Political satirist Hasan Minhaj devoted a recent episode of his Netflix series “Patriot Act” to the rapid increase in the price of insulin and other drugs. In his sharp-tongued and sometimes profane presentation, Minhaj accused insulin makers of price-fixing and acting like “basically an insulin cartel” for how they have raised the price of insulin in recent years.
Minhaj begins by reporting that more than three dozen drug companies have announced price hikes in 2019, and that drug prices are rising at a rate three times the rate of inflation. The effect can sneak up on consumers, he said. He then pivoted to insulin by sharing how the price of Humalog has risen from $21 a vial in 1996 to $295 a vial now. He argued that this rapid price spike can be a matter of life and death.
To make his point, he shared the story of Alec Raeshawn Smith, a young man with type 1 diabetes who died because he attempted to ration his insulin. In a news clip, Alec’s father, James Holt, said, “Can you even imagine what it was like to tell people that your son died at 26 because he struggled to afford the one medicine they created to save his life?”
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Minhaj argues that insulin prices in the United States are among the highest in the world. In a news clip, a diabetes advocate shares that NovoRapid insulin pen that costs $140 in the United States would cost just $8 in Taiwan and $13 in Canada. This was not how the Canadian researchers who were credited with discovering insulin therapy envisioned their invention being marketed, especially when they licensed the patent for insulin for $1 each in 1923, he said.
He first laid the responsibility for the high price of insulin on insulin manufacturers Eli Lilly and Company, Novo Nordisk, and Sanofi-Aventis. He said pharmaceutical companies routinely modify drugs to extend patent protection and avoid competition from generic drug makers. He also showed two charts comparing competing insulin brands that showed the prices of these insulins rose seemingly in unison.
“I’m not saying they’re price fixing, because look, these companies are very litigious, and I could get sued,” Minhaj said. He then paused before continuing. “So I’m just asking a question: ‘Are they price fixing?’ And then I’m answering a question: ‘Yes.’”
At this point, insulin makers are given a chance in the show to defend their pricing. Dr. Todd Hobbs, chief medical officer for Novo Nordisk, says his company has seen profits decline on a popular insulin brand in recent years because of rebates offered by pharmacy benefit managers (PBMs).
Minhaj also blames PBMs at least partly for the high price of insulin and other drugs, illustrating how PBMs can drive up the cost of some drugs well above what a patient might even pay out of pocket for it. He also argued that the push and pull between drug makers and PBMs makes the process for pricing drugs incredibly hard to understand. This can lead to inertia, he said.
“If you can’t figure out who to blame, they can all keep making money,” he said.
In the end, Minhaj sounded cautiously optimistic that action could be taken to solve the cost of runaway drug price increases. He noted that there is growing bipartisan support in Congress to take action, and that Congress had emergency powers to break patents. The threat of this, alone, might be enough to cause drug companies to lower prices.
“Right now, there could be enough political will to change things,” he said.
T1D Exchange Glu reports regularly on issues that are important to the type 1 diabetes communities. Publishing this story, or others on insulin pricing, should not be construed as the organization’s opinion on the issue.