The most commonly used forms of insulin cost 10 times more in the US than in any other developed country, according to a commentary in Mayo Clinic Proceedings. This prohibitive cost is causing some US patients with type 1 diabetes to ration the amount of insulin they use, with life-threatening implications.

The commentary by S. Vincent Rajkumar, MD, a Mayo Clinic physician, describes the cost of insulin as an urgent public health issue. "There are 30 million patients with diabetes in the United States, and about 25%, or 7.4 million Americans, need insulin. For the 1.3 million patients with type 1 diabetes, insulin is as vital as air and water. Some patients are rationing insulin or switching to cheaper forms without proper supervision. We cannot wait to act."

The commentary appears in the January issue of Mayo Clinic Proceedings, which focuses on diabetes and the discovery of insulin in 1921. The use of insulin to treat diabetes has transformed the lives of millions of people, but the sharp cost increase in recent years has threatened patient care.

Insulin is a naturally occurring hormone that helps regulate blood sugar levels. Insulin therapy is vital for people with type 1 diabetes and for many patients with type 2 diabetes. Type 1 diabetes is a chronic condition where the pancreas produces little or no insulin. With type 2 diabetes, the body resists the effects of insulin or doesn't produce enough to maintain normal glucose levels. Long-term complications can be debilitating and life-threatening.

"There have been many recent reports of deaths in patients with type 1 diabetes because of the lack of affordable insulin," Dr. Rajkumar says. "The high prevalence of diabetes, the chronic lifelong nature of the disease, and the fact that patients with type 1 diabetes will die without access to insulin make this an urgent problem that must be solved expeditiously."

"The No. 1 reason for the high cost of insulin is the presence of a vulnerable population that needs insulin to survive," he says. "This population is willing to pay almost anything to have access to a lifesaving drug, and manufacturers know it."

Dr. Rajkumar, the Edward W. and Betty Knight Scripps Professor of Medicine at Mayo Clinic College of Medicine and Science, proposes several solutions that would help make insulin and other prescription drugs more affordable. They include:

• Patent reform to protect against monopolies in the pharmaceutical industry
• Creating an easier regulatory path for generic and biosimilar drugs to enter the market
• Legislation to prevent unjustifiable price increases
• Promotion of nonprofit generic drug manufacturing
• Laws to provide access to affordable and safe insulin in emergency circumstances

"We cannot afford to lose a single additional life because of the high cost of insulin," says Dr. Rajkumar. "The price of insulin is a stark and troubling example of what's happening with other prescription drugs, and it highlights a systemic problem with how drugs are priced, compared with just about every other commodity."