Travis Paulson pulled out two vials of insulin. Both were made by the same company but came in slightly different packaging. The biggest difference between the two vials was the price tag — Paulson bought one in Canada for $27 and the other he bought in the United States for $350.
Fortunately for Paulson, he can go to Canada and purchase this lifesaving medicine at a cheaper price. Others are not so fortunate and might decide to ration their insulin, putting their own lives at risk.
A bill U.S. Sen. Tina Smith, D-Minn., introduced last month aims to fix that and help those who need insulin now and can’t afford to pay for it.
“There are lots of solutions that we need to pursue in order to bring down the cost of insulin, and this emergency insulin bill is an important part of what we need to be doing to help people who are struggling to afford insulin as prices go up and up and up,” Smith said.
The Emergency Access to Insulin Act, which was co-sponsored by Sen. Kevin Cramer, R-N.D., sets up a grant program that states and tribes can apply for. The grant program will give federal money to the state or tribe that sets up its own program to allow its residents or members to receive emergency access to insulin.
The bill also sets up a fee for companies that overcharge for insulin. The funds created from the fee will sustain the grant program. Smith said companies will be charged even more if they raise the price on insulin to help offset fees.
“It's based on how much they raise the price of insulin, so they can’t just make up the difference by raising the price of insulin,” she said.
Once a state or tribe receives funds from the federal government and a program is set up, a person can submit an application to receive free insulin. As soon as the application is submitted the person would receive an insulin card within five business days for a week’s supply. The person could take that card to a participating pharmacy to get their supply.
“What we want is if you are in an emergency, you don’t have time to go through the eligibility process,” Smith said.
Once a person’s application is approved they would receive a three-month supply.
“Then during that three-month supply period, they would have somebody to work with them to figure out what’s the best insurance that they could use for the long term,” Smith said.
If the bill is made into law, Smith said she’s uncertain how long it would be before states or tribes, and even insulin users, could start benefiting from the grant program.
“But I would certainly do everything that I could to make it be as fast as possible,” she said.
Paulson, who uses insulin himself and has been an advocate for this issue, said the bill is a step in the right direction.
“Ideally insulin should be a human right,” Paulson said. “It’s not a new issue. It’s something that’s been building for years.”
Paulson goes to Canada every three months to buy insulin. Sometimes he’ll take caravans of people with him, some of whom didn’t know Canada was an option, he said.
“When Nicole (Smith-Holt) went with us she broke down crying and literally said, ‘If I had known I could have done this, I would’ve crawled here,’” Paulson said.
Smith-Holt’s son Alec Smith died at the age of 26 while rationing his insulin supply after he lost his health insurance. Alec Smith’s story is one of many stories that inspired Tina Smith to take up this issue.
“What happened to him, I just thought this is just ridiculous,” Smith said. “So, I began working at the federal level to come up with a plan.”
When asked whether she thought her bill would become a law, Smith said she feels optimistic.
“But it’s going to be a push to get this bill down because these big drug companies have a lot of power, not only in the state houses but in Congress and they’re not supporting this bill,” Smith said. “So that means we have to overcome that opposition on their side. But I’m hell bent to work on this and do everything I can to get it passed.”
Only three companies manufacture insulin in the United States — Eli Lilly, Sanofi and Novo Nordisk. These three companies hold the patents to the medicine and, according to Smith and Paulson, they are constantly changing the formula ever so slightly to extend the patent, which prevents competition from flooding the market and lowering the price of insulin.
“For instance, they’ll take a little thing like a digestive enzyme and they’ll add a little bit of that to the bottle. It doesn’t do anything for your diabetes or affect your blood sugar, but it’s going to allow them to hang onto a patent,” Paulson said. “And these patents are going 20 to 30 years and they’re not expiring and they keep it that way on purpose because there’s no regulation on their industry.”
Smith said she does have a bill that was passed out of committee in the Senate that would no longer allow companies to make little changes that don’t have an impact on the efficacy or safety of a drug just to keep their patents longer.
Smith said she is also recently introduced the Affordable Insulin Approvals Now Act — with bipartisan support from Cramer and Sen. Dick Durbin, D-Ill. — which would help smooth the regulatory path and remove some of the hurdles for other companies to move into the market with biosimilars, or generic versions, of insulin.
Those who want to help this cause should make their voices heard, Smith said.
“The voices of people who understand how important this is can be more powerful than the voices of those big drug companies, but only if we all speak out,” Smith said. “Those big drug companies are making a ton of money because their voices are stronger in Washington right now, and we have to change that.”