Insulin is not affordable for many Americans. That could be a violation of human rights, the report says.

The cost of insulin has affected congressional hearings and calls for change in diabetics and advocates of patients. However, for many Americans who rely on the medication, it remains out of reach – and that contributes to human rights abuses, according to a new report by Human Rights Watch, an organization better known for its research. of war crimes and atrocities such as genocide.

The issue is specific to the United States, given the nation’s lack of controls on drug prices and complex insurance systems that can leave people under- or uninsured, according to the watchdog group.

Other nations pay much less for life-saving medication, with a congressional report finding that Americans pay about three times the cost of a dose of insulin compared to 11 other developed countries.

The three major insulin companies that control the insulin market – Eli Lilly, Novo Nordisk and Sanofi – have significantly increased the prices of their analogue insulins since the introduction of their products more than two decades ago. Analogs, which are synthetic versions of insulin, control blood sugar better than so-called human insulin, and now represent more than 90% of the market, according to the Central Right American Action Forum.

Eli Lilly’s list price for Humalog, its analogue insulin product, jumped 680% to $ 275 a bottle in 2018 from its introduction in 1996, Human Rights Watch said.

The cost of Novo Nordisk’s Novolog has jumped by about 400% to about $ 289 per bottle since it was introduced in 2000, while the list price of Sanofi 420% has increased to $ 276 per vial since it came on the market, also in 2000, said the report. All numbers are adjusted for inflation.

“Almost every insulin-dependent person interviewed by Human Rights Watch said that they had assessed insulin by analogy because of out-of-pocket costs, and took it in ways not recommended by their doctor to stretch their supply,” “said the report.

The result can be illness and even death, as in the case of Alec Smith, who had trouble paying for insulin after he was older than his mother’s health insurance plan.

The 26-year-old could not afford the out-of-pocket costs of his insulin, produced by Eli Lilly, and died of diabetic ketoacidosis, a complication arising from diabetes that can be treated with insulin. He died a month after leaving his mother’s insurance plan.

Insulin manufacturers “know that people are dying, that people can’t afford it,” Sa’Ra Skipper, a diabetic, told Human Rights Watch. Her sister, also a diabetic, was admitted to hospital for diabetic ketoacidosis after splitting her insulin with her due to cost.

Eli Lilly, Novo Nordisk and Sanofi did not immediately return requests for comment.

“A privilege that many cannot afford”

To be sure, insulin is not the only drug that has experienced sharp price increases, and Human Rights Watch noted that access to life-saving drugs is often a “privilege that many cannot afford.”

But the people most affected by high drug prices are “socially and economically marginalized, and reinforce existing forms of structural discrimination.”


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Lower limb amputations, for example, are at risk of diabetes, but black adults are more than twice as likely to undergo a diabetes-related amputation as white adults, the report said. Hispanic and black diabetics are also more likely to ration insulin than white patients, it added.

The U.S. does not regulate drug prices, which has allowed pharmaceutical companies to set “very high prices,” the report said. But it said some of the blame sits with it pharmacy benefit managers (PBM) – powerful healthcare intermediaries who manage which medicines are covered by insurance companies.

Drug companies compete to be included in the forms of PBMs, as a list of covered drugs, by offering so-called “discounts”, or cash payments offered by drugmakers to the PBMs. But pharmaceutical companies are then raising their list prices higher to ensure they do not sacrifice the bottom line, the report found.

“View of international and international law”

So how does this contribute to human rights abuses? Human Rights Watch says insulin is so expensive in the US that it undermines “equal and affordable access” [to essential medicines]a cornerstone of human health. “

The impact on disadvantaged groups is “in violation of domestic and international law prohibiting discrimination,” he added.

Several human rights agreements signed or ratified by the US are also violated by the high cost of insulin, the group said. It specified the U.S. government for its “persistent failure” to establish policies that would limit the skyrocketing cost of insulin. But it has also become for drugmakers.

“Companies also have a responsibility under the United Nations Guidelines on Corporate and Human Rights to respect human rights and ensure that their practices do not cause or contribute to human rights abuses,” Human Rights Watch said.

But the biggest step could be taken by lawmakers, the group noted: “Congress needs to consider legislation to provide insulin to all insulin-dependent individuals in the country for free.”


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