In the face of rising drug costs, some Americans say they are driving north of the border to purchase the exact same medicine for a fraction of the price.
Americans living with Type 1 diabetes are raising awareness about the pricey problem through an online campaign using the hashtags #CaravanToCanada and #insulin4all.
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One insulin user from Minnesota, Quinn Nystrom, documented her five-hour trek for insulin on Twitter.
Nystrom said that she bought a nearly identical product — one vial of insulin from Novo Nordisk — that cost US$320 in the U.S. and $30 in Canada.
“Where have we gone wrong America?!?” she tweeted.
“We should be ashamed as a country that this is a solvable issue, and nothing has been done to make it more affordable.”
A standard vial of the NovoRapid insulin pictured below costs C$37 at Shoppers Drug Mart located in Toronto.
Seema Nagpal, who works with Diabetes Canada, told Global News that it’s difficult to put an exact number on insulin pricing in Canada. While there is a “ceiling price” set by regulations, she said the market price varies across provinces, between insurance plans and at individual pharmacies.
But Nagpal noted that the U.S. does see some of the highest insulin pricing.
“That ceiling provides some protection to Canadians for the extremely high prices that we see in the United States,” she said.
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The U.S. Senate launched a bipartisan investigation into the high prices earlier this year. The probe is looking into three insulin products that dominate the market: Eli Lilly’s Humalog, Novo Nordisk’s Novolog and Sanofi’s Lantus.
According to the Senate, Humalog costs US$234, Novolog is sold for $540 and Lantus is $431.
Many of the groups travelling to Canada are affiliated with T1International, a U.K.-based advocacy organization for those with Type 1 diabetes.
Elizabeth Pfiester, who founded the organization, explained that the average person with the medical condition needs at least one or two vials of insulin per month.
“So, obviously, these costs are just adding up dramatically for people with the condition who already have a lot to worry about,” she told Global News,
Many Americans don’t have insurance plans that provide adequate coverage, Pfiester added.
Pfiester explained that while the group doesn’t organize the so-called caravans itself, some members of the organization “semi-regularly” travel to Canada for insulin as a last resort. Other members also travel to Mexico for insulin.
The FDA permits U.S. residents to bring medication for personal use across the border but not more than a three-month supply.
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“We really want to make it clear that many people don’t have a second option,” she said. “We know people have to sacrifice rent or food or gas or student loans payments, all because the cost of insulin is so high.”
She noted that Type 1 diabetes patients recognize that this isn’t a “long-term solution” and not something T1International would encourage people to do on a regular basis.
“But we understand the desperation that people are feeling,” Pfiester said, noting that not having proper doses of insulin leads to painful side effects or even death.
Karyn Wofford recently made the trek to Canada, flying first from her home in Georgia to Seattle, then taking a flight to Vancouver.
Wofford, who has had diabetes since she was 12 years old, told Global News that the cost has risen dramatically since she first started needing insulin.
“I would classify my husband and myself as very average; we both work. But we actually live with my mom just so we can afford my diabetes supplies,” she said.
In the U.S., Wofford spends $1,500 for Humalog insulin and another $1,700 for Lantus every three months.
In Canada, her purchase of two boxes of Humalog cost her $700 — she noted the same insulin would have cost her $2,500 in the U.S.
While going to Canada for insulin takes some load off those with Type 1 diabetes, Wofford says she knows it’s not a solution and she often worries about the legality.
“Is there going to be a way that they block us from going to Canada to get it? I think a lot of people have found their lifeline in Canada,” she said.
Rising cost of insulin in U.S.
The rising price of insulin, which is essential to the well-being of those living with diabetes, in the United States is well documented.
An analysis conducted by Reuters found that the price nearly doubled over a five-year period.
It found that the average Type 1 diabetes patient spent US$5,705 on insulin in 2016. In 2012, they spent roughly half that amount at $2,864. The means that for the average patient, who uses 60 units of insulin per day, the daily cost went from $7.80 to $15.
The figures represent the combined amount paid by a patient and their health plan for the medicine and do not reflect rebates paid at a later date.
The rising cost of insulin has also led to protests in the U.S.
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Insulin prices around the world and in Canada
An estimated 100 million people need insulin across the globe.
A September 2018 study published in medical journal BMJ Global Health noted that the high price of insulin prevents people in several countries from accessing the necessary medicine.
It explained that three companies control 96 per cent of the global insulin market, and few medicines similar to it are available.
The study predicted that if the insulin market was competitive, human insulin prices could fall to an annual cost of $48 to $71 per person and $78 to $133 for analog insulin.
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While U.S. residents may be travelling to Canada for cheaper insulin, Nagpal explained that there are still concerns about affordability for Canadians.
“(This) shouldn’t be taken to mean that drug costs are not a problem in Canada; it’s quite the opposite,” she noted.
Nagpal pointed to a 2015 survey by Diabetes Canada, which found that 25 per cent of people with the condition couldn’t take the exact treatments they were prescribed by their physician because of the cost.
“So they either don’t refill their prescription because it was too costly, or some try to stretch out their prescription by taking a lower dose,” she said.
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