Memorandum

Diabetes Spectrum publishes editorial by Dr. Irl Hirsch on “insulin in America” – June 14, 2016

Diabetes Spectrum, a journal of ADA, recently published an editorial by Dr. Irl Hirsch (University of Washington, Seattle, WA) entitled, “Insulin in America: A Right or a Privilege,” in which Dr. Hirsch calls for action to bring down the pricing of insulin. In the piece, he reviews the history of insulin pricing from the University of Toronto’s $1 insulin patent to the exponential growth of insulin costs to reach the $21 billion global insulin market of 2013. Dr. Hirsch movingly highlighted his patients’ specific experiences (“my insulin now costs more than my home mortgage”), pointed to the complex bureaucracy of the assistance programs and pharmacy benefit managers involved, and pointed out the US’ disproportionate burden of insulin costs”. He made a passionate call to action, asking “how do we rationalize the fact that this elixir, required for survival by ~1.5 million people and used by another 4.5 million in the US, has become unaffordable to many” and labeled insulin a “right, not a privilege.” By way of potential solutions, Dr. Hirsch advocated for greater regulation of US insulin distribution, stressing that “to those who detest the thought of having our government involved in the distribution of insulin, I would say that I detest more the pain, suffering, cost and potential death from diabetic ketoacidosis resulting from patients’ inability to afford insulin.” We hope that the issues Dr. Hirsch raises can bring together manufacturers, policymakers, payers, clinicians, and patients to collaboratively take on the complexity of these systems. Dr. Hirsch has become an outspoken advocate of insulin pricing over the last year, with a chorus of other voices from the healthcare field and even the general public chiming in. We have felt some of the suggestions are more fruitful and productive than others (some have suggested anyone with problems go back on regular insulin) – we’d love to see more reform on the front to help patients pay for therapy they need that will help reduce short term and long-term complications and will help sustain innovation in the field. To learn more, please see our coverage of Dr. Hirsch’s landmark talk on insulin pricing from last year’s ADA and our year-end reflections.

-- by Melissa An, Helen Gao, and Kelly Close