Hiltzik: Iqiniso mayelana nokwehliswa kwentengo ye-insulin ka-Lilly

U-Eli Lilly & Co. badlale ikhadi le-altruism njengompetha ngoMashi 1, lapho bememezela yehla intengo ekhuphukayo emikhiqizweni yayo ye-insulin efika ku-70%.

Inkampani enkulu yezidakamizwa ithe isenzo sayo simayelana nokusiza iziguli ezinesifo sikashukela, inhloso yayo “ukusiza abantu baseMelika okungenzeka babe nobunzima bokusebenzisa uhlelo lokunakekelwa kwezempilo oluyinkimbinkimbi olungase lubavimbele ekutholeni i-insulin ethengekayo.”

NgokukaSihlalo kaLilly kanye noMphathi Omkhulu uDavid Ricks, uhlelo lokunakekelwa kwezempilo lwaseMelika “alukanikezi i-insulin ethengekayo kuwo wonke umuntu, futhi lokho kufanele kushintshe.”

U-Lilly wajabulela indumiso yomphakathi ngemva kwesimemezelo. UMongameli Biden ubonile ukuthi ukusikeka kukaLilly kuzophoqa izimbangi zakhe ezimbili eziyinhloko, uNovo Nordisk noSanofi, ukuthi balandele okufanayo.

Uma uthambekele ekucabangeni kangcono uLilly ngokuthatha lesi sinyathelo esimangalisayo, nasi iseluleko sethu: Bamba ihlombe lakho.

Iqiniso liwukuthi ukuncishiswa kwentengo kaLilly ngeke kubize inzuzo encane; ingase iqoqe ngisho ngaphezulu inzuzo. I-Wall Street yakubona lokho ngaso leso sikhathi: Intengo yamasheya ka-Lilly yenyuka ngosuku lwesimemezelo futhi iye yaqhubeka ikhuphuka kusukela ngaleso sikhathi, izuza cishe u-6% ngokuhweba kwangoLwesine.

Ngaphezu kwalokho, ukuhlehliswa kwentengo akukambuyiseli uLilly insulin lapho kufanele kube khona ngokwesisekelo sokushintsha kwamandla emali uma kuqhathaniswa nentengo yomkhiqizo wawo obalulekile, i-Humalog, ngesikhathi yethulwa ngo-1996.

Ngaleso sikhathi, i-Humalog yayibiza u-$21 ngesitsha ngasinye, okungaba cishe u-$40 emalini yanamuhla; ukuhlehliswa kuzokwehlisa intengo ye-vial kusuka ku-$ 274.70 kuya ku-$ 66.40, ngokusho Izibalo ezenziwe yinkampani yaseWashington iVeda Partners. Ngakho-ke lisephezulu ngokuphindwe kabili kokuthathu kunalokho obekufanele kube, kubalwa ukwehla kwamandla emali.

Enye into eqhuba isimemezelo sikaLilly ukucutshungulwa komphakathi kwentengo ye-insulin ekhuphukayo. I-Inflation Reduction Act eyaphasiswa ngo-Agasti odlule okuhlanganisa nesimiso esihlanganisa izindleko eziphuma ephaketheni ze-insulin kwababhalisele izidakamizwa ze-Medicare e-Medicare. $35 ngenyanga. Leyo nzuzo ihlaziywe kabanzi nangokuzwakalayo nguMongameli Biden njengobufakazi bokuzibophezela kwakhe ekwenzeni inqubomgomo esekela abathengi.

Ngokuvumelana nalowo mthetho, ingxenye eyodwa yesimemezelo sika-Lilly sokwehliswa kwentengo isamba esingu-$35 ngenyanga ezinkokhisweni eziphuma ephaketheni zamakhasimende anomshwalense. Njengoba Ngike ngabika ngaphambilinilezi zinhlelo zokusiza iziguli zifihla kuphela kubathengi izindleko zangempela zemiyalelo yabo – abashwalensi basakhokha amanani aphezulu abenzi bezidakamizwa, okugcina kumaphrimiyamu aphezulu kuwo wonke umuntu.

U-Andrew Mulcahy, umcwaningi omkhulu e-Rand Corp. kanye nombhali oholayo we-Rand Corp. ukuqhathaniswa kweRandi ngo-2020 kwamanani e-insulin e-US nakwamanye amazwe.

Lokho kuhlaziya kwabonisa ukuthi amanani entengo ye-insulin yase-US ayesephambanweni nomhlaba wonke: Ngokwesibonelo, izindleko zeyunithi yesilinganiso (ngamadola aseMelika) u-$6.94 e-Australia, u-$12 eCanada no-$7.52 eBrithani—kodwa cishe u-$100 e-US Even. uma ukuncishiswa kwentengo ka-Lilly kulandelwa izimbangi zakhe, “izintengo zase-US zisaphakeme kunezintengo kwamanye amazwe,” kusho uMulcahy, nakuba izikhathi ezimbili kuya kwezintathu kunezikhathi eziyi-10.

Intengo ephezulu yohlu lwe-insulin iqhubekisele phambili imizamo yokwakha eminye imithombo. UHulumeni waseCalifornia uGavin Newsom wamemezela ngonyaka odlule uhlelo lwezigidi ezingu-$100 ukwakha i-insulin eshibhile yegama likahulumeni, ngokunokwenzeka ngokwenza inkontileka nefemu yamajenerikhi; isimemezelo semininingwane singafika zingakapheli izinsuku. Umzamo ofanayo kuqhubeka eMichigan.

Ukwehliswa kwentengo ka-Lilly ngeke kwenze lutho ukubhekana nokungasebenzi kahle kohlelo lwaseMelika lokubiza izidakamizwa, oluhambisana nezinkampani ezifuna indawo yokuhlala – hhayi nje abakhiqizi bezidakamizwa, kodwa abaphathi bezinzuzo zamakhemisi, noma ama-PBM, abathengisi abathembisa ukuxoxisana ngamanani aphansi egameni. zomshwalense wezempilo ngokukhipha izaphulelo kodwa bazigcinele ingxenye yemali okuthiwa bazongile.

Abenzi bezidakamizwa kanye nama-PBM bakhombana ngeminwe lapho amanani entengo ezidakamizwa ephonselwa inselelo emacaleni noma ezinkantolo zekhongolose. Kodwa akungabazeki ukuthi uhlelo ludala izikhuthazo zamanani aphezulu omkhiqizi, ngoba lezo ziyadingeka ukuze kuhlinzekwe i-headroom yezaphulelo.

Ngempela, ngo-2021 ikomidi leSigele libike ukuthi abaphathi bakaLilly babemanqikanqika ukwehlisa amanani emishanguzweni yesifo sikashukela ngoba besaba ukuthi ama-PBM azophikisa: Amanani ehlisiwe ayezonciphisa izimali ama-PBM ayengazikhokhisa amakhasimende awo ohlelo lwezempilo futhi anciphise amandla awo okufinyelela iziqinisekiso zesaphulelo ayezithembise amakhasimende.

Ubudlelwano phakathi kwabenzi bezidakamizwa nama-PBM yinkinga ecaleni elifakwe enkantolo yesifunda sase-Los Angeles yi-California Atty. Gen. Rob Bonta ngoJanuwari.

Icala liyasola ukuthi abakhiqizi abathathu babopha uzungu nama-PBM amathathu abusayo, i-CVS Caremark, i-Express Scripts ne-OptumRx, “yokwenyusa ngokungeyikho” amanani e-insulin ngaphezu kwesilinganiso sokwehla kwamandla emali. Akekho noyedwa kwabamangalelwa osaziphendulile lezi zinsolo enkantolo.

Njengoba kwenzeka, abanesifo sikashukela abekho ngisho naphakathi kwabasebenzisi bezidakamizwa abahlukunyezwa kakhulu amanani aphakeme e-US Lokho kungenxa yokuthi ukuba nabakhiqizi abathathu abaqhudelanayo ngalokho okuyisidakamizwa esiyimpahla kuholela ekwephulelweni okukhulu okugeleza ezigulini ezinomshuwalense okungenani ngokwezinga elithile.

Izaphulelo ezivela kuhlu lwezintengo ze-insulin zifinyelele ku-70% kuye ku-80%, UMulcahy nozakwabo baseRand babika ngo-2021. Akunjalo ngemithi yomdlavuza, ekwazi ukuthwala amanani entengo yamakhulu ezinkulungwane zamaRandi kodwa ivame ukungancishiswa, noma “imishanguzo eqeda isifo samathambo” esetshenziselwa ukwelapha izimo ezizimele ezifana ne-lupus, multiple sclerosis kanye nesifo sika-Crohn, lapho cishe ingxenye eyodwa kwezintathu yezintengo zohlu zehliswa.

“I-Oncology iyisibonelo esicacile sezidakamizwa lapho izaphulelo ezisuka kumanani wohlu zincane kakhulu,” kusho uMulcahy. Lokho kungenxa yokuthi isenzo sale mithi singase siqondiswe ngqo, okwenza kube nzima ukususa isiguli komunye umuthi ukuya kwesinye ukuze sifune inani eliphansi.

Cishe abantu baseMelika abayizigidi ezingama-40 banesifo sikashukela, isifo lapho umzimba ungakwazi ukukhiqiza i-insulin, i-hormone edingekayo ukulawula amazinga kashukela egazini, noma ungakwazi ukusebenzisa i-insulin ngokuphumelelayo. Ezingaba yizigidi ezingu-7 kuzo zidinga imijovo ye-insulin nsuku zonke.

Kulabo, ngokusho ucwaningo olwenziwa abacwaningi baseYale eshicilelwe ngonyaka odlule, u-14% ubhekene nokusebenzisa imali “eyinhlekelele” ku-insulin, okuchazwa ngokuthi u-40% womholo wabo ngaphezu kwalowo abawusebenzisa ngokudla nezindlu. Cishe uhhafu ubikile ukulinganisa i-insulin yabo ukuhlinzeka ngenxa yezindleko zayo. Lelo yisu elibeka impilo engcupheni.

Bayizisulu zokukhuphuka okukhulu kwamanani entengo ye-insulin yabenzi bezidakamizwa kule minyaka engama-30 kuye kwengama-40 edlule. Lezi zintengo ziwela ezigabeni ezimbili: Izintengo zohlu, e-US okwamanje ezingasebenza ngaphezu kuka-$200 ibhodlela ngayinye, kanye nentengo ephuma ephaketheni.

Ibhodlela ngalinye linemithamo eyi-1,000, futhi isiguli esijwayelekile singasebenzisa izitsha ezimbili kuya kwezine ngenyanga.

Zimbalwa iziguli ezihlala zikhokha inani lohlu, nokho. Iningi likhokhiswa inkokhelo ehlanganyelwe kuphela ngohlelo lwazo lwezempilo noma bathola i-insulin mahhala nge-Medicaid.

Intengo yohlu oluphezulu ilimaza kakhulu iziguli okufanele zithenge i-insulini ngokuqondile, ngokuvamile ngenxa yokuthi azinamshwalense noma zinezinhlelo zezempilo ezidonswa kakhulu ezingakhokhi zonke izindleko. Kodwa ngisho neziguli ezinomshwalense omuhle azivikelekile ngokuphelele ohlwini lwenani lentengo, kusho u-Shaina Kasper, onesifo sikashukela ongumphathi wenqubomgomo yase-USA we-T1International, okuyiqembu lomhlaba wonke elimela abanesifo sikashukela.

“Kwesinye isikhathi ngisho nabantu abanomshwalense kumele bawuthenge ephaketheni,” usho kanje. “Uyaphula ibhodlela uma uvakashele eholidini. Uyaphela ngoba kukhona okwenzekayo. Emasontweni ambalwa edlule, isisebenzi sami sezinja safaka impahla efika efrijini, futhi yafa yonke. Ukuba nenketho yokukwazi ukuthola i-insulin ethengekayo kuzosindisa izimpilo. ”

I-insulini isiphenduke “ingane eyiphosta yezikhuthazo ezibalekayo zohlu lwamanani aphezulu,” njengoba uMulcahy ekubeka, ngenxa yezizathu ezimbalwa.

Lokhu kufaka phakathi ubukhulu bokwenyuka kwamanani entengo, inani elikhulu lemali ebiza ukukhiqiza – imali encane efika ku-$6 ibhodlela – kanye nezintuba abenzi be-insulin abaye bazisebenzisa ukuze balondoloze amalungelo abo okumaketha umkhiqizo abanamalungelo obunikazi wawo. ngokuvamile ngabe iphelelwe yisikhathi emashumini eminyaka adlule.

Indlela eyodwa evamile iwukuba abakhiqizi baveze amafomu amasha noma izisetshenziswa abathi zimelela intuthuko ebalulekile yomtholampilo. Lokho kuthuthukiswa kuvame ukuba nesizotha kunalokho okushiwo abakhiqizi, noma kungase kungafaneleki kubo bonke abasebenzisi.

Noma kunjalo, kuphawula uRobin Feldman, uchwepheshe womthetho wemithi e-University of California College of the Law, izinguquko zivumela abenzi bezidakamizwa ukuba banwebe amalungelo abo okumaketha.

I-Sanofi, isibonelo, ifake izicelo zelungelo lobunikazi ezingama-74 zomuthi wayo we-insulin esebenza isikhathi eside i-Lantus, kubika u-Feldman esihlokweni esilandelayo sejenali; iningi lafakwa ngemuva kokuthi umuthi ufakwe emakethe ngo-2000 kodwa uvumele iSanofi ukuthi inwebe amalungelo ayo okumaketha ngo-2031.

Uma sibuyela esimisweni sika-Lilly, phakathi kwezikhuthazo zenkampani zokumemezela ukwehliswa kwentengo ye-insulin manje kunemithetho ye-Medicaid ekhishwa ngonyaka ozayo ezojezisa abakhi bezidakamizwa ngokukhuphula amanani ngokushesha kunokwenyuka kwamandla emali. Le mithetho emisha ingaholela ekukhokhisweni imali efinyelela ku-$430 million kuLilly, ngokwezilinganiso zeVeda.

Ngenxa yezici zentengo ye-Medicaid, ukwehla kuka-Lilly kungase kuphumele ekuqoqeni imali emisha ye-Medicaid engaphezu kwezigidi ezingu-85 zamaRandi, i-Veda icabanga, iphetha ngokuthi: Hlanganisa lezo zici ezimbili, futhi ukuncishiswa kwentengo ka-Lilly kuzokhiqiza cishe izigidi ezingu-517 zamaRandi.

“Izinkampani zizenzela zona,” kusho uFeldman. “Lokhu kwehliswa kwentengo kuyafana. Inkampani ikwazile ukwenza kahle ngokwenza okuhle.”