May 29, 2023

Type 1 diabetics need insulin to live, but prices for some brands in the U.S. have tripled or more over the last 10 years. That’s not the case in Mexico. In fact, the cost disparity is so huge that it’s sending American diabetics south of the border.

What was the last time you went 15-20 minutes of that thinking about diabetes when i was 8 years old 5 years 6 years ago mmm constant presence yeah like 1.25 million americans lauren and louise are type 1 diabetics how long have you been a diabetic 21 years okay yeah i was diagnosed in 1988 i was nine at the time how long have you had it going on about four years

I was diagnosed in my 50s with type 1 diabetes lauren has become an advocate for diabetics working with the nonprofit t-1 international her family lost their insurance soon after she was diagnosed before i moved out of the house my family we just always scrambling they would get enough insulin for one month and then start planning in for the next month we went

To canada a few times to get insulin and kind of stocked up there i would get expired samples from my endocrinologist and sometimes we would just meet people that had extra insulin because they were insured and would be willing to share some with us in 2007 the list price of five pens of humalog a common brand of insulin was a hundred and forty seven dollars by

2013 it had doubled in price to two hundred and ninety five dollars and by 2017 it had almost doubled again before an insured diabetic meets their deductible they would pay five hundred and thirty dollars there’s another option you can join the estimated 1 million american medical tourists who flock to mexico every year for cheaper prescription drugs lauren does

This regularly louise has never been and i was interested in purchasing insulin too i was diagnosed with type 1 diabetes soon after my 28th birthday shall we go get some insulin let’s go to mexico so i mean i saw in the internet that there are a bunch of these big ones it basically advertised for americans yeah and that the websites are in english and they say

Come we’ll take your money yes your health care systems terrible yeah and we’re gonna go find those guys yeah yeah so lauren we’re sure all of the insulin is actually insulin a lot of people ask oh what’s it like buying from another country but i know this is like gonna come as a real shock to everyone but people in mexico have diabetes – and also need influence

The formulas are the same they’re made by the same drug manufacturers it’s just cheaper you sell you some we do okay what do you need so yeah okay i’ll need you do you have vials humalog vials or just the pens we have the pens okay all right so it comes one in a box seventeen dollars for one minute i can get a pen of this percentage do you know of any apartments

In tijuana that i can rinse the novalog right now i’m paying thirty seven dollars you paid thirty seven dollars for the novalog hey it’s your copay so this is cheaper than your copay so this is 850 to 900 dollars worth of insulin yeah 13 you’re paying how much 115 115 so a 5-minute walk over the border saves you yeah eight hundred some odd dollars rodrigo is an

American citizen that moved to mexico to run this pharmacy with his family the percentage of people becoming here are america probably the majority it’s ridiculous a lot of people like on a monday will get a good 900 tickets so that will come through i mean there it’s too much we couldn’t handle it the space was too small that’s why we had to open up over here

So because of the crisis in american healthcare you’re expanding that’s that’s pretty much it what’s great for you yeah it is that’s why it’s so huge the the medical tourism here cuz you know you have the border crossing they open the lanes specifically for medical tourism insulin is cheap in mexico and canada because those government’s negotiate market access

And prices without middlemen but in the u.s. access to markets are controlled by pharmacy benefit managers pbms who manage drug benefits for insurance companies and employers a pbm will allow drug companies access to their customers for a price so drug companies offer pbms bulk rebates on the price of insulin to sweeten the deal but instead of these negotiations

Driving prices down pbms and pharmaceutical companies end up wildly inflating insulin list prices because higher prices mean bigger profits for the pbms and insurance companies someone ends up pocketing the cash rebates but a lack of transparency in the system means it’s nearly impossible to track down where those savings end up and its patients the one party

Who has no negotiating power that ends up paying for this scheme in the u.s. there are only three companies that make insulin eli lilly novo nordisk and sanofi and they make up 90% of the global insulin market eli lilly agreed to let us into their main production facility the first time that allowed an outside camera crew in each person needs one of these gowns

This looks like a body bag the first place we’re going to go is isolation area this is where we take the fermentation broth from another site bring it down and starts separating it takes over two months to make a vial of insulin it’s a complicated manufacturing process that lilly has invested one point two billion dollars in since 2012 so this this is where we

Make insulin there’s three main manufacturing plants that are required for every gram of insulin every vial of insulin that comes out first is the insulin crystals but if you can think of this just a mound i mean this is millions of dollars with your honor in one of these ten what is that this you know tens of millions of dollars every week of insulin yes being

Pumped through here in process that’s correct that’s a lot eli lilly says their net price for a box of pens which includes manufacturing labor research and development regulatory fees promotional expenses insulin donations and profits is only a hundred and twenty two dollars a box the list price is five hundred and thirty dollars it’s that difference between a

List and net price that’s causing problems what is one of these costs now one of those guys you know i’m not able to tell you that that how much does it cost um the diabetic comes with that cost me you tell me yeah well i have an insurance if i don’t like just the list price of something like this is emma i think when you go and talk to make me senators don’t talk

About the price ranges prices i mean it’s like what a couple hundred dollars right no i get it depends on what period are paying from an insurance point of view in april mike mason eli lilly’s senior vice president of insulins and connected care talked insulin prices before congress for starters we have not increased the list price or insulin since 2017 but we

Recognize that the issue is more complex but mason was only willing to talk to us off-camera he says there’s not one cause for the high price or one solution like other insulin manufacturers lily has various programs to help uninsured patients in may the company introduced a generic version of their own insulin and half off the ordinary list price george huntley

Is the former chairman of the board at the american diabetes association he now sits on the national diabetes volunteer leadership council how do we fix this the way you fix it is to break the system back tear it apart best-case make the whole system illegal and force the discounts to be upfront then it can be easily passed through and work like everything else

In the in the in the medical world so why doesn’t a company like lilly just back out of this old arrangement you know the manufacturer the pbm the insurance company they’re all on this merry-go-round nobody can get off unless the whole thing stops at once and they all get off together and no singleplayer has the power to do that is what we did illegal no such

A bad liar lauren and i both bought cheap insulin in mexico we might have been breaking the law according to the fda in most circumstances it’s illegal for individuals to import drugs into the u.s. for personal use the customs will generally allow americans to bring a 90-day supply of medication back home good haul or not yeah pretty good did you come back and

Do this again i would come back again you would come back yeah okay you

Transcribed from video
Inside The Factory Where Most Of The World’s Insulin Is Made By VICE News