The Future of Insulin — Will It Be Affordable for the People Who Need It?
A panel of experts at the 2022 American Diabetes Association presented exciting research on new weekly oral and injectable insulins. However, there is already a crisis of people with diabetes rationing their insulin in the United States due to skyrocketing prices of existing insulins. Is creating more types of insulin the answer?
Session: The Future of Insulin—Weekly, Oral, Smart, or Interchangeable Therapies
Presentation: Insulin Access + Affordability—The Role of Biosimilars and Interchangeable Insulins
Speakers at this ADA Scientific Sessions presentation included: Rita Rastogi Kalyani, MD, MHS (Johns Hopkins University School of Medicine)
Insulin therapy is one of many tools used in diabetes management. However, some people are reluctant to start insulin due to stigmas or fear of injections. New weekly oral and injectable insulins are hoping to overcome some of the barriers to insulin therapy by reducing the number of injections or eliminating injections completely. But these types of insulin will only be helpful if the people who need them to survive can actually afford them.
Why it matters?
People living with type 1 and type 2 diabetes utilize insulin to manage their blood sugar levels. Without enough insulin or other diabetes medications, people with diabetes significantly risk developing debilitating diabetes-related complications, diabetic ketoacidosis (DKA) and death. It is a basic human right to have access to life-saving medication—and yet many still cannot afford the insulin they depend on to stay alive.
New insulins show promising results for lessening the every day burdens of living with diabetes, but only if they are accessible.
“Will this be affordable to our patients? Will this actually be something that patients can use with all these new developments?” asked Rita Rastogi Kalyani, MD.
What is impacting current insulin accessibility?
There are several factors impacting insulin affordability and accessibility, including:
- Most insulins used/prescribed are analog insulins
- Analog insulins are more costly to produce → impacts affordability for patients
- Analog insulins are superior in managing blood sugars safely but significantly more expensive than older human insulins like NPH and Regular
- Pharmacy benefit managers (PBMs) and other players have driven the price of modern insulins through the roof
- Insulin supply chain is a complex system
So what’s a potential solution?
A possible solution proposed by Kalyani to improve insulin affordability and accessibility is to increase the use of biosimilars.
Biosimilar insulins are manufactured using living organisms (yeast, bacteria) to produce large quantities with a process that differs from that used to produce the reference biologic [insulin]. Biologic insulins require greater complexity in manufacturing, which impacts the cost of production compared to biosimilars.
- First biosimilar insulin (Basaglar) was approved in 2015
- Biosimilar use has increased since 2016 but still only 8.2 percent of all insulin use
Why has it taken so long to produce biosimilar insulins? The short answer is patents. The insulin glargine patent expired in 2015, making it available for use in other manufacturing.
“The Endocrine Society believes the following policy changes could help expand access to lower cost insulin…expedite the approval of insulin biosimilars to create competition in the marketplace,” explained a statement released by the Endocrine Society.
Biosimilars offer the opportunity to lower insulin prices, but the manufacturing process may be cumbersome and requires new manufacturers to enter the market and create competition.
People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, visit GetInsulin.org.