TAMPA, Fla. (WFLA) — November is National Diabetes Month, a time to bring awareness to a disease that affects more than 34 million Americans of all ages and roughly 13 percent of adults in the United States. As the number of patients with diabetes increases, the cost of diabetes care has also risen, even beyond wage increases and rising inflation rates.
In Florida, the disease has increased its prevalence, more than doubling the population affected since 1995, according to state health data.
Population diagnosis
The Florida Diabetes Advisory Council’s 2021 report on diabetes in the state reported that a statewide study conducted in 2018 showed 12.6 percent of the state was diabetic.
In 1995, the council’s report said that number was 5.2 percent.
While Florida’s population continues to grow with residents across the United States moving to the Sunshine State, the overall percentage of diabetic residents has technically decreased. Now, the advisory council estimates that 2.4 million Floridians suffer from the disease.
That’s just over 11 percent of the state, based on 2020 Census population data.
The U.S. Centers for Disease Control and Prevention’s statistics on diabetes reported that as of 2018, 34.2 million Americans had diabetes. Another 88 million Americans were reported to have prediabetes. While that report showed new cases of diabetes among adults had decreased over 10 years, from 2008 to 2018, the number of cases among U.S. youth or adolescents was increasing “significantly.”
The 2021 report from Florida said the number of youths being diagnosed with diabetes, both type 1 and type 2, is rising. In the 2018-2019 year, the advisory council found that around 260,000 residents under the age of 20 had been diagnosed with diabetes.
The Florida Diabetes Alliance, a non-profit health advocate, believes the number of diabetic patients in the state is higher, equaling 13.1 percent of the adult population, or 2.35 million Floridians. The organization also reports that nearly 39 percent of Floridians, 5.8 million people, have prediabetes, or have higher blood sugar levels than normal, but are not yet diagnosed as diabetic.
Diabetes, explained
So, what is diabetes?
The CDC defines diabetes as a “chronic (long-lasting) health condition that affects how your body turns food into energy.” The agency says “If you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should.”
There are technically three types of diabetes mellitus, an endocrinological disease that prevents patients from either producing their own insulin, producing enough insulin, or producing the right type of insulin in their own body.
Insulin is a hormone produced in the pancreas that helps the body use glucose, or sugar, from the food you eat. When insulin is made and working correctly, it lets you metabolize the sugar in the carbohydrates, fats, and proteins in food and absorb it as energy for your cells.
Type 1 diabetes is believed to be caused by an autoimmune response by the body, which stops the pancreas from making insulin. Between five to 10 percent of patients with diabetes have type 1, and it’s typically diagnosed in children, teens, and young adults, making it well-known as juvenile diabetes.
Type 2 diabetes is when your body has trouble using the insulin you produce, and can’t normalize blood sugar levels on its own. Between 90 to 95 percent of diabetes patients have type 2 diabetes, and it typically presents itself in adults, though the CDC reports it is becoming more common among children, teens, and young adults.
Type 2 diabetes can be delayed or prevented with lifestyle changes to diet, exercise habits, and weight loss.
Gestational diabetes is the third type and develops in pregnant women who have not had diabetes, according to the CDC. The health agency says this type of diabetes usually goes away after your baby is born, but does increase the risk of type 2 diabetes later in life.
The inability to process the sugars from food can cause serious health issues over time, even causing vision loss or kidney disease. It’s a lifelong illness and is currently incurable.
Treating diabetes became easier in the early 1920s. A team of medical scientists at the University of Toronto discovered and purified insulin in 1922, according to the Science History Institute, leading to commercial production of the hormone for patient treatment.
According to a report from the National Institute of Health, insulin “remained affordable” for years, with a cost of $14 per vial in 1982, rising to $24 per vial in 1996 as insulin analogs were developed. The report from NIH found vial costs continued to rise, reaching $60 per vial in 2005.
In 2021, a single vial of insulin can cost hundreds, putting the monthly cost for multiple vials at $1,000 or more, depending on brand and dosage requirements. Patients with insurance pay less out of pocket, but this does not address the overall cost, nor does it assist patients who are uninsured.
Complicated conditions
Treating the disease itself is also complicated. Managing diabetes is a process that combines lifestyle changes with medical equipment and pharmaceutical drugs to stabilize blood sugar levels.
Supply costs differ from patient to patient. While that’s true for any disease, the number of factors that affect diabetes care can make managing the disease tricky, regardless of which type a patient is diagnosed with.
Of note, the CDC reported that type 2 diabetes diagnoses were becoming more frequent in minority populations, particularly among patients who were 10 to 19 years old.
The diagnosis rate for type 2 diabetes in that age group reportedly “remained stable among non-Hispanic whites and increased for all others, especially non-Hispanic Blacks,” according to the CDC.
The disease’s long-term effects are “overwhelming,” according to the Florida Diabetes Advisory Council. Their 2021 Legislative Report showed that diabetes has significant costs, both physically and financially. The report said that more than 20 percent of the country’s health care spending is for diabetes.
“It is estimated that in 2017 the total cost of diabetes in Florida was $25 billion, with $19.3 billion attributed to direct medical expenses for diagnosed and undiagnosed diabetes, prediabetes, and gestational diabetes, and $5.5 billion attributed to indirect costs,” according to the 2021 Legislative report. “People with diabetes have medical expenditures approximately 2.3 times higher than those who do not have diabetes.”
No matter what the treatment options are, a common cost for many diabetics is simply the insulin itself.
Financial factors
The treatment options for diabetes differ in cost and method depending on which type of diabetes a patient has, and sometimes even by what type of insulin they have to take.
According to a bipartisan report from the U.S. Senate, the price of insulin has increased dramatically over multiple years.
“List prices for short-acting and rapid-acting insulins have also risen dramatically” from 2013 to 2019, the report said. “For example, in 2017, Eli Lilly’s Humalog 50-50 Kwikpen had a WAC of $530.40 compared to $323.95 in 2013—representing an increase of approximately 64% in 4 years.”
The CDC estimates the annual cost for diabetes in the U.S. was about $327 billion in 2017.
So, what did those billions of dollars go toward, for an average diabetic patient?
Supply costs are different for each patient but typically revolve around purchasing insulin, pharmaceuticals, syringes, and other medical equipment used to deliver insulin into a patient’s body. The costs for insulin pump supplies, test strips, and a variety of insulins have all gone up year after year.
From the bipartisan Senate report authored by Sen. Chuck Grassley (R-Iowa) and Sen. Ron Wyden (D-Ore.), insulin’s net price growth was “significantly greater than the Consumer Price Index growth” tracked by insulin producers such as Eli Lilly and Sanofi. While the report found the average net price of Eli Lilly’s Humalog Kwikpen had decreased a few dollars from 2015 to 2018, the wholesale acquisition cost had nearly doubled.
The CDC reported the bulk of the $327 billion was paid in 2017 for direct medical costs, such as prescriptions and supplies. The health agency estimated $237 billion was spent nationally on medical costs alone, while the other $90 billion covers what they call “absenteeism, reduced productivity, and inability to work.”
Treatment for diabetes can be anything from insulin pump tubing to blood sugar monitoring sensors to syringes or insulin pens for direct injection. The devices themselves, not including disposable pieces to make them function, can also add significantly to patient costs.
Diabetes advocates have pushed for the cost of insulin to be addressed for years. Despite support from lawmakers across the political spectrum, there has yet to be a legislative solution drafted.
Some state governments, such as Colorado, Illinois, Maine, New Mexico, New York, Utah, Washington, and West Virginia, have passed laws that limit the amount patients pay out of pocket, the co-pays, per month. A stronger federal effort is currently being promoted by President Joe Biden as part of his Build Back Better agenda.
“After months of negotiations, we reached a deal on prescription drug prices last week. It’s going to lower prices for folks like Gail [deVore] and make a real difference in the lives of Americans across the country,” Biden tweeted. Gail deVore is a patient advocate for type 1 diabetics at Patients for Affordable Drugs Now.
In the president’s plan, Medicare would be allowed to negotiate prices for high-cost prescriptions and would impose a tax penalty if companies increase their prices faster than inflation. More directly, the White House documents on the plan say they want to “lower insulin prices so that Americans with diabetes don’t pay more than $35 per month for their insulin.”
The cost of insulin for diabetics in the US is not the same elsewhere.
Possible savings solutions
Insulin costs hundreds of dollars less in other countries, leading to some patients traveling abroad or ordering insulin to be shipped in from other countries as a more affordable method to receive the life-saving prescriptions.
Despite the lower cost and the ability to ship it in from other nations, doing so requires federal approval.
Florida made an effort to address this need by passing a law in 2019 to let Floridians import drugs like insulin and other prescriptions from Canada and bring savings to its diabetic residents. To do this, Florida needed the federal government to allow the purchase and import.
In May 2021, Gov. Ron DeSantis again requested federal approval at a stop in Lakeland. At the event, he estimated the program could save Florida between $80 to $150 million, and that drug costs had risen 150% over the past 15 years. DeSantis blamed Big Pharma, the pharmaceutical industry, for the costs and regulations.
“Any guesses why it wasn’t utilized? Obviously, this is not something that Big Pharma wants to see,” DeSantis said in May. “Because it disrupts the current market where we have a restricted market here and artificially high prices.”
Soon after, Biden signed an executive order that would do something similar but for the whole country by allowing cheaper drugs to be imported from outside of the U.S. He also asked a federal court to dismiss a lawsuit filed by pharmaceutical companies to prevent Florida and other states from allowing the imports.
Still, costs for diabetic supplies and pharmaceutical goods have remained high.
Without new legislation to curb these costs or limit price increases going forward, diabetics in Florida and across the country will continue to risk financial ruin or poor health outcomes as a result of the high prices.