the diabetes meds for a short time, but as he was Type II diabetes that was less hazardous for him than for someone Type I. It's not good for Type II diabetic to, say, skip meds for a bit but they can still function. For someone Type I that could be lethal.

That's something to keep in mind - although the problem is pressing for someone Type I, people with Type II diabetes are also suffering. Some Type II folks also need insulin, either daily or from time to time (there were a couple occasions my spouse's blood sugar went berserk and he temporarily needed insulin until the problem was resolved.) While short term deprivation is less of a problem for Type II's, long term they, too, can get damaged kidneys, destroyed eyesight, nerve damage, amputations, and early death.
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