Source: Anonymous reader of The Gate.

Travel and the Rising Cost of Insulin?

The price of insulin has been insultin’.

Several people I know have been in the hospital recently. One of those people is a friend of mine who began to experience pain and swelling on his lower left leg, ankle, and foot; so he decided to walk on a treadmill as part of the start of a new regimen of working out, thinking that exercise would alleviate the symptoms…

Travel and the Rising Cost of Insulin?

…but that turned out to be a bad decision, as the pain and discomfort reached the point of excruciating when sores developed on his foot — meaning that he could hardly walk. He checked himself into the hospital which is located approximately one mile from his home. I visited him several times to either help out or just keep him company.

He had been initially informally diagnosed with Charcot foot, which is also known as Charcot-Marie-Tooth disease. It is a rare but serious complication that can affect people who have been diagnosed with peripheral neuropathy — especially those people with diabetes mellitus — and no cure exists for this disease, which affects the bones, joints, and soft tissues of the foot or ankle. “The bones become weak and can break and the joints in the foot or ankle can dislocate. If not caught in its earliest stage, the joints in the foot collapse and the foot eventually becomes deformed”, according to this article from Cleveland Clinic. “A deformed foot can cause pressure sores to develop in the foot or ankle. An open wound with foot deformity can lead to an infection and even amputation.”

He was ultimately diagnosed with cellulitis, which is a common yet potentially serious bacterial skin infection. The affected skin is swollen and inflamed and is typically painful and warm to the touch — and the color of his swollen leg was a red so deep that it almost seemed purple. “Cellulitis usually affects the lower legs, but it can occur on the face, arms and other areas. The infection happens when a break in the skin allows bacteria to enter”, according to this article from Mayo Clinic. “Left untreated, the infection can spread to the lymph nodes and bloodstream and rapidly become life-threatening.”

The functioning of his kidneys was lower than normal — which was enough to cause the kidney specialists to be concerned — and he revealed the reason why to me.

“I quit taking insulin ten years ago,” he told me. “It cost me as much as $300.00 per month — and I lost 70 pounds, which was great.”

I did not know he was diabetic — nor did I know how serious was his diabetes.

Multiple Billions of Dollars in Costs — and Profits

I have known many people over the years who have been diagnosed with diabetes, which is a group of conditions with which too much sugar is in the blood and thus can cause many complications throughout the human body. A friend of mine who died last December — may she rest in peace — was completely convinced that a cure for diabetes has existed for years; but too many entities handsomely profit from what has become a lucrative subset of the medical profession and are supposedly preventing the cure from being released to the public.

Whether that allegation is true or false, maintaining control over this chronic disease can be expensive, as medical costs can exceed $9,500.00 per year for each person. Although greater than 37 million people in the United States have been diagnosed with diabetes, approximately 20 percent of them — or greater than seven million people — require some form of insulin. Just for those seven million people, that adds up to $66.5 billion in United States dollars. The cost of diagnosed diabetes is theoretically as much as a $350 billion in the United States alone — not counting the rest of the world.

“The total estimated 2017 cost of diagnosed diabetes of $327 billion includes $237 billion in direct medical costs and $90 billion in reduced productivity”, according to this article from the American Diabetes Association, which is a network of greater than 565,000 volunteers, their families and caregivers, a professional society of nearly 16,000 health care professionals, as well as more than 250 staff members — all of whom are committed to a life free of diabetes and all its burdens, as well as to prevent and cure diabetes and to improve the lives of all people affected by diabetes. “People with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.”

The largest components of medical expenditures are:

  • Hospital inpatient care — 30 percent of the total medical cost
  • Prescription medications to treat complications of diabetes — 30 percent of the total medical cost
  • Anti-diabetic agents and diabetes supplies — 15 percent of the total medical cost
  • Physician office visits — 13 percent of the total medical cost

Tips For Traveling With Insulin

The American Diabetes Association offers a comprehensive list pertaining to what diabetic medical supplies can be brought aboard an airplane for travel.

Additionally, GoodRX Health offers six tips for traveling with insulin:

  1. Bring more insulin and supplies than you need
  2. Store insulin correctly while traveling to your destination
  3. Store insulin correctly when you reach your destination
  4. Avoid exposing your insulin to extreme temperatures
  5. Know how to adjust your insulin dose during travel
  6. Prepare for the worst

Finally, no fewer than 21 tips for traveling with diabetes are offered by the Centers for Disease Control and Prevention of the United States — including before you go, while you are traveling, and once you arrive at your destination. This includes being able to get an optional notification card from the Transportation Security Administration to help the screening process go more quickly and smoothly; and that people with diabetes are exempt from the 3.4 ounce liquid rule for medicines, juices and other fast-acting carbohydrates, and gel packs to keep insulin cool.

Medical Tourism For Insulin

People who have diabetes cannot produce their own insulin — or, at least, enough of their own insulin — in order to regulate their blood sugar; so they must rely a medication based on the hormone that is produced by the pancreas.

Because of the high cost of insulin — one vial can can cost as little as $50.00 and as much as $1,000.00; and a pack of pens can range from $45.00 to greater than $600.00 — some diabetics have turned to traveling to save money on insulin.

“Upon arrival at the pharmacy I was nervous, but when I walked in and met the pharmacist, my fears dissipated into pure excitement took over, as three boxes of Humalog pens and two boxes of Lantus were loaded into an insulated bag with a cold pack”, according to Karyn Wofford in this article at T1International, which details her experience of traveling from Georgia to British Columbia for insulin which is less expensive. “It all rung up with a total of just under $700. Roughly, those insulins cost me $500 per box in the USA, so I would have spent $2500 at home for exactly what I bought in Canada for $700. All I needed was a prescription from my doctor in the USA. I learned from the pharmacist that it is all too common to have non Canadians visit their small little Vancouver shop.”

She also wrote in that article from Friday, May 3, 2019 “For the same price I would spend on a three month supply of Humalog, I booked two plane tickets to Vancouver, a one night hotel stay, and bought enough Lantus and Humalog to get me through the rest year.”

In this article for Healthline, Mike Hoskins wrote on Monday, May 13, 2019 that “The cost comparison was striking: I paid less than $50 U.S. currency for a bottle of the Humalog I was using in my insulin pump at the time. By comparison, a single vial of that elixir in the U.S. processed through my insurance pre-deductible would have been four times the price, at over $200 then (whether purchased at a local pharmacy or via mail order).”

Medical tourism not only can resolve the expense of insulin; but the cost also typically includes travel expenses — and those who do this usually have money left over than if they simply purchased insulin in the United States…

…but if you are thinking of doing something similar, you may want to know if this is even legal.

“In most circumstances, it is illegal for individuals to import drugs into the United States for personal use”, according to this article from the official Internet web site of the Food and Drug Administration of the United States. “This is because drugs from other countries that are available for purchase by individuals often have not been approved by FDA for use and sale in the United States.”

Interestingly, guidance is offered by the same federal agency on personally importing drugs or device products for medical use. This includes information regarding situations for which this might be allowed:

  • Product is not for treatment of a serious condition and there is no known significant health risk — Over the Counter, OTC — or
  • Product is for the treatment of a serious condition — Prescription Drug Products:
    • The product is for a serious condition for which effective treatment may not be available domestically either through commercial or clinical means.
    • There is no known commercialization or promotion of the product to persons residing in the United States
    • The product does not represent an unreasonable risk.
    • The consumer affirms in writing that the product is for personal use.
    • The quantity is generally not more than a three month supply and either:
      1. Provide the name and address of the doctor licensed in the United States responsible for  your treatment with the product, or
      2. Provide evidence that the product is for the continuation of a treatment begun in a foreign country.

Moreover, this Know Before You Go article from the official Internet web site of Customs and Border Protection of the United States is devoted to what you need to know about traveling with medications — as well as other prohibited and restricted items.

Affordable Insulin Now Act

If medical tourism for insulin is not for you, financial help may be on the way: members of the House of Representatives of the United States passed a bill called H.R. 6833 on Thursday, March 31, 2022 that is now known as the Affordable Insulin Now Act, which limits cost-sharing under private health insurance and the Medicare prescription drug benefit for a supply of selected insulin products for one month at $35.00 or 25 percent of the negotiated price of a plan — after any price concessions — whichever is less, beginning in 2023.

The Centers for Medicare and Medicaid Services is currently testing a voluntary model under the Medicare prescription drug benefit — the Part D Senior Savings Model — in which the copayment for a month’s supply of insulin is capped at $35.00 through participating plans. The model is set to expire on Wednesday, December 31, 2025.

Meanwhile, the Affordable Insulin Now Act must still be passed by the Senate of the United States and signed by the president of the United States before it becomes law — but enough vials of insulin for a month is starting to be offered by some retailers at the cost of $35.00.

Final Boarding Call

Pharmaceutical companies and other entities of the medical profession certainly have a right to profit on the ailments of other people. After all, they have to earn a living too…

…but does a company have a right to increase the price on a product — to the point of what is called price gouging — which people desperately need to survive?

Although the concept may initially seem heartless, John Stossel gives an interesting perspective in this video on how gouging the prices of goods and services which people absolutely need — especially after a natural disaster, such as a hurricane — may not necessarily be immoral or unethical.

I do believe in the basic economic principles of supply and demand and believe they should dictate the cost of goods and services — but for me, the exception to that rule is when a supplier unnecessarily takes advantage of customers to the point of being grossly unfair.

What should happen is what many other industries do: offer levels of products and services. For example, offer basic doses of insulin at the lowest prices possible while still earning a reasonable profit; and offer pens and other products which are more advanced in terms of technology, strength, effectiveness, and other attributes. This way, more segments of the market are served — and in a fairer manner.

Most importantly, however, is to ensure that you remain as healthy as possible — my friend is currently recuperating in his home and is getting healthier once again — and for diabetics, that means not going ten years without insulin, as that could lead to greater problems in the future.

Source: Anonymous reader of The Gate.

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