June 21, 2019

'It makes good people feel like outlaws': Meet the Americans caravanning to Canada to save 90% on insulin

Daily Briefing

    U.S. residents increasingly are visiting Canada to purchase insulin, as costs for the diabetes treatment in the United States have spiked in recent years.

    Advisory Board's take: Why some pharma companies are offering fixed-price insulin

    Background

    According to a report from the Healthcare Cost Institute, per-person spending on insulin for patients with Type 1 diabetes doubled between 2012 and 2016. Even for patients with health insurance, out-of-pocket insulin costs can reach $1,000 per month.

    The sudden cost increase has sparked concerns among patients and Congress about patients' access to the life-saving drug. In response, federal lawmakers have launched investigations into rising insulin prices and have called for new measures to expedite FDA approval of new insulin products.

    A caravan to Canada

    However, patients today still are struggling with insulin costs, and some have begun purchasing insulin from other countries, where the drug typically is less costly and available without a prescription.

    For example, Lija Greenseid, whose 13-year-old daughter has Type 1 diabetes and needs insulin, last month "led a small caravan … to the town of Fort Frances, Ontario, where she and five other [U.S. residents] paid about $1,200 for drugs that would have cost them $12,000 in the United States," "The Americas" reports.

    According to "The Americas," Greenseid's group is planning another caravan to Canada this month to purchase more insulin and to raise awareness about high insulin costs in the United States. The group plans to drive to London, Ontario, from Minnesota, and drive through Illinois, Michigan, and Wisconsin on the way.

    While U.S. officials do not recommend that U.S. residents purchase drugs outside of the United States, and doing so could be illegal under FDA guidelines in some instances, the group is choosing to publicize their trips so U.S. residents are aware of the strain high drug prices are placing on patients. "When you have a bad health care system, it makes good people feel like outlaws," Greenseid said. "It's demeaning. It's demoralizing. It's unjust," she added.

    Elizabeth Pfiester—founder and executive director of T1International, a United Kingdom-based nonprofit that advocates for people with Type 1 diabetes—said, "It's kind of a myth that America has the best health care system in the world, because it is set up to allow Americans to go bankrupt or die because they can't afford their medicine."

    Lawmakers, drugmakers eye fixes

    According to the Washington Post's "The Americas," some U.S. lawmakers are eyeing legislation to address high U.S. drug prices, including insulin prices, and some have proposed allowing the United States to import certain drugs from Canada.

    But in Canada, some people are concerned that allowing the United States to import Canadian drugs could spur drug shortages in the country or drive up their prices. Barry Power, director of therapeutic content with the Canadian Pharmacists Association, said Canada's insulin prices are low because of the country's policies, which include negotiations with drugmakers and price caps. "This is something the U.S. could do," Powers said.

    Meanwhile, some states and drugmakers have begun capping patients' costs for insulin products, and some drugmakers are offering lower-cost alternatives to brand-name insulin drugs.

    Holly Campbell, a spokesperson for the industry group Pharmaceutical Research and Manufacturers of America, said drugmakers increasingly are offering rebates on insulin products in the United States, but said health insurers do not always pass those rebates on to consumers. "Too often, these negotiated discounts and rebates are not shared with patients, resulting in the sickest patients paying higher out-of-pocket costs to subsidize the healthy," she said, adding, "This is the opposite of how health insurance is supposed to work."

    But Greenseid believes the United States must put regulations in place to solve the issue and, until then, she will continue to purchase insulin outside of the country. "I don't think that the solution is going outside the United States. The reason [other countries] have lower prices is because they have put in regulations to make sure their citizens are not paying too much. We have not yet made that decision in the U.S.," she said (Rauhala, "The Americas," Washington Post, 6/16).

    Five ways to control the flow of drug expenditures

    Prescription drug expenditures are the fastest growing component of health care spending. And while reducing unwarranted prescribing variation is the single biggest improvement opportunity, there are several other near-term chances to reduce spending and grow revenues.

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