Last week I traveled to Indianapolis to participate in a diabetes blogger summit held by Novo Nordisk. When I was invited Novo told me that we would speak about a number of issues revolving around living with diabetes. Initially, I wasn't thrilled about the prospect of flying, missing time at home and the rest that comes with business travel. But in the end the promise of having a conversation about insulin pricing got me on that plane. - commuter flights, bumpy.
The summit spanned two days. We spent our mornings in a conference room and the afternoons at the Indianapolis Motor Speedway where we meet with Charlie Kimble (T1D/Indy Driver/Novo Spokesperson). I even saw some of (had to get on a plane) a real Indy car race. - not a huge race fan but it was cool.
I arrived in Indy with my own incomplete thoughts and perspectives about insulin pricing. I believe that insulin should be affordable for all but I knew going in that I didn't fully grasp the complexity of the issue. My desire for this trip was to get closer to clarity on this big subject and I did in many ways. It was interesting to hear directly from an insulin maker and I felt that we were being spoken to rather candidly. But I'd be lying if I didn't tell you that there were moments in the conversation when I just wanted to yell, "make it cheaper". However, the more I learned the less realistic my primal urge felt. Make it cheaper may be what's right but wishing it so isn't how this is going to happen. One of the people from Novo, had what I considered to be, a complete grasp of the issue. I'm trying now to get him on the Juicebox Podcast because I want you to be able to hear what we all heard in that conference room. - so you can decide for yourself.
If you think that you have a commonsense idea that fixes the problem - I promise that you don't. The issue of insulin pricing, in my estimation, is a microcosmos of every political stalemate that I've ever considered. On the surface it feels like someone just needs to do the "right thing". Problem is, there are too many 'someones' and they all hold a different version of what doing the 'right thing' means. - no magic wand.
I left the summit with one concrete belief. This is isn't getting fixed anytime soon without a reimagining of the process. I saw a flow chart (available here) that proved to me that there isn't simply a "bad guy" that needs to be stopped. For example, it seems to make sense that Pharma should just drop their price. But when you look further you find that If they do PBMs (Pharmacy Benefits Managers) could and more likely would remove that insulin in favor of one that they (PBM) could make more money with. Every "fix" scenario that you can conceive, someone in that room floated that idea. They all played out the same way. "Hey what about this....". "That won't work because...". - defeating but enlightening.
takeaway. The world doesn't work the way it should. Right doesn't always win. But the good news is that once we understand the complexity of the problem we can actually find a real and lasting solution. Simply yelling, "make it cheaper" isn't going to help. I had an alternative idea in the room and I shared it. I talked about changing distribution, eliminating PBMs and removing the entities that scrape profit from your drugs. I don't know if that could ever happen but I do know that I saw some smiles on some faces and they made me think that I wasn't the first person to say that out loud. That made me feel hopeful, like someone was trying to find a new and better way. In my opinion the best thing that you can do as an outsider is to first understand the complexities associated with this battle and then speak up. Your voice will only ring clear when you are asking the right questions and pressuring the right people. I guarantee that just yelling "cheaper" isn't getting us anywhere. It can't. This mess is well beyond being righted by good thoughts and righteous sentiments. It needs new ideas, constant positive pressure from us and a willingness from Pharma to be the change that this paradigm needs.
the rest. Novo Nordisk paid for my travel, lodging and meals. In return I sat on a rather uncomfortable chair in a florescent conference room and got to see pit row at Indy. My plane ride home was turbulent and I ended up exhausted on Mother's Day. Charlie Kimball is one handsome fella. Race cars are cool in person but racing is repetitive to watch. I hope to bring you more information with the relationships that I tried to foster during my trip. Oh also... a high up person at Novo has an Instagram about soup. In the end these are my thoughts untouched by any influence.