Type 1 diabetes, which according to the CDC accounts for about 5 percent of all diagnosed cases of diabetes, is an autoimmune condition in which the body attacks and destroys the insulin-producing beta cells of the pancreas. Because their bodies cannot make insulin, type 1 diabetics require insulin prescriptions to live (in some extreme cases this is true for type 2 patients as well). 

"When type 1 diabetics take less insulin than they need, at the expense of having higher blood sugars… glucose rises significantly and in an attempt to find alternate fuels for the brain, keto acids are formed which are potentially toxic and lower the body's pH. DKA (Diabetic Ketoacidosis), when left untreated, can be lethal, and can set in quickly. In the absence of insulin a person might get DKA within 24 hours," - Robert A. Gabbay, the Chief Medical Officer and Senior Vice President at Joslin Diabetes Center in Boston.

According to an international survey of type 1 diabetics conducted in March 2016, the average out-of-pocket monthly cost of diabetes in the US is $360, with a single vial of Novolog insulin costing between $14 and $300 and a vial of Humalog insulin priced at $435. "Each person has different insulin requirements… for some people, one vial a month may be enough; for others several vials are needed," Gabbay says. The amount of insulin a diabetic uses daily can fluctuate depending on a number of factors, like whether they're sick, stressed or on their period.

Novolin, an older and cheaper kind of insulin available at Walmart, is often pointed to as a cost-effective solution for diabetics, but according to Gabbay, "some patients just don't manage their diabetes best using these older insulins."

In November Senator Bernie Sanders called for a federal investigation into suspected collusion in the pricing of insulin, and in January Donald Trump accused the entire pharmaceutical industry of "getting away with murder," a statement Sanders agreed with, though in a tweet he still wondered if "Trump and Republicans [had] the guts to police drug companies and lower prices." Though Republicans failed to repeal the ACA last month, Health and Human Services Secretary Tom Price has expressed plans to dismantle parts of the act by narrowing what it currently defines as "essential benefits" in coverage. Some diabetics fear this will cut their prescription coverage entirely.

The price of insulin has skyrocketed in recent years, with the three manufacturers — Sanofi, Novo Nordisk and Eli Lilly — raising the list prices of their products in near lock step, prompting outcry from patient groups and doctors who have pointed out that the rising prices appear to have little to do with increased production costs.

In the United States, just three pharmaceutical giants hold patents that allow them to manufacture insulin: Eli Lilly, Sanofi and Novo Nordisk. Put together, the “big three” made more than $12 billion in profits in 2014, with insulin accounting for a large portion.

What makes this so worrisome is that the big three have simultaneously hiked their prices. From 2010 to 2015, the price of Lantus (made by Sanofi) went up by 168 percent; the price of Levemir (made by Novo Nordisk) rose by 169 percent; and the price of Humulin R U-500 (made by Eli Lilly) soared by 325 percent.

In much of Europe, insulin costs about a sixth of what it does here. That’s because the governments play the role of pharmacy benefit managers. They negotiate with the manufacturer directly and have been very effective at driving down prices. In the United States, we rely on the private sector and a free market for drug pricing. But in order for this to work, we need to regulate it better and demand greater transparency.

Over the past 10 years, the Federal Trade Commission has brought only a single enforcement action against benefit managers, over an issue of patient privacy violations.
WE NEED AFFORDABLE INSULIN. OUR LIVES ARE AT STAKE, AND THIS IS UNETHICAL!