Some patients turning to Craigslist for affordable insulin
People are using Craigslist to buy and sell lifesaving drugs, particularly insulin, according to a research letter published in JAMA Internal Medicine.
“For those who need insulin, the type of insulin used and the dose can mean the difference between life and death,” Jennifer N. Goldstein, MD, MSc, program director for clinical research education at the Value Institute at Christiana Care, told Healio Primary Care. “Our findings suggest that patients are doing whatever they can to find affordable insulin. But when it’s purchased from illegal sources, there is no guarantee that it is going to be safe or effective.”
Craigslist — which is celebrating its 25th anniversary this year — is a website where users can post advertisements anonymously. Although unregulated financial transactions for prescription medications are illegal and against Craigslist policy, Goldstein and colleagues found evidence that patients are “seeking and likely finding” insulin on the website.
The researchers conducted a mixed-methods, cross-sectional analysis of advertisements on Craigslist in the United States to determine how often certain medications are marketed. They searched for insulin, albuterol and EpiPen listings for every city in every state on the website.
Findings of Craigslist search
The researchers identified 432 advertisements on Craigslist, 75.7% of which were for insulin and 24.3% were for albuterol. Analog insulin was the most common product, representing 71.9% of advertisements. The advertisements encompassed 240 cities across 31 states.
Among analog insulin advertisements, 27.8% were for Lantus (Sanofi), 27.5% were for Humalog (Eli Lilly) and 21.4% were for Novolog (Novo Nordisk).
The cost of albuterol on Craigslist was an average of $18.77 more expensive than the retail price.
Meanwhile, the cost of insulin was significantly cheaper on the website — the price per vial was $372.30 less for analog insulins and $123.19 less for human synthetic insulins.
When examining the text of the advertisements, Goldstein and colleagues found that people selling insulin often were motivated by altruism, wanting to avoid wasting medication, or financial need.
Researchers noted that the descriptions of many of the advertisements raised concern about the quality and safety of the medications sold. For instance, one advertiser wrote in an ad for Lantus insulin that the bottle “was open about 30 days ago. It was always used with a new needle. It is 75% full.”
Cause for concern
“There's no way for patients to know that the drugs they're buying on Craigslist are safe and effective,” David U. Himmelstein, MD, a professor at the City University of New York School of Public Health at Hunter College who was not involved in the study, told Healio Primary Care.
Goldstein explained that insulins sold on Craigslist are not monitored or regulated, meaning that they may be contaminated and could cause patients serious harm.
In addition, “because insulin is sensitive to extremes of temperature, improper storage can lead to loss of potency,” she said.
“These insulin products cannot be considered safe for patients to use,” she continued.
How did this happen?
“The price of insulin has increased dramatically over the past decade,” Goldstein said. “Patients simply can’t afford it.”
One study published in JAMA Network Open found that from 2012 through 2017, the median total cost of Humalog increased 117%, the cost of Lantus increased 82%, and the cost of Novolog increased 118%.
A report from the American Diabetes Association Insulin Access and Affordability Working Group explained that the cost to patients varies depending on their type of insurance and the insulin they use but can be significantly higher for patients who are insured, those with high-deductible plans and those in the Medicare Part D Coverage gap.
Himmelstein said that Goldstein and colleagues’ findings “illustrate how drug companies’ price gauging has forced people to turn to what is effectively a black market for drugs.”
How to stop unregulated sales
“The sale of prescription medications is specifically prohibited according to the Craigslist policy,” Goldstein said. “However, we found hundreds of advertisements for prescription insulin.”
“It is important that online marketplaces such as Craigslist take the necessary actions to prevent the illegal sale of prescription medications,” she continued.
Himmelstein noted that rather than making additional efforts to regulate Craigslist and similar online markets, steps should instead be taken to “regulate drug prices and improve insurance coverage for drugs,” to ensure that patients do not need to turn to Craigslist for affordable prescription medications.
State, federal proposals to lower prices
Colorado became the first state to limit insulin prices in May 2019, setting a cap for insulin copays at $100 per month for private insurers. Illinois and New Mexico passed similar legislation, and several other states are also considering caps.
At the federal level, the bipartisan Insulin Price Reduction Act was introduced to the Senate in July 2019 and to the House in October 2019. The bill would not allow insurers to receive rebates for insulins and would require manufacturers to change their list price for insulins to the 2006 list prices.
“Rebates have been a significant factor in what’s driving insulin prices higher, but we know we cannot simply restrict rebates with no strings attached for big pharma — there needs to be accountability,” Sen. Jeanne Shaheen, D-N.H., who introduced the senate bill, said in a press release. “That’s why this bill is so important — it reduces costs and includes mechanisms to hold health care middlemen and insulin manufacturers responsible for keeping prices down.” – by Erin Michael
Reference:
Ahamed A, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2019.7514.
Cefalu WT, et al. Diabetes Care. 2018; doi:10.2337/dci18-0019.
Congress.gov. H.R.4906 – Insulin Price Reduction Act. https://www.congress.gov/bill/116th-congress/house-bill/4906/text. Accessed February 28, 2020.
Congress.gov. S.2199 – Insulin Price Reduction Act. https://www.congress.gov/bill/116th-congress/senate-bill/2199/text. Accessed February 28, 2020.
NPR. At 25 Years, Understanding The Longevity Of Craigslist. https://www.npr.org/2020/02/24/808965078/at-25-years-understanding-the-longevity-of-craigslist. Accessed February 26, 2020.
Wineinger NE, et al. JAMA Netw Open. 2019;doi:10.1001/jamanetworkopen.2019.4791.
Disclosures: Goldstein and Himmelstein report no relevant financial disclosures.