After Thomas Thomas Strathmann from Bozeman, Mont., Collapsed at his job and spent a week in a hospital, he was diagnosed with type 1 diabetes and two insulin cassettes. He was told that they would take "a few days," he recalls. The next box would cost between $ 500 and $ 600. He was 28 and not insured.
Strathmann, an emergency mental health worker, earned just enough not to qualify for Medicaid and said he could not afford a plan on the Healthcare Marketplace ("Obamacare"). He turned to the same local nonprofit health service to which he referred his clients. The organization offers single-use insulin pens, which are calculated on a sliding scale according to income. For the past three years, he has been buying boxes of five pens for $ 1
"I can not describe this situation in which you have something to live on and can only have as much as you can have at any given time," says Strathmann.
Concerned that something is breaking his supply, he has begun to skip cans and store pens.
Who is rationing insulin?
One in four people with diabetes in America has rationed insulin, according to a December study by Yale University. The cost of diabetes drugs has increased exponentially in the last 20 years, so patients have to struggle with spending out of pocket. A study published in JAMA showed that the price of insulin, as it was raised at the pharmacy, tripled from 2002 to 2013.
Since then, insulin prices have continued to rise. A study published last month by the Health Care Cost Institute measures a rise between 2012 and 2016 in terms of how much is spent on Americans with type 1 diabetes (in total by insurance companies, governments or patients). It doubled from an average of $ 2,864 per patient in 2012 to $ 5,705 in 2016.
To cover these costs, some diabetics save insulin. "I hear about it once a week," says Kevin D. Codorniz, medical director of diabetes treatment at Loma Linda University Health in Southern California. "Their cost share is so high that it is impossible for them" to take over the prescribed amount.
David Nathan, MD, Director of the Diabetes Center at the Massachusetts General Hospital, says he has heard of patients struggling to spend $ 300 to $ 500 a month. Some tell him they skip dosages. "I suppose [others] I'm embarrassed to tell," says Nathan. It is the proud or timid patients he worries most about.
What happens if you skip doses of insulin
The results of insulin rationing can be fatal. In February 2017, Shane Patrick Boyle died of diabetic ketoacidosis in Arkansas shortly after leaving the Obamacare regime, allowing him to stay with a parent until the age of 26, and after not having enough insulin supply for one month had applied GoFundMe. In another published case, Alec Smith, a restaurant manager from Minnesota with type 1 diabetes, who also left his parental insurance contract at age 26, died in search of affordable insurance options.
Dr. Codorniz warns that insulin with inadequate recovery can lead to diabetic coma and have serious long-term effects, including kidney disease, infection, stroke and amputation risk. "Most people do not know," he says. "They think they're too young to hurt them [for rationing]it's ten years later, if you're dealing with those complications."
Insulin has been used since the 1920s and has been produced in much the same way for decades – Extracted from an animal's pancreas or made using recombinant DNA techniques extract it from bacteria.There are some new products for diabetes, such as insulin pumps and longer lasting medications, but most of them are for one-time or severe cases or for people with high quality Most patients use basic forms of insulin, which according to Dr. Codorniz existed for decades, with pharmaceutical companies making changes to the medication or administration process to maintain patents.
What companies do?
Drug manufacturers owe inflation to prices: In 2017, people with diabetes filed a class action lawsuit against a court in Massachusetts against Sanofi, Novo Nordisk, and Eli Lilly, accusing the three companies of working in Lock Step In 2018, the Attorney General of Minnesota filed a lawsuit against the SA, a three-party I, accusing them to raise insulin prices in Cahoots.
Eli Lilly has reacted to the anger by producing an "authorized generic" version of her insulin Humalog for $ 137, half of her usual price, and opening a "solution" center, where patients can call to to ask for cheaper options.
Dr. Codorniz warns it's "a complicated matter, not just the drug companies that are greedy." He said many offered rebate coupons for low-income and underinsured patients, but these rebates often have the effect of pushing up consumer spending
The American Diabetes Association has opposed the rise in costs and made policy proposals, including streamlining the process to obtain approval from the Food and Drug Administration for generic versions of insulin drugs to ensure price transparency and The organization has also produced a guide that contains suggestions and resources for anyone who has difficulty paying for insulin.
Dr Nathan says it is time for the government to carry out cost controls "There are no adults in the room," he says. "There is no one the pharmaceutical industry says: "You can not do what you want. "
For Thomas Strathmann, before and after the day he collapsed on diabetic ketoacidosis, there's a blatant confrontation, he has switched to less stressful work, cashed in a ski shop, and landscaping." He says he insists Be careful not to make too much money. "It's this Catch-22 that can not give you insulin if you make too much money, but if you make too little, you can not afford to eat."  Formerly enjoying trail running and other mountain sports, he now occasionally takes a mental walk, the biggest change being a constant state of fear for his health. "To experience this on a daily basis is debilitating," he says. "It's in your head if you come to the time you go to sleep. "