EDITORIAL: Insulin price debate highlights health care's ills [The Columbian, Vancouver, Wash.]

Feb. 23—A debate in the Legislature about the cost of insulin goes well beyond the scope of the lifesaving drug. It speaks to inefficiencies in American health care and the need for vast changes.

That is beyond the purview of state lawmakers as they consider Senate Bill 5546, which recently passed the Senate by a 48-1 vote (all senators from Clark County voted in favor). The bill, which now is in the House, would set a co-pay cap of $35 for a 30-day supply of insulin for patients on state-regulated insurance plans. Currently, a vial typically costs more than $200, and prices have increased an average of more than 15 percent a year since 2012.

The Washington bill would not apply to private health insurance, which covers more than half the state's residents.

There are good reasons for supporting the legislation. With sharp increases in cost, various studies have shown that about one-quarter of Americans who rely on insulin have taken to rationing their supplies.

Such a practice is dangerous and can lead to blindness, kidney failure or death. For diabetics, insulin is a lifeline that helps the body process sugars and carbohydrates in food. A 2019 report from the state Department of Health lists diabetes as the seventh-leading cause of death in Washington.

Currently, 18 states have laws capping insulin co-pay costs, and President Joe Biden's Build Back Better legislation also would limit co-pays at $35 per 30-day supply for certain Medicare patients. That bill has passed the U.S. House of Representatives and is under negotiation in the Senate.

A 2017 paper published in Lancet, a British medical journal, found that most patients with private insurance are prescribed newer and costlier versions of insulin. Kasia Lipska, a Yale University endocrinologist, told Vox.com: "Are they 20 times better? I'm not sure." Yet they often cost 20 times as much as previous iterations of the drug.

All of this violates the mission of insulin's founders. When the drug was discovered in 1923, the co-inventors sold the patent to the University of Toronto for $1, believing that everybody who needed insulin should be able to afford it.

The modern pharmaceutical system is not so magnanimous. A study last year by the University of Southern California found that middlemen in the insulin supply chain now take 53 percent of the net proceeds from sales — up from 30 percent in 2014.

Insulin is not the only medication that has seen exorbitant price increases in recent years. But because it is a life-or-death drug for many patients and because it is so widely used, the situation has brought attention to the United States' warped health care system.

According to WebMD.com, consumer prices for hundreds of prescription drugs increased 5 percent on Jan. 1, an increase that has been typical in recent years. As Rep. Jaime Herrera Beutler, R-Battle Ground, has noted: "Southwest Washington seniors and other patients pay way too much for prescription drugs and it's not uncommon for them to skip doses, cut pills in half or forego filling prescriptions altogether."

A 2021 report from Rand Corporation found that brand-name medications in the U.S. cost 3.44 times as much as in comparison nations. For a country that has the world's largest economy, that should be unacceptable.

Washington lawmakers can help ease the situation by limiting insulin costs for residents on state-sponsored health insurance, but that will be only a drop in the ocean of a system that is swamping consumers.

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