Insulin’s deadly cost

View this email in your browser.

Insulin’s deadly cost: Ultrahigh prices in the U.S. mean many diabetics can’t afford the medication they need to survive

It may seem shocking that in the world’s richest country, high cost can block sick patients from getting a drug that they need to survive. The situation is unique: Insulin in the U.S. costs on average some 800% more than in other developed economies. And yes, people die for lack of it, sometimes within days or even hours of missing their dose. No one knows how many; data suggests that in the U.S. it’s at least a few every day. Far more may suffer other ravages of diabetes—blindness, heart attacks, loss of limbs.

The plight of many U.S. diabetics, egregious in itself, is also a particularly stark example of a much larger phenomenon that touches virtually everyone in America: the extraordinarily high prices of prescription drugs, which in the U.S. typically cost multiples of prices elsewhere. Those prices are the end product of a health care ecosystem that has evolved over decades, filled with perverse incentives and populated with industry players—drugmakers, insurers, pharmacy benefit managers—that respond to the incentives they face. An increasingly urgent bipartisan effort in Washington aims to put new pressure on a system that has been driving prices higher for decades. But it’s a deeply complex challenge, and whether meaningful change will result is far from certain.

There’s no better way to understand this seemingly mysterious system, the machine that powers the world’s largest prescription drug market, than to examine the business of insulin. “When we’re first diagnosed, we get the scare tactics pretty early on,” says Gail deVore, who was diagnosed with Type 1 diabetes almost 50 years ago and is a vocal advocate for diabetics. “We’re told if you don’t take care of yourself you’re going to lose your eyesight or lose a kidney.” But she says that’s not what scares diabetics most. “In reality, the biggest fear that we have is not being able to afford insulin, which is the only thing that keeps us alive.”

$1 for first month!

Subscribe to Fortune for unlimited access to
global news, insights, and rankings.

*New subscribers only