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Regarding the cost of insulin…..
The public pressure for price controls (at least here in MN) came from the case of Alec Smith, who died because he could not afford $1300 a month for insulin in 2021.
The benefits of competition sure did not reach him. I would be curious to know why.
Also, Pat Toomey who wrote this article now works for Big Pharma. Caution is warranted.
Alec Smith apparently died in 2017. Mayo Clinic breaks down the reasons for insulin’s costs in an essay that will make your head spin: https://www.mayoclinicproceedings.org/article/S0025-6196(19)31008-0/fulltext
John Abramson also talks about Smith’s case and more in “Sickening: How Big Pharma Broke American Health Care and How We Can Repair It.” One reason Abramson gives is that the Pharma corporations continually pushed newer formulations with higher monopoly prices, going from relatively cheap animal-derived insulin in the 1920’s and recombinant human insulin in the 1980’s, to various patented insulin analogs starting from the 1990’s. The latter with only marginal improvements in safety and efficacy.
Insulin aside, I did find Toomey’s conclusion defending PBMs to be disturbing.