Diabetes is the most expensive chronic disease in America, but the drug used to regulate it costs under $2 to manufacture. How did we get here? 

Let’s get into some history before we deal with that heavy question. The CDC defines diabetes as an autoimmune disease that attacks the pancreas and destroys the cells that create insulin, causing the body to stop regulating blood sugar entirely.  

A century ago, diabetes was a death sentence with a near-perfect fatality rate, which is why it was a miracle of science when a synthesized form of insulin was discovered in 1921. It was an even greater miracle that the patent for the manufactured hormone was sold to Toronto University for just $1 and the promise that insulin would be given out free of charge.  

As one of the creators, Frederick Banting said, “insulin does not belong to me, it belongs to the world.” 

Now, where folks with any morals at all saw an accessible miracle medicine that could save the lives of millions, Big Pharma manufacturers saw dollar signs. The patent for artificial insulin was quickly snatched up, and now only three companies, Eli Lilly, Novo Nordisk and Sanofi, have the legal power to manufacture insulin. 

So long as there is a market for insulin, these companies will continue to treat the 34 million human beings who need the hormone to live as nothing more than a convenient source of income.  

After all, if the prices continue to rise, what will diabetics do? They can’t buy insulin from anyone else, and they certainly can’t boycott the use of the drug. 

This viewpoint leaves American diabetics incredibly vulnerable, since according to a 2020 study from the Health and Human Services Department, diabetics in the U.S. are forced to pay eight times more than those in any other country. In the U.S., a 10mL vial insulin can cost upwards of $100 without insurance, while the average cost in 32 other high-income countries is around $9.00. That’s just the drug on its own, not to mention the blood test strips, syringes, pens, pumps, injectors and various other tools needed to measure blood sugar and properly administer insulin.  

Because of the volatile nature of the disease, diabetes not managed with regular, pure insulin injections is incredibly dangerous and unfortunately deadly. Diabetes is currently the 7th leading cause of death in the U.S., with around 80,000 fatalities every year. The ADA found that diagnosed diabetics pay around $17,000 every year in medical expenditures alone- that’s double what the average healthy American spends.  

That leads us to the Affordable Insulin Now Act, one of the only meaningful laws surrounding insulin prices. The act was initially introduced to Congress in 2017, but was only recently signed into law by President Biden as part of the 2023 January Inflation Reduction package. Under this new policy, out-of-pocket insulin charges will be capped at $35 for those on Medicare insurance. Which is great!…in theory. 

In truth, the Affordable Insulin Act will only benefit Medicare-eligible diabetics age 65 and up. Most diabetics at this age are type-2, meaning that with regular exercise, dieting and regular insulin injections, the condition will improve. But what about everyone else, those with private insurance, or no insurance coverage at all? What does this act do for the type-1 diabetics who will rely on artificial insulin for the rest of their lives? 

Well, the harsh reality is that if insulin prices continue to rise as they have for the past decade, most type-1 diabetics won’t make it to 65.  

According to the ADA, the average life expectancy for a type-1 diabetic is about 64, 12 years less than the average American. Even if they do manage to beat the odds, the financial aid this act offers to diabetics will do little to fix the lifetime of medical bills incurred from simply having a non-functional pancreas. 

To make matters worse, there was a version of the Affordable Insulin Now Act up for Senate vote that would have provided a $35 insulin cap for anyone with insurance, not just those with Medicare. As you can probably guess, the bill was shot down by Republican majority vote, and was edited down to its current form.  

House Rep. Matt Gaetz (R-Fla) was one of the loudest objectors to the bill, writing in a resulting Twitter thread that “insulin price increases have more to do with increased consumer demand than the bad behavior of Big Pharma,” and “the price of insulin increases as waistlines increase.”  

This upsettingly common trend and truly sickening attitude of reducing the life or death of human beings to “increased consumer demand” is exactly what is enabling pharmaceutical companies to continue charging outrageous prices for simple, life-sustaining hormones.  

It shouldn’t matter why a person has diabetes; whether they developed a genetic defect or an unhealthy lifestyle, a person with need for insulin should have safe, affordable access to it. No one should be forced to ration hormones, or substitute with animal medicine, or travel across state lines, or die in their homes from lack of access while insulin can still be created. 

While the Affordable Insulin Now Act is a small step towards financial relief for diabetics, the problem is far from solved for the millions of Americans living with diabetes. We need drastic insulin cost reduction in the next few years, otherwise we will be sitting back and watching our brothers and sisters pay to die.