Gallows Humor

[kyburg]

Things that haven't changed, number one: I am still surrounded by people with diabetes.

Things that have changed: the cost of a bottle of insulin.

(The DDoS stuff yesterday made me lose a buttload of stuff - the fingers flew, but the network went OM NOM NOM NOM *finger* - alas.)

Keep in mind Cliff passed in 1998 - at the age of 36. This is not to say if you get a type I diabetes diagnosis, you will as well. When he was diagnosed in 1969 - NINETEEN SIXTY NINE - at the age of 5, there were no meters, no in-home anything other than wee little tabs you peed on (that ALWAYS indicated positive, if you left them alone long enough 'just to make sure'), no time-release style insulin, no disposable ANYTHING...and all insulin was of animal origin. You a vegetarian? Uh oh. Close your eyes and take the shot - it's all we got. And they thought one shot a day of regular was GREAT. (Oh, and no A1c monitoring. Have a nice life!)

Cliff was also from a family that had a high cholesterol issue - he never fell below the mid 300's without medication - and often was MUCH higher. Set-up? Oh very much so.)

He started showing signs of major complications in his teens.

You weren't allowed in public schools, public pools (yes, really) and people either thought you were contagious or genetically inferior. (You're still 4F for the draft.) It wouldn't be until AIDS showed up that type I would be 'discovered' as an auto-immune disease, likely of viral origin combined with a genetic tendency towards overkill - yay viral research, hooray - oh, about 1988.

I remember how much some things cost - finding the $$$ to pay for it all after he retired disabled and lost 1/3 of our income permanently will engrave such things on your memory.

A bottle of regular insulin, beef/pork origin from Eli Lilly - $8. Box of syringes, oh about another $11 or so. (I still have some tucked away - they're very useful. Don't look at me like that. I'll feed you some congnac-treated strawberries and amaretto lychees someday.)

So we would have multiple bottles working at any one time - and a kit in the car, a kit at the desk at work - no problem. Didn't even bill insurance for it. If I needed to get all the dough out of a medical savings plan, fine. But - *shrug* - eh.

The recombiant DNA insulins were *just* coming online in the nineties, and while they were recommended as soon as they came out, the stuff wasn't all that available, and was a tad bit more a bottle. We kind of looked it as an experiment and gee whiz, that's keen.

A tad being - oh, it was $12 vs. that $8 I just told you about, for the stuff Eli Lilly was culling from the slaughterhouses.

Imagine my surprise when I went to go shop plain regular insulin yesterday and discovered Eli Lilly had stopped manufacuring that $8 a bottle stuff in 2005. Now, all insulin (it looks like) is recombinant DNA origin - and the $12 a bottle stuff?

Would you believe $41 a bottle?!

*jaw drop* That's -

A lot of things I'd rather not put to paper. The fact this product is a result of my taxes going to fund research for it - not to mention voluntary donations and fund raisers to boot - ah. Yawp.

I can HEAR Cliff in the afterlife from here - the screeching is amazing. HOW MANY TIMES DO I HAVE TO PAY FOR THIS - yes, yes, yes. Okay. I got it. I got it.

When you hear in the news that diabetes is now an epidemic, you just tuck that away somewhere. Without this, people don't live. Without *enough* of it, people live very compromised lives - and complications? Don't get me started.

We have some of the best tools to treat this that has ever been. You get this diagnosis, you can expect to have a lot of work - and never see what Cliff saw before you leave this place for the next one. If you can get access to the tools and use them. Meters that retain records and only require a tiny scratch (Cliff was seen at a hospital in 1996 that was still doing all its monitoring by draw. That's a stick in the arm, for you and me. How many times a day? They recommend four times, yanno. DRAW. 1996. Yo. When he died, I donated them his meter in his memory. Dumbshits.) They routinely put kids on pumps like clockwork and the results are incredible.

$41 a bottle. I've said I am glad I don't have to do with Cliff what I did in the nineties, now. There is nothing like finding out your information is out of date to get slapped in the face - and do you think Eli Lilly has a prescription drug assistance plan for regular insulin? Gallows humor kicking in here. You might as well ask the Clean Air Board in California for financial assistance to get air to breathe.

Wow. If you ain't rich, what right do you have to live. They used to just keep you out of the public pools.

Comments

[vampireanneke.livejournal.com]

My older sister has Type 1 Diabeties. She is 36 now, and doing fine and I think suppose to live into her 50 maybe 60 even.

[kyburg.livejournal.com]

Justice Sotomayor is a Type I - and you never even heard it mentioned in the hearings. *applauds*

[feyandstrange.livejournal.com]

I hate to disagree with you on such a lovely rant, but it's for good reason:

http://www.needymeds.org/ shows that Lilly's prescription plan *does* cover at least some kinds of insulin (I saw pens and human insulin in there).

They've also got a listing (under 'by disease') for some programs that will help folks get monitors, needles, and other gear.

That's one hell of a price jump.

Medicare still only pays for some of that stuff, although I think they now consider paying for pumps. Insulin is supposedly under the Medicare D prescription plan - and wouldn't be the only drug whose costs shot up a bit when *those* kicked in. No idea if Medicare cover any of the rest of it, although foot care is still out.

My state and city clinic started offering free podiatric services to diabetics. I suspect it's been pushed through as a cost-*cutting* measure. Or at least - they had that three months ago. Schwarzenegger has slashed Medicaid and my clinic's funding.

Oh hey, I like that idea. I'm gonna write to the Clean Air Board and ask about asthma medication help. Ought to be good for a laugh.

[kiyone.livejournal.com]

Just because I have to see it everyday...

Diabetic supplies actually are covered under Medicare B.

The D plan is for all the other prescription meds (the one that was put into law back in 2005).

So most D plans will not cover diabetic stuff, because they expect the patient to be on B which does cover it.

[kyburg.livejournal.com]

Those plans have a finite amount of 'funding' - entirely dependent on how big Eli Lilly wants to be on any given day. If they don't have it to spare, there isn't any assistance - sorry.

Medicare Plan B (as also mentioned) is the one who pays for supplies for testing - but it would be Plan D (the worthless one) that would cover insulin...maybe. If you get a prescription for it, and manage it that way. (We never did. We never needed to. We got the prescription and tucked it away with the taxes.)

Plan B funding is how those Liberty Medical people can do business. Wow - if it didn't pay well, how in the world could they be in business anyway?

I'm all for extending Medicare - which has three qualifying categories - complete disability more than two years, End-Stage Renal Disease (hello, you're on dialysis) or age 65.

The way Medicare bills is completely different than any private plan - and is very clear up front what it will and won't cover and a lot of services can be used up completely. (We used up all of Cliff's in-patient hospital days, for example - and he wasn't on it three years. Lifetime. Yup.)

[elfwench.livejournal.com]

Jesus! $41 a bottle. That's ridiculous. You know, I bet if the drug companies quit giving away clocks and other doodads to the doctors (my doctor's office is filled with clocks the drug reps brought them - I mean, in his little office area where the computer is, he has about 20 or so wall clocks each advertising a different drug, none of them on the same time) that medicine would be a lot cheaper.

[forestcats.livejournal.com]

The give away programs with any product name was made illegal as of January 2009. The drug reps may not give as much as a pen. There needs to be clocks in every room in order to have a second hand for taking pulse and blood pressure.

[elfwench.livejournal.com]

Well, it's good that the drug swag has come to a halt.

I know that it's good to have a clock with a second hand in every exam room. But, in the doctor's office (not exam room, his actual office) there do not need to be 20 clocks on the wall. ;)

[(Anonymous)]

Yes, so now the drug reps come empty handed, nothing for the staff to take home and the physician is expected to hear the hawkers. Have you ever asked why your doctor has all of those clocks up? Competing drug company crap all next to each other?

My real question is why there isn't tort reform. When 70% of all medical malpractice cases are found to be unable to stand up in court but are filed in hopes that the malpractice insurer will drop a few K instead of going to court has not been addressed.

[kyburg.livejournal.com]

I'd be for tort reform, except it has a very clear reason for being where it was today.

It's how we pay for long-term care - or any medical care that insurance can't be obtained for or won't cover. And it's about as good as playing the lottery for the funds - but when you're faced with something that can bankrupt you and then contine after that...shoot, call Larry Parker! HELP!

If we won't look at why people sue - nothing is going to help, long-term.

[ms-hecubus.livejournal.com]

I doubt it would make the drug any cheaper. If doctors don't find out about the drugs they won't prescribe them and the companies won't make money on them. Doctors often struggle to keep up on necessary medical knowledge. There just isn't time to learn every new drug on the market too. Besides, those wall clocks are seriously cheap methods of advertising. Heck, I can buy a cheap wall clock for $5 retail.

Not saying the system was right or wrong, I just don't think it has added substantially to the price of insulin.

[kyburg.livejournal.com]

Dude, it's not the swag. It never was.

Keep an eye on who's making a profit - and how. Check how much a share of stock is.

Follow the money, honey. Follow the money.

[violet-tigress1.livejournal.com]

We've come a long way, baby. Sometimes I'm not so sure which way...

Oranges and oranges

[forestcats.livejournal.com]

My grandmother was diagnosed in 1967 with type 2. There was no anesthesia that was safe for diabetics then, she had an abscess in her leg and had to have live awake surgery tied down with no pain killers. Rent for a house in Chicago was $89 and minimum wage was $1.00. Today rent for the same neighborhood is $1200.(That house burned down) My grandmother was the exceptional diabetic, she NEVER cheated. She would chop her lettuce every day in order to measure it. She ate on time for every meal and lived to age 88. The pain from the surgery in 67 was her moment of choice to live by the rules. Her diabetes wasn't from weight it was more likely from having suffered from Scarlet Fever as a child. Just like there aren't any nickle movies the cost for everything rises with demand. When I hear some tort reform being bandied about as well as universal care then I might drop my suspicion a bit.

Re: Oranges and oranges

[kyburg.livejournal.com]

Tort reform will follow health care reform like carts follow horses.

The cost of providing care when there is no other way than litigation is what drives it. No question about it.

[foogod.livejournal.com]

To be fair, a few points:

1. It's a little unclear from your post exactly what year you were remembering the $8/$12 bottles from, but it's important to note that general consumer price indices have more than doubled since just 1985, which means a $12 bottle in 1985 would cost over $25 today, just due to inflation, etc. (which doesn't account for the full differential you mentioned, but it's not an insignificant part of it)

2. Modern insulin analogs do perform substantially better for many people than the older stuff. It's now possible to get versions which are significantly more targetable, predictable, and safe, including for many people not having to be taken in as large quantities or as often, which can mean that $41 bottle may actually last longer than the old ones.

3. It is possible to get some of the older versions of the insulin analogs (not the old pig stuff, but older biologic ones that aren't quite as nifty as the new line) for reduced prices. One article I saw was talking about being able to get older analogs at Wal-Mart for $19 a bottle (which, when inflation-adjusted, would be equivalent to about $9.25 in 1985-terms, and will probably perform far better than the 1985-version insulin ever did)

This isn't to say that there aren't problems still. Frankly, I agree that this all should be a lot cheaper than it is at the moment (the fact that the FDA is effectively stalling all production of generic insulin seems to be one factor), and the fact that diabetics have to pay out of their own pockets (even partially) for something so critical to just staying alive and healthy is, in my opinion, wrong in and of itself. (Then again, if we're going to list everything that's wrong with current US health care, it's gonna be a long night..)

[kyburg.livejournal.com]

We were using at least two bottles of regular concurrently - how fast, not so sure anymore (one was dedicated to dialysis) in 1998. It never went above $10 a bottle, that you can tie to. No, I did not use the human analogs at home. They were used in the hospital, but once we were home again - back again we were to what we were used to.

We would play with the humulin - but never went to it completely. We found it burned faster, reduced levels quicker - so we had to rearrange schedules when we used it - but did it do anything with the complication load we were under? Not so much. By the time Cliff got access to it - the damage had been done, and done so well it was pointless to change routines - and to be honest, we were doing all we could to stay stable as it was.

The figure of $41 was come to after checking my best resources for cost. Floored is just one word I'd use for my reaction - brother, I tried. (Remember the guy who said he'd could find it for $30? SOLD. He wins. I tried to find that price, and didn't.)

Having a good memory is something of a curse when people just assume you're making things up.

[muimi07.livejournal.com]

And it's not just the insulin. What shocked the hell out of me was that testing kits are relatively cheap. But the strips... the STRIPS!!!!... well, that's close to fucking highway robbery. 90 strips for $45 ~ $60 out of pocket. On a good day, that would have been a month's supply on but there were days that I was testing damn near 5 to 6 times a day. That's not including lancet cost, alcohol, swabs, etc.

One of my biggest, crippling fears is being a diabetic without insurance. 3 months on insulin was a huge thing that made me realize -- omfg how the hell do Type I's live without health insurance? And unfortunately, with my family history, for me, it's not a question of if I'll develop Type II, it's when. Trying to stave off the inevitable as long as I can, as it is. I can only hope that I don't need insulin and also hope that I have continuing health coverage.

[kyburg.livejournal.com]

Oh, I always check the cost of the strips before someone hands me a 'free' meter. *facesmacks* Oh very yes I know that game - and how incredibly UNFAIR.

Cliff's (and my) priority was always health insurance. Always always always. No, really. We even used the MRM California provides - when I didn't have $100 for the phone bill, I had $300 for insurance. And I made it back in prescription drugs the first two weeks of every month.

Yes, I'm going to go talk to my senator about health care this week. IN HER OFFICE.

[zedmanauk.livejournal.com]

Is this the price straight from Lilly or from a pharmacy? Pharmacies seem pretty crazy on their price differences. Earlier this year we needed to pick up a prescription that was not covered by our insurance. Rite Aid quoted us $225. The local pharmacy we ended up getting it from was only $84.

[ms-hecubus.livejournal.com]

You aren't kidding about that! When my cat was on IV fluids I was quoted $200 for a case of solution by CVS and bought it at Costco for $35 a case.

[kyburg.livejournal.com]

My best sources, both by web and by phone. Sickening.

[veronica-rich.livejournal.com]

Well, just remember - don't do something stupid like support a public health care option, or the gubmint'll come around and kill your old people for soylent green!

[kyburg.livejournal.com]

I wonder how many of those folks know about the Futility of Life Act from *gasp* TEXAS!

(How COULD they? Simple. You're too expensive to live - bye bye!)

[veronica-rich.livejournal.com]

So is that actually true, or just more Wiki goodness? (I'd believe such a law exists. What I have a problem believing is Wikipedia - I warn all my reporters against using it as a source in their articles. *G*)

[kyburg.livejournal.com]

It exists - all you have to do is Google some of the names and the original news stories float to the surface like dead fish. :/