Waiting for affordable medications is a matter of life and death

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OPINION – “Sorry doc, but I just can’t afford my insulin.”

As a practicing physician for over 30 years, I have heard those words too many times from my patients. Young and old, type 1 or type 2 diabetes- it doesn’t matter. The cost of insulin has skyrocketed over the last few decades, and people feel the crunch in their pockets, and in their worsening health.

The list price of insulin – discovered over 100 years ago – has tripled in recent years, and people have been hurt. I’ve seen patients ration their insulin when they can’t reliably afford it.

With the idea of a generic, biosimilar insulin coming to CA through the CalRx initiative, I really felt hope for the first time in a long time.

However, California’s effort to produce a low-cost, generic insulin has been significantly delayed, with no firm timeline in sight for people with diabetes getting this insulin into their hands. Its program also currently includes just one form of long-acting insulin, glargine, with no foreseeable prospect for a more affordable rapid-acting mealtime insulin.

All people with type 1 diabetes and many with type 2 must inject rapid-acting insulin multiple times per day to manage their diabetes. Only having one option of insulin, a biosimilar of long-acting insulin, is insufficient to meet the affordability and treatment needs of people with diabetes.

Furthermore, CalRx is just now starting clinical trials for this glargine insulin, which will inevitably extend the delay to market, pushing back the timeline for real, tangible savings for patients.

This reality hits home for people who need help affording their insulin now. The reality is that people living with diabetes suffer in the meantime. People with diabetes are rationing their insulin, making impossible financial choices, and dealing with dangerous health consequences as a result.

When someone rations their insulin or even goes a couple of days without taking their insulin, they can face life-threatening complications, such as diabetic ketoacidosis (DKA), where one’s blood turns acidic from lack of insulin and they can also face cerebral edema, seizures, and even death.

Over the long-term, taking less insulin than you need to be healthy can result in permanent and debilitating complications such as blindness, lower-limb amputations, heart attack, stroke, kidney failure, and result in shorter life-expectancy. I have seen this time and again in my patients, and it is cruel and unnecessary.

We need multiple approaches to this affordability crisis. We cannot afford to rely on just one solution, CalRx insulin, especially when progress has been so slow.

The California Legislature has now passed Senator Weiner’s CA Senate Bill 40, which would cap cost-sharing for insulin on California health plans to $35 per month, and is currently awaiting the Governor’s action. By signing SB 40, Governor Newsom would bring tangible savings to people now, instead of years down the line.

Across the country, 26 states plus Washington, D.C. have already limited cost sharing for insulin in state-regulated commercial health insurance plans and it’s time for California to do the same.

In my experience, waiting for affordable medications is a matter of life and death. Each day that goes by without state-level action on affordable insulin is a day that someone struggles unnecessarily. I urge us to do better by people in California living with diabetes and I hope our Governor can agree that Senate Bill 40 can help us in the here and now.

Dr. Francisco Prieto is a family physician in Sacramento, California and a member of the American Diabetes Association (ADA) National Advocacy Committee.