How can I afford insulin?

Alec Raeshawn Smith dies three days before he gets his paycheck. He dies because he has no more money to pay for his medicine. He was 26 years old. Alec, like millions of other people, suffered from type 1 diabetes. His body did not produce any insulin; he had to inject the hormone regularly from small vials. A mass product that he could no longer afford.

Alec Raeshawn Smith had health insurance through his mother until February 2017. When that was no longer possible, Smith was faced with a choice: take out private health insurance - or try without insurance. He was too young for the cheap public health insurance Medicare - it only insures seniors aged 65 and up. He earned too much for Medicaid, the insurance for the needy.

But private insurance is expensive in the US. Smith would have had to pay $ 450 a month for his diabetes - with a deductible of $ 7,600. Too much. Alec worked as a restaurant manager. Income: $ 35,000 a year. He renounced health insurance. It would work somehow, he thought. It didn't work. His pharmacist confronted him with the new reality: the insulin drugs would now cost $ 1,300 - a month.

Alec Smith didn't even survive the first month of paying all the expenses himself. His family believes he rationed the syringes to save money. His death sentence? The 26-year-old died of diabetic ketoacidosis alone in his small apartment. It is an agonizing death: the blood sugar level rises rapidly, the blood acidifies, the body cells dehydrate, the body functions gradually stop.

The US has a lot of big problems. But none hits people as hard, as unprepared, as the skyrocketing cost of prescription drugs. In no other industrialized country have the prices for these drugs increased over the years.

It starts with everyday medication like antihypertensive drugs. A monthly pack of "Edarbi 40" with 30 tablets, one for every day, costs less than 35 euros in Germany, where the drug is not paid for by the statutory health insurers. In the USA, the same pack costs the equivalent of 200 euros.

In the USA, too, health insurance companies pay for medication. But in order to be able to lure with low monthly premiums, many insurance companies now work with high deductibles, as in the case of Alec Raeshawn Smith. Insured people have to pay several thousand dollars a year out of their own pocket before health insurance takes effect. Many contracts also include a percentage share; 20 percent is quite common. For patients who need expensive medication for months and years, this often means financial ruin.

30 00 euros per year for medication

At the beginning of 2018, Gloria Rickert's husband from San Diego, California fell ill with a rare and aggressive brain tumor. Many patients die twelve to 24 months after this diagnosis. That's tough enough. But Gloria Rickert is already running out of money. The drugs are expensive, the part she has to pay for herself is $ 400 for 15 capsules. This dose is enough for five days, she says. Calculated over the year, she has to raise almost $ 30,000 just for drugs. If she doesn't get help, she says, her family is in danger of financial collapse.

The prices for drugs against rare or life-threatening diseases are particularly high. Such supplements only make up two percent of prescriptions in the US - but one third of the cost.

The pharmaceutical company Cataylst Pharmaceuticals, for example, has just launched a drug against Lambert-Eaton myasthenia syndrome, an autoimmune disease that affects around 100,000 people in the United States. According to the manufacturer, the annual dose will cost $ 375,000. For 30 years, the family company Jacobus Pharmaceuticals had manufactured the active ingredient and given it to patients free of charge. Now Cataylst Pharmaceuticals has had the active ingredient certified by the FDA, the US federal agency for drug and food safety, for the first time - in order to be able to sell the drug on the free market at an extreme price.

Americans can no longer afford drugs

Leigh Purvis, health researcher at the AARP Public Policy Institute, says many people simply can no longer afford their treatment. The prices have risen to such an extent that patients often leave the pharmacy without their medication. His institute has calculated that the prices for the most frequently prescribed drugs rose by an average of 8.4 percent in 2017 alone. This has been going on for years - and experts are predicting further price increases.

A 2016 survey by the Kaiser Family Foundation found that 44 percent of Americans are seriously concerned about how long they can still afford medication. 21 percent said they had not redeemed prescriptions because they had no money, 16 percent said they had reduced prescribed doses, sometimes omitting a tablet or syringe in order to save costs.

The USA is a paradise for pharmaceutical manufacturers. Nowhere else is so much money spent on health and medication: The US health care system devoured $ 3.3 trillion in 2016, 17.9 percent of the total economic output of the USA. Of that, $ 329 billion went to prescription drugs alone. For comparison: In Germany, 11.3 percent of economic output flowed into the health system in the same year. 360 billion euros, of which 55 billion was spent on pharmaceuticals. According to the OECD, the 19 leading industrialized countries spend around $ 452 per capita per year on drugs. In the US it's more than $ 1,000.