Insulin has saved countless lives since its discovery in 1921. But nearly a century later, there is somehow still no cheap, generic version of insulin available in the U.S—making the "wonder drug" too expensive for many patients. Why?

In the New England Journal of Medicine, Jerome Greene and Kevin Riggs call it the "paradox of incremental innovation." Generics drugs only come on the market when patents expire, and insulin has seen steady parade of new patents over the past 90 years.

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Early forms of insulin were derived from cow or pig pancreases, and like all early versions of a drug, they were imperfect. Manufacturers spent decades improving animal insulins, increasing their purity and making them last longer. With each improvement came a new manufacturing-process patent.

Then, in the 1970s, recombinant DNA technology came along. The gene for human insulin could be spliced directly into the genomes of yeast, which then produced insulin en masse. Scientists could even tinker with the genetic code for insulin, creating forms that were both faster-acting and longer-lasting. And—you know the drill now—with each new form of insulin came a new patent.

Meanwhile, the cheaper animal versions of insulin disappeared from the market in the U.S. (They are still available in other countries like Canada.) True, the new drugs were slightly better, but they are also drastically more expensive. For uninsured patients, out-of-pocket expenses for insulin are as high as $400 a month, compared to the $4 a month for many other generic medications. The choice between a marginally better and unaffordable drug versus a effective and cheap drug is obvious.

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There is a tiny glimmer of good news, as the latest round of patents have expired and generic-like "biosimilar" versions of insulin are coming on the market that could be 20 to 40 percent cheaper. That's still expensive, but a even a slightly more affordable insulin couldn't come soon enough. [New England Journal of Medicine via NPR]

Top image: Africa Studio/shutterstock


Contact the author at sarah@gizmodo.com.

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