Rising Prices Lead to Deadly Insulin Rationing: How Much to Subsidize Low-Income Diabetics?

The death panels are the corporations who are pricing diabetics into dangerously rationing their insulin:

As insulin prices rise, patients go without. One study in the Journal of the American Medical Association, cited by the Guardian, found that around one in four patients with diabetes say they ration the medicine due to cost, but pharmaceutical companies show little interest in slashing prices back down to humane levels. Meanwhile, rationing can have dangerous consequences for patients who depend on insulin to survive. CNN reported in January that a teenager with diabetes had reduced his insulin intake by a third to try to save his underemployed parents hundreds of dollars every month. His parents only discovered the deception when a doctor informed them that the boy’s blood sugar was dangerously high. Others aren’t so fortunate. As I previously wrote for Intelligencer, Shane Boyle died in 2017 after he began rationing his insulin in order to cover the costs of his mother’s hospice care [Sarah Jones, “Another Person Has Died After Rationing Insulin,” New York Magazine: Intelligencer, 2019.07.15].

Minnesota legislators are trying to save lives with a little government intrusion into this failure of the market:

Minnesota GOP leaders are pushing a proposal that calls on drug makers to provide free insulin supplies for up to a year for those who meet income requirements. DFL lawmakers want to allow emergency supplies without a waiting period to determine eligibility [“Group Fears More Insulin Rationing if Minnesota Lawmakers Don’t Act,” KELO Radio, 2019.10.07].

If you’re wondering what it would cost to provide a year’s supply of insulin on the public tab here in South Dakota, let’s do some quick and dirty math:

• The CDC Diabetes State Burden Kit indicates that, in 2013, Medicaid covered medical costs for about 8,600 South Dakotans with diabetes.
• This GoodRx article gives the cost per unit of several brands of insulin. Let’s take a loose average of 20 cents per unit.
• According to the same article, a person my size (about 70 kilograms) with type 2 diabetes needs 40 units of insulin a day.
• 20 cents × 40 units × 365 days = $2,920 a year per diabetic.
• $2,920 × 8,600 patients ≈ $25.1 million.

According to the CDC, each death attributable to diabetes costs our economy $180,000 in work and household productivity (I’m not even factoring in the sadness of the loss of a single fellow human being—this post is pure green eyeshade.) If South Dakota were to spend $25.1 million on insulin for 8,600 low-income diabetics, and if that taxpayer-funded insulin saved 140 diabetics from dying from lack of insulin, the program would pay for itself solely in preserved productivity. If you want to start factoring savings from non-fatal interventions—diabetics who might not have otherwise died without a steady supply of insulin but would still be sicker, miss more work, and require more costly medical interventions—$25.1 million for South Dakotans who can’t afford insulin to get what they need to manage their condition looks like ever smaller potatoes.

We could cover a two-year stock of insulin for low-income South Dakotans with the money donors are pouring into a sports complex here in Aberdeen. We could fund a state insulin stash sustainably with the tax rebates the Governor’s Office of Economic Development hands out to big corporations each year… with arguably the same job creation/preservation impact.

But, you know, priorities….