Crisis of unaffordable insulin in the US
Diabetes has bagged the seventh leading cause of death in the US and is also the major reason for causing renal failure, lower limb amputation, and blindness among its victims.
This also has negative effects on health like increasing the risk of mortality from infection, cardiovascular disease, stroke, chronic kidney disease, chronic liver disease, covid-19, and cancer, and reduces life expectancy.
Before the invention of insulin in 1921 from animal pancreas extraction, victims hardly survived longer than a year after being diagnosed. Over 30 million Americans are diagnosed with diabetes and more than 7 million adults use formulations of insulin to regulate the level of their blood sugar daily without which the patients may experience a rise in their blood sugar also known as hyperglycemia leading to serious and even life-threatening situations and if left unchecked, may kill.
This lifesaving drug can cost a person more than 300 dollars for a single vial and may add up to more than 1000 dollars in a month due to inadequate coverage of their health insurance and sometimes this high cost of insulin is paid with lives and livelihoods of people. Over 14% of insulin consumers invest 40% of their income in bearing the cost of the drug.
The failure of the us government to provide and ensure affordable insulin access is a violation of the right to health for its citizens suffering from diabetes leading to tragic consequences as a result of such a crisis.
For the citizens of the US, access to lifesaving medication is a privilege that many fail to afford due to its soaring prices and inadequate health insurance which further drives the people into financial debt and instability impacting them socio-economically marking their marginalization and reinforcing the existing structural discrimination.
These profound flaws in the healthcare facilities and insurance policies adopted in the US undermine access to this medication affecting people suffering from this chronic disease and contributing to the destruction of millions due to the medical debt.
Through the research made by Human Rights Watch, they analyzed the three widely used insulin analogies with their respective manufacturers namely – Humalog by the US-based Eli Lilly company, Novolog by the Danish company Novo Nordisk and Lantus by the French Company Sanofi which is produced by one of the three multinational pharmaceutical manufacturers dominating the global market of insulin making.
The price set for insulins by these manufacturers has soared in the late 1990s and early 2000s since their introduction in the market. It further discovered that Eli Lilly increased 275 dollars per vial of Humalog insulin in 2018 which was a rise of about 680%, Novo Nordisk rose its price by about 403% making it cost 289 dollars per vial of Novolog insulin between 2018-2000 on the other hand Sanofi’s price for Lantus rose for about 420% making the insulin cost 276 dollars per vial in 2019.
This helpless condition of running out-of-pocket to access the bare minimum need for living like bearing the cost of essential medicines such as insulin which can cost the life of a patient depending on it has its regressive impact.
This negative impact affects the standard of living for people who requires insulin to survive as at times this access to medicine comes at the cost of food, rent, and secure living conditions. Sometimes even the people who are not classified as low-wage earners face issues affording insulin for themselves.
At times, economically vulnerable people may achieve charitable assistance from private programs or programs of public health insurance based on income that funds these insulins but they can exclude people from enjoying the benefits who may qualify the requirements but may not be able to afford the cost of the medicines.
As of 2021, in most states, the qualification required for the Medicaid states that a single person would require to earn below 17,774 dollars without any dependents, and in the rest 12 states where the Affordable Care Act of 2010 has not been adopted, not a single person without dependent would be eligible for this safety program. This marks more than 2 million uninsured adults falling into this coverage gap disproportionately affecting and impacting the lives of black, indigenous, and other minor communities nationwide.
The socially, politically, or economically marginalized communities in the US are greatly impacted by Diabetes and its outcomes such as lower-limb amputation and black adults were more likely to experience this diabetes-related amputation as compared to white adults living in the US.
For many residents, the initiative of the charitable fund as taken by the manufacturing companies is just a means of defense against the burning cost of insulin and its eligibility is limited.
Though through these initiatives, the manufacturing companies have lessened the burden for some but have failed to provide this help and easy access to the majority of people or cut the issue of high cost.
Further, both the bodies of the public and private sectors that provide financial assistance restrict the grant of aid to its permanent residents or citizens often excluding immigrants both documented and undocumented which is a harmful violation of human rights. It’s like a do-or-die situation for those people and they need to pay whatever it takes for survival regardless of the price.
The reason for this drive-in soar price for insulin is unknown since, unlike most other countries, the US does not regulate its price for drugs directly. Neither there is a place for regulating the fair price of the drugs nor is there any restriction on the manufacturers or intermediaries on price hikes of the cost of insulin.
Though an unregulated practice of pricing is followed, the manufacturers are not the sole cause behind this unaffordability. The supply web between the intermediaries and the purchaser is very complicated and it contributes to the affordability of insulin for an individual and the needs one has to bear to avail the access of such essential medication.
Further, the rebate system in the US forces economically vulnerable people to subsidize the manufacturer’s revenue as well as other people’s insurance premiums even though they do not gain any potential benefits or discounts stemming from the rebates. Other developed nations pay less for this medication as compared to Americans who pay about triple the cost of this drug.
The unaffordability of lifesaving insulin due to the soaring price is a cornerstone of the human right to health. This disproportion discrimination based on the economic strata pushes disadvantages to the racial and ethnic groups in violation of both domestic and international law.
The US has signed both ‘the Universal Declaration of Human Rights’ and ‘The International Covenant on Economic, Social, and Cultural Rights (ICESCR) but it did not ratify or affirm that its government is bound to ensure health care or the accessibility of essential drugs to its people as determined by World Health Organisation (WHO) to provide so without any discrimination and make such facility available and affordable as a duty of a nation-state to prevent and protect human rights.
