That came as a shock to the Americans who shell out hundreds of dollars a month on insulin, a number of whom posted triple-digit pharmacy bills to social media immediately after the president’s assertion.
“I looked at my husband and slapped my leg and said, ‘Can you believe that!’ ” said Tiffany Garrioch, 36, a public health nurse and educator in Minnesota with Type 1 diabetes, who watched the debate with her family.
“We’re already an underserved and highly vulnerable population,” she said. “To hear the president say it costs as much as water makes us look like we’re crybabies or liars.”
Insulin costs her $36.76 a day, she said. In 2008, it was $9.81.
Insulin prices have ballooned over two decades, including during the Trump administration. A subset of people enrolled in Medicare drug plans that cap payments at $35 a month are insulated from those costs. Otherwise a patient with diabetes can spend hundreds of dollars on a monthly insulin supply.
A few decades ago, people could pay about $20 per month for insulin, said Jeremy Greene, a primary care physician and medical historian at Johns Hopkins University. “Insulin prices have been a travesty of American pharmaceutical policy.”
The only way Trump’s statement could not be anything but an “out-and-out fabrication,” Greene said, is if insulin were compared to some of the priciest bottled water on Earth — such as the liquid harvested twice a year from melting Arctic polar ice that the doctor once spotted for sale in a Norway airport.
“The cost of insulin is still high for the majority of Americans who need it to survive,” said Laura Friedman, vice president for federal payment policy at the American Diabetes Association, which supports insurance co-pay caps and Medicaid expansion to help people with diabetes afford the drug.
“The ADA and the millions who are living with diabetes look forward to the day when insulin is affordable so that people can stop suffering from the consequences of dangerous practices like rationing insulin due to exorbitant costs,” she said in a statement.
About 1 in 4 patients with diabetes report underusing insulin because of financial pressure, which “effectively means that they are trying to make their insulin stretch, or having difficulty buying groceries or paying utility bills,” said physician Jing Luo, a professor at the University of Pittsburgh’s Center for Pharmaceutical Policy and Prescribing.
Switching to cheaper but less effective forms of insulin, or rationing it, can be devastating. People with diabetes can suffer strokes, kidney failure or death without sufficient insulin.
“The consequence of the untenable price of insulin can be measured in body counts,” Greene said.
Three companies — Eli Lilly, Novo Nordisk and Sanofi — dominate the market for insulin.
Insulin sold by Novo Nordisk, under the brand name NovoLog, was priced at $40 per vial in 2001 and rose to $289 in 2018, as The Washington Post reported last year. Eli Lilly’s Humalog insulin was $275 a vial as of last year, up from $21 when it entered the market in 1996. Sanofi’s Lantus was up to $270 a vial last year from $35 when it debuted in 2001. A box of Lantus exceeds $1,000 in the United States, Luo pointed out, “yet that same box lists under $100 at any Canadian pharmacy without a prescription.”
The three drugmakers have reduced the cost of insulin for some patients who have lost jobs, health insurance or both as a result of the pandemic. But attempts to encourage the industry to rein in insulin prices have been largely unsuccessful, Greene said, with manufacturers blaming the third-party companies that manage insurance benefits, and those middlemen in turn blaming the manufacturers.
Earlier this year, the Food and Drug Administration approved a compound that is biologically close, also known as a biosimilar, to insulin. That can be purchased for about a third of the price of brand-name insulin drugs.
This was progress — but “not progress attributable to Trump,” Greene said.