How 'fake' Eli Lilly tweet brought spotlight on prohibitive insulin costs

“We are excited to announce insulin is free now,” said a tweet last week from what was ostensibly the Twitter handle of Eli Lilly and Co, a global pharma major that dominates the insulin market. The post seemed real as the account @EliLillyandCo sported Twitter’s blue check verified label. 

While what turned out to be fake news offered momentary relief to millions of diabetics, the Eli Lilly stock plunged, for insulin is among the company’s cash cows. The company had to hastily put out a tweet from its “real” Twitter account, @LillyPad, to clarify that a fake account had released a “misleading message”. In the real world, no pharmaceutical company is about to give away its money-spinner for free.

Lifesaver for diabetics

Insulin is a  protein needed to maintain stable blood sugar levels. But in patients who cannot naturally produce the protein, insulin injections are a lifesaver. Two main types of insulin are injected — human insulin and insulin analog. The former, synthetically made in a lab using E. coli bacteria, replicates the insulin naturally found in the body. 

Insulin analogs, which are actually a subgroup of human insulin, are genetically altered to change the way they act in the human body. These take effect more quickly than human insulin, but are often more expensive. These are the preferred mode of diabetes management in most countries.

Insulin and American politics

Twitter’s new owner Elon Musk faced much flak for his $8-a-month ‘blue tick’ subscription plan — which emboldened a fake account to pass off as Eli Lilly — but the entire incident brought the spotlight on the prohibitive pricing of insulin. There was a massive furore as more than 10 million Americans rely on insulin to control their sugar levels and the cost of this life-saving medicine runs into hundreds of dollars a month. Over the past decade, the price of insulin in the US has gone up to over $1,000 per month for those without health insurance.

Insulin prices have been a major bugbear in the US. Senator Bernie Sanders took this opportunity to tweet that Eli Lilly should apologise for increasing the price of insulin by over 1,200 per cent since 1996 to $275, while it costs less than $10 to manufacture. Further, he added, the inventors of insulin sold their patents in 1923 for $1 to save lives, not to make Eli Lilly’s CEO obscenely rich.

That’s the situation in a rich country like the US. In India, considered the Diabetes Capital of the World, insulin remains out of reach for a large chunk of the population. With 80 million diabetics — estimated to rise to 135 million by 2045 — India accounts for 17 per cent of the world’s diabetic population.   In India, the cost of newer versions have shot up by nearly 50 per cent in the last four years. 

What makes insulin so expensive

According to the WHO, the main barriers to access insulin, especially in poorer countries, is the fact that analog insulins have replaced much cheaper human insulins. These new insulins are 5-10 times more expensive than conventional insulins. For instance, in India, Huminsulin R cartridge (human) costs ₹300, while Humalog Lispro (analog) costs ₹690. Both contain 3 ml of 100 insulin units.

The cost of insulin for a Type 1 diabetic patient for a month in India is estimated at ₹10,000-12,000. Associated treatments could increase the monthly care cost to ₹20,000. 

Moreover, across the world, three companies — Eli Lilly, Novo Nordisk and Sanofi — control the insulin market, and these companies control 95 per cent of the market in low and medium income countries (LMICs). According to WHO estimates, three in four people who live with diabetes are in LMICs, but they are also the ones with the lowest access to insulin.

What can bring down the prices

While the analog version is far more expensive than human insulin, the latter is not the preferred option. One of the best hopes for more affordable insulin is to increase market competition and drive down prices with the introduction of so-called biosimilar drugs. Biosimilars are highly similar versions of the original biologic medications – and typically far less expensive. 

Medecins Sans Frontier has been pushing domestic drugmaker Biocon, which is leading the biosimilar insulin plan across the world, to apply for WHO prequalification so that it can start supplying to other LMICs without much regulatory hurdles.

Experts believe biosimilar insulins have revolutionised the management of type 2 diabetes mellitus and look promising from the economic point of view. The WHO’s move to encourage generic drug makers to enter the market is also a beginning, said experts.