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Since 2002, the cost of insulin has increased by almost 200 percent, according to a new study.

Editorial: Cigna’s announcement it will limit cost of insulin will not help vast majority of Type 1 diabetics

When Emilia Bloomquist of Dayton contracted seasonal influenza, she didn’t bounce back the way other kids do. Her mother, Kelli, took her to the doctor. As they were driving home from the appointment, the doctor called with news that changed the Iowa family forever. 

“He said, ‘I need you to pull over and turn around and I’m sending you to Blank,’” a children’s hospital in Des Moines, Kelli said. Emilia was diagnosed with Type 1 diabetes. 

Type 1, which is much less common than Type 2, frequently strikes children. There is no way to diet or exercise out of the disease. Staying healthy requires several injections of insulin daily and adhering to a strict regimen. 

Emilia, one of only three insulin-dependent diabetic students in the school district, struggles with infections and swings in blood glucose levels. Recently her blood sugar dropped so low she didn’t have the energy to board the bus after school.

Without insulin, she would quickly die.

Two years after the diagnosis, the family’s out-of-pocket cost for the 12-year-old’s insulin, pump to administer the hormone, and other supplies is about $5,000 annually, or about $400 per month. That’s after their $1,200 insurance deductible is met each year.

So what does it mean to this Iowa family that Express Scripts, a pharmacy benefit manager owned by health insurer Cigna, recently announced it will cap the cost of insulin at $25 per month for patients? 

Nothing. 

They aren’t insured by Cigna. Neither are millions of other diabetics. Americans with employer-based coverage through Cigna may save about $15 per month. 

Meanwhile, Type 1 diabetics spent an average of $5,705 per person on insulin in 2016, according to a recent report from the non-profit Health Care Cost Institute.

The high cost leads to diabetics rationing insulin, which can result in complications and death. Earlier this year, the Register’s editorial board wrote about Iowan Jesse Lutgen, a Type 1 diabetic who lost his job, health insurance and access to insulin. After he died, his mother found only empty vials that had been given to him from the belongings of a deceased diabetic. 

So one insurance company responding to public anger, increased scrutiny and congressional inquiries about the outrageous cost of insulin is not the remedy.

Sen. Chuck Grassley — who has taken an interest in understanding the cost of insulin — rightly responded to the Cigna announcement with guarded enthusiasm. He has held hearings, written letters and issued press releases. 

So have lawmakers before him. The price continued to skyrocket. The pharmaceutical sector will keep doing what it’s done for years: Focus on making as much money as possible.

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What is Grassley willing to do?

Because reducing the cost of decades-old hormones will require congressional intervention beyond lamenting the lack of transparency in pricing.

Lawmakers can allow the government to negotiate lower prices for drugs covered by Medicare the way it does for drugs used by veterans; legalize the importation of drugs from other countries; limit pharmaceutical sector profits; impose price controls on drugs; and fund the manufacturing of less expensive insulin. 

Meanwhile, the Bloomquist family will continue to manage both an intensive illness and its expense.

Kelli reduced her teaching load at a community college after Emilia’s diagnosis. Her husband teaches and works a summer job at a golf course. The thousands of dollars they spend on the medication and supplies to keep their daughter alive is money that cannot be used to pay for dinner or housing or funding college and retirement savings. 

The financial burden on this Iowa family is a burden Emilia will live with for the rest of her life. When she grows up, she will need health insurance that covers preexisting conditions. Even then, she may face huge out-of-pocket expenses. 

There is much Congress could do to help young people like her — if lawmakers really want to do so. 

Vast majority of diabetics are Type 2

Both Type 1 and Type 2 diabetes involve an imbalance of insulin, a hormone that helps regulate blood glucose levels. With Type 2, which accounts for about 95 percent of diabetes diagnoses, the body has become resistant to insulin’s effects. These people may be able to control blood sugar levels with oral medications and they may not need insulin. Type 1, which is much less common, is frequently diagnosed in children. All Type 1 diabetics need to take insulin to stay alive.

This editorial is the opinion of the Des Moines Register’s editorial board: Carol Hunter, executive editor; Kathie Obradovich, opinion editor; Andie Dominick, editorial writer, and Richard Doak and Rox Laird, editorial board members.

 

Read or Share this story: https://www.desmoinesregister.com/story/opinion/editorials/2019/04/10/teen-insulin-should-not-cost-iowa-family-hundreds-per-month-pharmaceutical-drug-imports-grassley/3400337002/