Americans Cross Border into Mexico to Buy Insulin

https://khn.org/news/americans-cross-border-into-mexico-to-buy-insulin-at-a-fraction-of-u-s-cost/

by howard941 • 7 years ago

121 116 7 years ago

khn.org

umeshunni• 7 years ago

whatshisface2• 7 years ago

Insulin has been manufactured for decades, and is made by more than one company. Why are the prices rising?

RcouF1uZ4gsC2• 7 years ago

Not all insulins are the same. My guess is that this insulin is glargine (https://en.wikipedia.org/wiki/Insulin_glargine) which just came off of patent in 2015. Glargine is a synthetic long-acting form of insulin that gives allows absorption without peaks, which is much better than previous types of long-acting insulins.

ng122• 7 years ago

Short acting is the biggest problem. There's no generic for it.

echlebek2• 7 years ago

My understanding is that there are insulin analogs that are vastly better treatments, due to being faster acting. These analogs are still patented.

However, even considering the patents, insulin prices for the same product are much higher in the USA than in Mexico or Canada. American prices have increased by an order of magnitude. [1]

IMO this rampant price gouging can only be explained by the pharmaceutical lobby, and a political apparatus addicted to their money.

[1] https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-i...

whatshisface2• 7 years ago

It sounds like the solution should be that patients can opt for cheaper, worse treatments, if they do not like that the more recent treatments are also more expensive.

ng122• 7 years ago

The short answer is patents. There's a cartel of a few makers (Novo-Nordisk, Lily and Sanofi) that slightly "improve" their insulin every few years to extend the patents. There are some generics available but they're not the fast-acting kind most diabetics use.

noir_lord• 7 years ago

The perverse one is where the new patented version is only marginally more effective but 5x the price and they stop making the old one.

It's a sick system.

SamReidHughes• 7 years ago

What do you mean extend the patents? Making a new version of insulin prevents the older version from going out of patent?

jahewson• 7 years ago

Unlike most drugs insulin is derived from animal cells so it’s not really possible to make a generic because you can’t demonstrate that your end product is identical to an existing product (at least not as far as the FDA is concerned).

The formulations are constantly tweaked by manufacturers to evergreen the patents too. New patents allow the price to be pushed up without risking new competition arriving.

acdha5• 7 years ago

Insulin has been produced by bacteria since the 1980s when recombinant DNA techniques became viable. That’s very precisely controllable compared to the historic animal sources.

fzeroracer4• 7 years ago

Because endless profit growth is the only thing that matters regardless of the morality or reality of the situation. And what better market to exploit than one where most people have to make a decision between being priced gouged or death.

This is of course an extremely simplistic way of looking at it but the reality is that we allow companies to abuse the patent system (under the guise of making research profitable for profiteering medical research) making generics impossible for things such as Insulin.

KorematsuFred4• 7 years ago

Most insulin companies are not really making endless profit growth. They are very profitable but not by as much as you think. Secondly, no one runs a business of charity. Can't really blame them if they want to make huge profit by offering you something you really want.

The real solution here is that FDA needs to close the loopholes on the patents that help them renew patents indefinitely. Secondly, drug import must be simplified from countries like Canada, China and Mexico for personal consumption.

Third, people should opt for cheaper alternatives which might be slightly less effective than cutting edge.

refurb11• 7 years ago

The actual price the manufacturer charges hasn't been going up much. Novolog list and net prices show Novolog vial has gone up 36% in price since 2001 (less than inflation) and Novolog Pen has gone up 3% since 2001.[1]

[1] https://www.drugchannels.net/2016/12/novo-nordisk-sheds-new-...

Ancalagon• 7 years ago

American healthcare is frankly - and I say this as an American - disgusting and infuriating. It needs to be re-structured from the ground up.

ushealth• 7 years ago

As a Dutch person who spoke to US people in Dutch hospitals —- who needed to pay full price —- I daresay the US health care system is worse than some 3rd world countries their health care system.

It is indeed infuriating.

dmarlow• 7 years ago

I think there are some differences though. "Worse" is a term that needs to define quantitatively what is worse. The quality is actually quite good here.

RcouF1uZ4gsC2• 7 years ago

Part of this is because the US prices of drugs, subsidize the development of drugs around the world. Pharmaceutical companies rely on the US market to offset the R&D of the drugs, while then providing other countries with drugs above the marginal costs (which is still profitable). In this scheme, the pharma company benefits (they increase their profits) as do the other countries (they get cheap drugs). The loser in this arrangement is the US consumer who gets to pay high costs so everyone else can have ground-breaking drugs at low cost.

acdha5• 7 years ago

Those companies spend far more money on marketing than R&D an they’re heavily reliant on US funded research — almost every erything they do starts with NIH funding.

tdb7893• 7 years ago

They can only do that because the US system is so broken so you are just reinforcing what the parent comment is saying (which may have been your intention but I was a little unclear on that)

octonion3• 7 years ago

R&D for insulin?

maxxxxx5• 7 years ago

Please stop believing this self-serving bullshit propaganda by the companies. If other countries raised their prices, prices in the US wouldn't go down a single bit. They would just make more profits. The problem is that the US allows these insane and corrupt billing practices.

mikeash• 7 years ago

Total medical R&D spending in the US is a few hundred dollars per year per person, out of about $10,000 in total health care costs. That’s everything, not just private drug research. Research does not explain the huge discrepancy in costs.

tanilama• 7 years ago

Not even developing country standard, at least those countries still can afford some of it.

yawz3• 7 years ago

I've lived and worked in a few countries including the US. In the US you are a "customer" first and then a patient. The entire healthcare system is run like a business that only cares about the money that they're making.

(Edit: small typo)

maxxxxx5• 7 years ago

You are not treated as customer. You are treated like a "resource" whose wallet needs to be exploited.

yawz3• 7 years ago

As an example, I still can't wrap my head around the price difference in a medical bill if one has insurance or pays out-of-pocket. Providers charge insurances excessively more than out-of-pocket prices. And this is done openly. Then the insurances are charging the patient with higher premiums. I mean, come on! How is this even legal?!?

HillaryBriss2• 7 years ago

this story cites one estimate that, for a certain list of drugs, the savings from buying in Mexico was 40-60%

that's huge. but -- how can US consumers possibly save any money by going to another country to buy a product? i thought globalization had brought US consumers free trade.

maxxxxx5• 7 years ago

there is no free trade in drugs,

HillaryBriss2• 7 years ago

US trade laws and agreements appear to protect certain sectors. has the US ever really had "free trade"?

pessimizer2• 7 years ago

The US is highly protectionist when it comes to intellectual property and agriculture. It generally only supports free trade in order to take advantage of lower labor costs and/or standards or raw materials in other countries.

RileyJames• 7 years ago

There seem to be services that mail insulin from Canada already, which is significantly cheaper.

Is it really cheaper, or necessary to fly to Mexico to pick it up yourself?

https://www.canadianinsulin.com/

sithlord3• 7 years ago

Since this is technically not legal, i wonder what percent get taken by customs

queercode• 7 years ago

I didn't know this was news. My mother, a US resident who's lived in the US for ~30 years, in a border town, goes across every time she needs any sort of medical care.

The Red Cross only takes cash, but it's so much cheaper (actually affordable).

jfnixon• 7 years ago

Huh, who woulda thought paying cash would be cheaper than filing a bunch of forms with an insurance company, giveing them a hefty discount, then waiting a few months to get paid.

shaftway• 7 years ago

Agreed. Many years ago I knew people who worked in an IVF office in Northern California. There was some drug they needed / used / prescribed / ??? that was crazy expensive. One of the nurses would drive down to Tijuana once a month to stock up. I thought this was just common practice.

Havoc2• 7 years ago

Same with tech actually. Busy flying a family member halfway across the world because the price diff on a single (!) laptop and cellphone covers the long haul flight costs.

Literally fly over, crash on my couch and spend a week exploring a different country for zero additional cost.

theatraine• 7 years ago

What country and tech? I haven't heard of this before and I wonder if it's a recent phenomenon due to the strength of the US dollar.

jbarham• 7 years ago

I'm guessing Brazil

Havoc2• 7 years ago

South Africa. Just a laptop & cellphone.

miguelrochefort• 7 years ago

Are you talking about the US or China?

interlocutor• 7 years ago

It is not just insulin. Prices of all drugs have been rising in the US, from 2x to 3x at a minimum, to 1000x in some cases.

The reason is insurance. When individuals are paying for drugs, drug companies can only charge what individuals can afford. When insurance is paying for drugs, drug companies charge what insurance companies can afford, and insurance companies are able to pay much higher prices (and they recover their costs by raising premiums.) You can't blame pharmaceutical companies for not leaving money on the table.

The fact that Medicare is legally not allowed to negotiate drug prices (a big handout by Bush administration to Big Pharma) isn't helping either.

freeflight• 7 years ago

If that'd be the case then any country with a single-payer healthcare system would suffer from similarly inflated drug prices as the US, but that's simply not the case [0].

What's stopping US insurers from pressuring drug companies into price agreements? Shouldn't that be also in their best interest, instead of just passing the costs along to the patients? If that's all they are doing, what do you actually need them for?

In Germany, price agreements between drug manufacturers and insurers happen plenty of times, and it usually works out because drug companies take reduced profits over no profits, any time of the day. Patients still have the option to buy the "fancy version", paying out of their own pocket, but the vast majority of patients are completely fine with whatever their insurance covers.

[0] https://www.commonwealthfund.org/publications/issue-briefs/2...

Sileni• 7 years ago

Insurance companies in the US have to pay out a certain percentage of the premiums they take in (80% last I checked) [0]. So they're also incentivized to let prices climb; their 20% for "administration and profit" is inflated when prices are inflated.

[0] https://www.healthcare.gov/health-care-law-protections/rate-...

greeneggs• 7 years ago

In the US, three pharmacy benefit managers (PBMs) control >70% of the market. [1] In an oligopoly, higher prices aren't such a bad thing.

[1] https://www.fda.gov/NewsEvents/Speeches/ucm599833.htm

"Capturing the Benefits of Competition for Patients" Speech by Scott Gottlieb, MD Commissioner of Food and Drugs March 7, 2018

jussij• 7 years ago

Shouldn't that be also in their best interest, instead of just passing the costs along to the patients?

But aren't those cost actually being passed onto the employer via the employees health care plan?

Here is Australia, where we have universal help care, we have a system call PBS and it's role is to define the drugs that get subsidized under that universal help scheme.

To keep those cost down it tries to pick generic versions of these drugs.

When Australia join a free trade agreement with the USA a side affect of joining that agreement was a weakening of the PBS.

We now have a situation where drug companies are able to manipulate the PBS for their gain, coming at the expense of the tax payer:

https://theconversation.com/the-tricks-companies-use-to-get-...

refurb11• 7 years ago

The fact that Medicare is legally not allowed to negotiate drug prices (a big handout by Bush administration to Big Pharma) isn't helping either.

That's entirely untrue.

Medicare pays for drugs either through Part B or Part D. In Part B, Medicare takes a discount by fiat, they get the same discount as commercial insurers.

For Part D, Medicare push the drug purchasing to private companies who can negotiate, lowering the cost of premiums.

Saying "Medicare can't negotiate" is technically true if you twist the meaning of the words, I guess?

nicoburns• 7 years ago

So what you're saying is that private companies can negotiate on Medicare's behalf, but that they can't negotiate themselves. Sounds like they can't negotiate to me.

prostoalex2• 7 years ago

When individuals are paying for drugs, drug companies can only charge what individuals can afford.

Insurance companies are consumers’ only venue for price negotiation.

Sick people in urgent need of a drug will likely not shop around, they will pay the asking price, sign up for any financing plan offered if the sticker price seems too high, or just charge it to the credit card.

tomca323• 7 years ago

Not sure about some of the numbers there. They say that a 3 month supply is $3700.

Humalog without insurance costs $95 per 3 ml cartridge, let's say it's a $100. This would mean that this child needs 37 cartridges for 3 months, or 12 cartridges per month, 3 per week.

That's a pretty crazy amount of insulin. I'm a T1 diabetic, that doesn't eat particularly healthy, and I need 2-3 cartridges a month, almost an order of magnitude less than the person in the article.

I don't think those numbers are right.

acdha5• 7 years ago

Humalog without insurance costs $95 per 3 ml cartridge, let's say it's a $100.

You have a citation that it’s available from every provider in the country at that price? The person quoted specifically said they’d been quoted that much and I would assume that people aren’t making up reasons to go on 5 hour drives.

tomca323• 7 years ago

I don't. I have this link that lists a bunch of providers and their prices and I don't see anyone going over $100 per 3ml cartridge: https://www.goodrx.com/humalog?dosage=3ml-of-100-units-ml&fo...

Of course, there might be a more expensive provider that I don't know of.

I don't think that those people are making up reasons to go on 5 hour drives, but I do think it's quite likely that journalists fudged the numbers or just found some theoretical maximums and approximated the price from there. Just so it's a juicier story, of course.

sithlord3• 7 years ago

i have had several insurances and switched between sometimes having to pay upfront cost, for a 10/ml vial it is around 230. I know, for example, I need around 9 vials per 3 months. pretty expensive stuff.

*edit, as I am on an insulin pump I only take fast-acting insulins. Lantus/Levemir other longer acting insulins usually are more expensive than the fast-acting stuff.

syn0byte• 7 years ago

They say her 3 month supply was $3700. Branding and "format" will affect the numbers. Pen? Vile? Pump? Humalog? Novalog? did the somewhat vague "3 month supply" include both short and long acting versions in the price tag?

I don't doubt the numbers, but I do detect some omission/simplification to make it seem extra stark.

rfinney• 7 years ago

Key phrase from the article is "modern generation of insulin". A good overview of the design and effects of the new insulins are here : https://onlinelibrary.wiley.com/doi/full/10.1111/dme.13692 ( "Lessons for modern insulin development" ).

sithlord3• 7 years ago

rotated between novolog and humalog 10/ml vials quite a bit (insulin pump - don't use long acting) and they are priced identically.

RHSeeger• 7 years ago

Basing things on previous numbers for myself (my insulin has changed since then because the insurance gets to override my doctor and experience).

Assuming

- 50 units of Lantus per day -> 4.5 vials per 3 months @ 300/vial = 1,350 USD/month

- 80 units of Apidra per day -> 7.2 vials per 3 months @ 300/vial = 2,160 USD/month

total = 3,510 USD/month

Now, to be fair, I'm older and have more insulin resistance than a younger diabetic would. Either way, the numbers without insurance add up real quick.

joeconway• 7 years ago

I think your numbers here are either out of date or not consistent for some reason. I got a batch of Humalog yesterday which claims 'retail price $1416.59' for 10 100 unit pens.

usausa92• 7 years ago

because it was haphazardly stitched together we ended up with healthcare that

1. does not cover everyone 2. it is rationed by for-profit companies 3. is is expensive and can bankrupt you 4. tied to employment which means you can lose it easily 5. confusing since you often have to deal with paperwork and multiple providers

If you are rich and can afford it the american system is great but it is awful for everyone else.

calyth2018• 7 years ago

4a. Because US health coverage tied to employment, it serves as golden handcuffs.

But hey, got to have those profits...

StephenAmar• 7 years ago

That's the case in other countries, like France.

usausa92• 7 years ago

you are right, it forces people to stay in jobs they don't like a forego other opportunities like starting a business.

ggreer2• 7 years ago

The reason health insurance became an employment perk was because of a tax loophole created during World War II. From A History of Employee Benefits and Taxation[1]:

At the same time, the federal controls on wages was leading to significant angst and frustration among the labor market, and the threat of widespread strikes and other forms of labor protest became a serious threat to the economy and war effort. In response, the War Labor Board implemented a new income tax exemption to employers sponsoring employee health plans. This made employer contributions deductible on federal returns, while the benefits were entirely tax-free, to the employees [3].
What started as a measure to avert crisis and labor strikes ended up becoming an expectation. As more and more employers leveraged these tax-benefitted health plans, American workers grew accustomed to getting their health insurance through work, rather than as individuals. The end of the war and the return home of American GIs exposed more workers to the new system, reinforcing its popularity and utilization [3]. By the 1960s, employer-sponsored health insurance plans had overwhelmingly displaced the formal individual market, a status that has persisted right into the start of the 21st century and provided a central tenant of the Affordable Care Act of 2008 [4].

In my opinion, this is yet another example of how even the most well-intentioned legislation can have disastrous consequences if it fails to account for incentives and second-order effects.

1. https://taxandbusinessonline.villanova.edu/resources-taxatio...

darpa_escapee• 7 years ago

If you are rich and can afford it the american system is great but it is awful for everyone else.

I know plenty of incredibly wealthy people who fly to places like France and Israel to see specialists, so take from that what you will.

thatfrenchguy• 7 years ago

Coming from middle class in France to upper-middle class in the US, the quality of care in the US is so subpar it makes me sad.

Sure, in exchange, you don't have to plan your annual visit to the optometrist 3 months in advance, but I'd rather have a doctor that actually cares instead of useless shiny tech.

infocollector• 7 years ago

There are five beneficiaries of these prices (or the broken system): Insurance, Doctors, Hospitals, Suppliers (Drug companies) and Politicians. It is easy to fix - fix the government (Politicians) - and everything fixes itself. And once the government is fixed, incentivize them to punish monopolies.

SamuelAdams• 7 years ago

I wonder if drugs are cheaper due to more relaxed regulations? the American FDA has many strict requirements around manufacturing and distributing drugs, but Mexico and Cananda do not need to follow the same standards, resulting in lower operating costs.

Lower operating costs = lower price.

decebalus12• 7 years ago

Nah.. Does the UK have lower standards or more relaxed regulations? What you're seeing here is the free market without government price control, at it's 'best'. Things in general are priced at what consumers are willing to pay. That's basically it.

danans2• 7 years ago

"what consumers are willing to pay" is intermediated through health insurance companies, whose policy premiums have skyrocketed in the US in the last few decades.

Before relatively recently, most US medication consumers didn't understand that rising drug prices were a factor in the rise of their health insurance premiums. Now they are catching on to that, which is why it is becoming a politically important issue.

decebalus12• 7 years ago

How unpatriotic. I hope the border wall will also keep Americans inside to contribute to the economy instead of spending their money abroad. The health care industry needs money to survive! Pharma companies need money to do R&D! Build that wall, Mr. Trump! /s

onlyrealcuzzo2• 7 years ago

We need to subsidize these poor drug manufacturers. It's hard times at GlaxoSmithKline.

maxxxxx5• 7 years ago

Don't give them any ideas. They may also start not only searching your laptop and at the border but also for antibiotics.

XaspR8d• 7 years ago

If you ever find yourself near Yuma, AZ, and have a sense for "weird travel" like I do, I'd recommend taking a jaunt into Los Algodones (AKA Molar City) immediately across the border. You can park at the border station and walk in. The tiny city is pretty much entirely dedicated to discount medical sales and is packed to the brim with dentists, pharmacists, opticians, and cosmetologists. When I was there, salesmen would literally call out "cavity? cavity?" to the passersby on the street. It's like some eerie alien recreation of Las Vegas where gambling is replaced with curbside botox and root canals.

We only spent about 20 minutes walking around (probably spent more time in the border office), but it was a super memorable pit stop for me.

chiph• 7 years ago

The Wynns went there about 5 years ago. To sum it up: It's a dental free-for-all, and there's no accreditation process or licensing, and everyone there is trying to sell you something on commission. But if you find a good dentist, you'll pay about 30-40% of what it'd cost in the US.

https://www.youtube.com/watch?v=KAECrmAOqy4

triplee• 7 years ago

What if this whole time the wall is really to keep US residents inside the country to make sure those hard working pharma execs get their rightful money? The slats are like those parking garage spikes that go one way -- US residents stay in, and everyone else can come in but never leave, keeping the easily exploited workforce from drying up.

Nah, that'd never happen.

opless• 7 years ago

This doesn’t happen with socialised healthcare that’s free at the point of service.

A government can negotiate lower prices than a commercial entity. They also can legislate to force bad actors to be reasonable.

Sadly the UK’s NHS is being slowly converted to the USAs fundamentally broken system of “what the market can bear”.

Rampant capitalism didn’t work for the banks either. They needed a social bailout when their markets crashed.

Americans Cross Border into Mexico to Buy Insulin

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