I woke up wanting to discuss “boots on the ground” diabetes. BUT, we are in the House now, so I have to notify you about that instead. In retrospect…WTF was that!!!
When it’s all said and done, diabetics had to do the following things in order to STOP companies from breaking the law (this is a lot):
1.) Federal regulators bring a case and settle over illegal behavior in the market (Price gouging);
2.) State legislation for copay caps (although they still don’t follow the law in my state)
3.) Federal legislation
4.) Allow negotiations/caps for insulin prices in Medicare
That took YEARS of peoples lives. Why is everything SO difficult for us? They still aren’t following state law in MY state…not to the letter. They follow it however they feel like it (which involves over charging what the law allows, but who’s got the time to keep dealing with them? My goodness).
The Medicare Part D limit to $35/insulin/month went into effect on January 1, 2023.
The Medicare Part B limit (for pump users except Omnipod) took effect on July 1, 2023
I won’t quote the facts because this post is not tagged so, but for those who care for facts try KFF: www.kff.org/medicare/the-facts-about-the-35-insulin-copay-cap-in-medicare/ The reference references certain political leaders so may not be appropriate for all audiences; I’d rate it PPP.
When the Medicare option was introduced it did not include anyone else, even though it was an opt-in option. When the Medicare law was introduced it did include all insurance; not just Medicare, every insurance policy. When it passed that had been stripped out and it was just us doddering old fools. Nice though.
If I were a democrat (I’m not) I would not be voting for this hypocrisy, but that’s just me. I’m being something of a hypocrite here because I have always maintained (since I was about 15) that hypocrisy is the saving grace of humanity. This is a prime example.
The ability for Medicare to negotiate prices was all part of this. Recognize that the clock doesn’t start when the law is passed. We might have been working on that for 5 years prior to it passing.
I get frusterated because Medicare ALWAYS gets handled first. They always say, “this is a 1st step to handling private insurance.” Then, that day never comes. This time, it came. They are gonna MAKE companies follow the law and prohibit price gouging. That’s a landmark effort because the government hasn’t done that in 40 years. That’s my entire lifetime. We were paying on average, 20K per year, every year of my life. Sometimes that was 50% of my salary when I was young. That’s a mortgage payment. That’s money that could have paid for college for most people.
But now, sometimes I think we might be the only community left NOT paying that much money, when it’s all said and done.
It seems a universal fact that when people get healthcare for free they become very attached to it. Now when I say, “for free”, I mean we don’t pay primarily at point-of-delivery, we pay in advance at a rate of 2.9% of our income (no limit, unlike “social security” which runs at 13% but maxes out).
It’s no different anywhere else; politicians who have tried to cancel established compulsory pay-in-advance healthcare hit a brick wall.
There’s a real strategy here; divide and conquer. By splitting off the Medicare insulin users from the private insurance ones the politicians who were a part of that split diabetics into those on Medicare and those not.
Yet I’m preaching to the choir:
Sometimes I feel really evil when I just pay $105 for a 3 month supply of insulin for my pump. I realize most IDDs pay $210, $105 for the bolus, $105 for the basal, and, while everyone in the line is very very quiet about how much they pay, I know that many of those behind me are paying much much more for some amazing cocktail soup of medicine.
And those who are simply not in line get nothing.
It does seem to be coming to pass, very, very slowly. I find it difficult to believe how my fellow capitalists argue so effectively against competition.
If they were rocks they would argue against gravity and I have no doubt they would float.
What should I do with these nordic economists coming to town, Bowler? Do I trust them? Can I joke around with them? Can I call them “Reds,” as a joke? From what I’ve read, they really hate being called communists.
They don’t like small business carrying the “weight” of healthcare. They are bringing lefties - antitrust guys - campaign guys. I read some of what they wrote, but I wasn’t moved by it. They read what I wrote. They are gonna respond to it in public speaking, I imagine. No idea what they will say.
I’ve been promised there won’t be any partisanism. But there will be campaign guys there. What do you supposed they want? They are bringing me a Nordic rapper. 50/50 chance Senator Klobuchar shows up.
The weight of US healthcare is carried by those who don’t have it. The poor who can’t afford it; small businesses do not have to provide healthcare even if they have employees rather than “contractors” (the IRS gets somewhat shirty about that trick, but it still happens; no one tells, no one can afford to.) The gig workers. Or are they talking about people like me?
The single biggest boost for small US employers and the even smaller US employees is healthcare funded up-front through the Federal income tax (which is, in fact, a sales tax, not an income tax; a tax on every hour’s labour) and Federal business tax; a true income tax because costs can be deducted.
If it’s so expensive (and I agree it is) take that cost away from business small and large; their profits will automatically go up, so they will automatically pay more tax. Take it out of the money the self employed have to pay; much larger than any small business, our profits go up and we pay more tax. Take it out of the costs of employees who are not covered; no need for premium tax credits (saving the government money quite directly) no need for itemisation, no need for HSAs. All these little costs saved soon add up.
So far as I’ve ever been able to work out that $35 insulin price “cap” is effected by Medicare covering the difference between the non-negotiated cost and the $35. Think about that and reflect on how easy it is to save Medicare all that money.
It is the job of our government to enable capitalism and it does that by providing infrastructure that is shared by all. The government has been paying for the interstates for years, at enormous cost, why is that is so bad? The government even pays for schools! Why? Private roads, private schools, we already have private prisons, but this isn’t capitalism. True capitalists benefit enormously from public schools, public roads and, indeed, public prisons. So what’s the problem with healthcare?
So, We think that insulin is not on the negotiated list. I think it was a cap, not a negotiated price.
I asked my mole directly. He says they want to talk about, “civility,” in biz practices. & that they are bringing a russian. They got the wrong girl for that. I’m WAY past civility. I’ll meake sure to wear high heeled shoes so I’m as tall as their Russian.
Found it. They talk about us on page 191.
I’m gonna go over this with a fine toothed comb.
The Finns want to persue biz relationships with Minnesota. The Danes are tagging along. Maybe they want me to stop being mean to their precious insulin manufacturers. Novo better bring more Russians and dudes from Detroit if they hope to achieve that. ■■■■■■■ Novo. They are always trying to secretly lobby diabetics into liking them. They are always lurking. https://www.youtube.com/watch?v=L6A_LZF8z7A
See. There’s a tenative truce between us and the insulin manufacturers while we fight with the PBMs because PBMs are such large dragons. It doesn’t mean we like insulin manufacturers. In practical real world situations, pharma funds attacks on the PBMs because it keeps everybody off their ass…a bit…for now. I think Medtronic divested Minimed for that reason.
The real political scam here is that both parties in the 80s allowed insurance companies to classify Insulin as a tier 3 prescription. This was so insurance companies could gouge captive insulin customers that have no choice. The developer of insulin (not a drug but a simple hormone) did not file a patent to keep insulin affordable (which it was until 80s). This is a monopolistic scam that politicians and insurance companies are pulling off.
Make insulin tier 1 or 2, like it was, and like other common prescriptions. That would make it right. Why are insurance companies allowed by our government to discriminate against diabetics? We have no choice, that’s why they prey on us.
Different insurance companies classify different insulins as Tier 1 or Tier 2 and others are excluded. This is likely to get more common because of the price cap; the insurers can do deals with manufacturers (via PBMs) to get insulin priced lower but they do that by guaranteeing purchases. To maximize the purchases they need to minimize variety.
Before 2025 I was told by my ACA insurance company that I would get onto a lower tier if I used Fiasp. Later that year I went on to Medicare and Fiasp was not covered (at all, IRC) so I went to Lyumjev. Then the insurer changed coverage. I swapped to another insurer (easier on Medicare than the ACA) and Lyumjev was a higher Tier (Tier 3, IRC) but was covered at the $35 copay. If I’d swapped back to Fiasp I think I could have got it on Tier 1 or Tier 2 (at less than $35/month.)
For me it’s about to happen again with my Part D policy costs going up from $1320 in 2026 to about $2200 next year and my “deductible” going up from $130 to $150 in 2027; that means I really need to either get a new policy (with a lower policy cost) or swap my insulin to one on Tier 1 or 2 ($0 payment in 2027).
This 2022 paper starts off with a world-wide summary of insulin costs then deep-dives into the weird US situation. It contains some observations about the effect of “cost-sharing” (i.e. where the total cost of the insurance is moved between the policy cost and the per-prescription cost):
That paper is pretty much a todo list for all the changes that need to happen in the US; @mohe0001 has talked about action on some, maybe many, of these before. I’ve talked about the false improvement offered by the “analog” insulins; chemically similar to the accepted formula of human insulin (humlin/novolin) but with very small differences that affect rate of entry into our blood stream.
I remember from my youth that I was on porcine regular insulin. I would describe it as “hard”, I tended to suffer low BG. After the first recombinant DNA GMOs were engineered to produce “human” insulin I went on to that and found the result much “softer”; it was more gradual and more manageable particularly when combined with the long acting “Ultratard” insulin Novo made. The latter was a very long acting insulin, an “Ultralente”; I found it to be the best long acting I’ve ever used.
These days I only use “long acting” insulin like Lantus as a backup for pump failures, but Novolin N (technically intermediate) would be fine. I was obliged to stop using ultralente and go on to Lantus which, for me, has an intermediate action time; a big step backwards. This was because the patent protection allowed higher prices for the analog insulin. With any luck those days are coming to an end (see the discussion towards the end of the paper) and physicians will realize that there are a lot more possibilities already out there; porcine, bovine, different NPH formulations.
To our benefit, neither party wants to appear to support these guys any longer. They will, but there are limits on what they can do.
It’s super tough to frame what is happening. Minnesota is starting to punch at the health insurers. (Yesterday: UCare's role in Minnesota Medicaid fraud: What the insurer knew and when | FOX 9 Minneapolis-St. Paul) That’s a big deal because it is a bipartisan effort (it’s also a working relationship between the state and the federal gov). It’s also a big deal because one of the largest, most problematic insurers has headquarters here (United Health Group).
So, historically, you would see MY state punch at the insulin manufactures, but NOT the insurers. They would take tiny little steps forward against the insurers, someone would immeditley catch wind of it, and the state would get their pants sued off. That’s part of why the states asked the feds for help.
There’s a power impablance between the state and UHG. UHG is MUCH more powerful and wealthy. They use that power to corrupt democratic processes, market competition, legal processes, and civil rights of citizens. That’s what monopolies do and that’s why they are bad.
That’s also why the insulin manufacturers are sending people to do PR in my community. They don’t want to get pulled into this mess unfolding between gov and insurers. Medtronic probably successfully sidestepped it, but Epic is likley to get pulled in because the feds are very concerned about monopoly power in tech AND healthcare. Epic is a better target than Medtronic. They like that one more because of the overlapping domains. They are aware of, and are watching, anticompetitive conduct by MDT like hawks. That’s enough to keep MDT in line, to some degree.
This is an older thread from FUD about Minnesota and insulin price lawsuits. It’s quite informative in a number of ways:
This is the case (from the first link)
State of Minnesota v. Sanofi-Aventis U.S. LLC, et al, U.S. District Court, District of New Jersey, No. 18-cv-14999
The Google AI reports thus (I have not verified this, I include the AI’s links):
Key Developments
Dismissal of Major Claims: In March 2021, U.S. District Judge Brian R. Martinotti dismissed 13 out of 16 claims—including all federal RICO counts and specific state false advertising claims—with prejudice. [1]
Remaining Claims & Settlements: Surviving claims focused on consumer fraud, deceptive trade practices, and unjust enrichment, which led to subsequent ongoing litigation and structured settlement discussions involving specific defendants like Novo Nordisk. [1, 2, 3]
The thing is - in my my - insulin costs between $8-10/vial to manufacture and distribute (and granted my numbers are old - circa about 2016-17). ANd that BS about needing so much profit in order to develop med meds is just that BS. Go to a pharma website, click on “for investors”, there you will see their fnancials. Pharma pays more in admin and/or marketing than they do for R & D. In the US, most R&D is (was) funded by the NIH - public $$ and the labor by NOH scientists and/or post-doc university students/faculty.
Another point, if we, people with T1D (and other folks) can afford what we need in order to live and thrive, we can continue to work, support our families, support the natinal and local economies.
Yeah, thanks John. It was c. 2018 when Lori Swanson (The MN AG) filed suit against them. That’s when they filed. She left office shortly after that. I went and saw her in her office that day. She’s a very petite woman and I felt really scared her. I asked her if there was any risk to her, personally, from doing something like this. She said no.
Here’s a pic of us. Her staffers brought me upstairs because I danced on the street to celebrate the filing. My dancing was just THAT good. I only dance if they do something VERY worthwhile.
That case dragged on until we got a settlement thru Keith Ellison. Maybe it took 5 years to settle. That settlement included a 5 year temporary cap on what they could charge (to the best of my understanding).
In the end, it didn’t amount to much, but it bought us time, as a state, to implement copay caps in state law. That’s really what fixed the problem in a permanent way. That was SF 2744 from a year or two ago.
That fixed me up good because it impacted my policy.
But, again, those large employer plans were left out.
Insulin Act will cover those plans.
Then, the pesky problem of insulin prices in MN are fixed, across the board.
It’s easily been ten years of moving legislation and how many different laws enacted to fix one single problem in healthcare and make companies follow other laws that already existed, but were not enforced or well undertood. That’s pretty bad. They still aren’t 100% following state law.
I will definitley dance for the Nordic economists when they come to town. I found pleather pants today in preparation. My legs, in a pair of good heels, can move policy all on their own.
They will bring with them, the best that Finnish rap has to offer. https://www.youtube.com/watch?v=iR6UvuE37yY Because I believe that what I wrote was better and more impactful than what their University guys wrote, Midwestern culture demands that do something humiliating like dance with abandon. Gotta be self deprecating with Finns & Danes. Don’t think I don’t work for this ■■■■, John.
What should I wear?!?!?!?!?!
There’s gonna be some culture gap. https://www.youtube.com/watch?v=qElYrlTpalU Is he burying a fish in this video? Is that a Russian sub? There’s no subtitles for Finnish. I’m so fucked.
@pugmommy, the feds have been trying unravel some of their scammy ways by going thru every drug patent they have, identifying all the bogus ones, and throwing them out.
It was a lot of work and they might still be at it. They call them, “patent thickets,” sometimes, because they have weed through them little by little and it’s really hard and time consuming work that eats up a lot of gov resources.
I would like for this to someday be true. We are getting closer. I might almost be there. I don’t want to celebrate too much or wave it in anybody’s face, though, because I know that not every state has completed all this work and there’s a lot of people left behind still. I think we can get there eventually. It’s coming within reach.
Maybe he wants to extend a formal apology for conducting illegal market behavior to the tune of 20K per year? From me, alone, that would amount to 35 years x $20,000? How much is that? 700K? I think they need to bring more than one ambassador for that. They are bringing 1.5 ambassadors/diplomats. Not enough.
I ought to leap across a table and just start socking them in the face.
It’s a good thing I didn’t know any diabetics at a younger age because if someone would have told me I would spend half or 3/4 million dollars on diabetes, and I thought I could save that money by gunning someone down, I would have considered it. How are any of us even still alive? How did we even make it thru those bad years where a vial of insulin was $300. It’s a miracle.
If I’ve understood what you said before correctly you’re going to meet some Scandinavians from Novo who are here to defend their pricing.
I believe Novo Nordisk have a reasonable argument about their pricing. I would summarize it in a way they would not like and most likely dispute, “It’s our fault not theirs.” That quote was in the first person; my person.
Should I make a thread with that question, or will I get in trouble? You guys JUST gotta trust me that this question has EVERYTHING to do with diabetes.
I think I got the Danes and the Swedes covered. But the FInns…there’s no google translate for Finnish. I don’t want to ■■■■ off the Finns because that is one country where I might apply for diabetic asylum if this whole American healthcare fiasco goes tits up.
P.S. The doctors are behaving like a bunch of entitled, bossy ■■■■■…as always. I bitched at them today. Those doctors will never be any help to us. They are impossible and they will never be ready when the ■■■■ goes down. Never. https://www.youtube.com/watch?v=tUApO77uUUk The ■■■■ is already going down. They are a complete waste of my time, except for the independent ones.
There’s too much culture gap for me to understand Finnish rap & politics. American rap is almost exclusivley about shooting people. As an American, I get confused if they suggest that shooting people is not the way. Rap is about American power dynamics and being poor. But Finland doesn’t have that same level of financial class or economic inequality. That’s why it might be a good place for me, as a diabetic.
In my imagination, everyone in Finland has diabetes and diabetics run happily through the snow and live in houses made of candy. I recognize that might not be totally true, but that is my visual metaphor for not living under the oppressive regime that is American healthcare system.
@jbowler I need to pull the quote. But somewhere you say that, you would charectorize this whole mess as, “our fault,” implying, it is the fault of the US government.
I would respond to that statement by saying that financial corruption, on the part of a nation-state (such as the United States) does not validate or excuse financial corruption on the part of an international corporate entity (such as Novo Nordisk or Eli Lilly).
The fact that I even need to state that, in a democratic society, is it itself kinda ridiculous.
That’s cross cultural. The Finns get that, even if Danish corporate special interests don’t. RIGHT? They might. But I’m not certain they do, which is in itself, kind weird and undemocratic, right? They don’t pay $300 for a bottle of insulin, right? The Finns are sending an Ambassador. Robert Strand is just sending himself on behalf of the Danes. I am sending myself on behalf of diabetics.
But I’m kinda already here. They are coming to visit & chit chat about such concerns.
50/50 chance Senator Klobuchar shows up.
I’ll meake sure to wear high heeled shoes so I’m as tall as their Russian.
