"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Thursday, 5 August 2010

Prescription Rationing

Yes, it is coming. The most vulnerable in our society - the sick - will find that in David Cameron's Big Society they are too expensive to be kept alive.

I have type 1 diabetes, I have had the condition for 35 years, ever since I was a boy. It is not my fault, it is a genetic condition. I am kept alive by regular injections of insulin. I take two, a short acting one (about £2 per ml) and a long action one (about £1.80 per ml). Without the insulin I would be dead in a few days, or maybe a couple of weeks. If I have too little insulin, or the wrong type, then it leads to complications. Insulins have changed a lot in 35 years, and understandably my control was not perfect when I was younger when I took the older, less effective, insulin. I am paying for that now. Five years ago I lost the sight in my right eye, but an operation from a skilled NHS surgeon restored my sight. The operation clearly cost money, and this is the cost of the poor control that the old insulins offered. Keeping your sight is a big incentive to look after yourself.

Insulins have changed over the years. Some have given improvements, others have not. Different people are suited to different insulins. I use human insulin - produced commercially by genetically engineered yeasts - and these suit me. They are not perfect, but my control is good enough to reduce the likelihood of complications. The human insulins I take are very common and are the cheapest on the market. Inevitably, when new insulins become available they will be more expensive and the drug companies will try to get as many people to use them.To do this their marketing people will tell doctors how wonderful the insulins are, and while this maybe true for some people, it is not necessarily true for all. 

About a decade and a half ago insulin analogues became available on the NHS and these were supposed to be the wonder drug for diabetics. I tried one short acting insulin analogue for a year (current price of this £3.20 per ml, so 50% more than my current insulin) and my control went haywire. I could not manage my blood sugar and I put on weight. I decided to go back to the human insulin and my control returned. So I was back on the cheap, but suited-to-me, human insulin.

Sometimes the drug companies use less acceptable methods to persuade you to move to their new products. Five years ago the manufacturer of the short acting insulin I take said that they would no longer produce it. (Interestingly, I can still find it sold online at £2.40 per ml.) Can you imagine how I felt? This was a drug that kept me alive and I was given just 2 months notice of it being withdrawn. Luckily I had a scheduled appointment with my diabetic specialist before that deadline. The recommendation from the drug company was to use their short-acting insulin analogue (current price £5 per ml). This was equivalent to the one I had tried five years before and with which I had problems. So my doctor put me on another short acting human insulin from another manufacturer (current price £2 per ml), and it turns out that I am suited to that. The drug company wanted the NHS to pay two and a half times more.

At the same time the doctor thought he could improve my control by changing my long acting human insulin to a long acting human insulin analogue. When I got home I looked up the new insulin on an internet pharmacy and found that it cost four times as much as the human insulin I was using before (current price £7.50 per ml as opposed to £1.80 per ml). Is the cost a problem? Well not really, if you consider that better control could mean that I avoid costly treatment for the complications of diabetes.

It turned out that I was not suited to the expensive long acting human insulin analogue. And after three years of battling with my blood sugar I took another unilateral decision and changed back to the cheaper long acting human insulin.

Why do I mention this? Well today I see that the National Prescribing Centre have issued cost-cutting guidelines to GPs and the long acting insulin analogue that I was using until the beginning of last year is on the list.Voluntarily my body had saved the NHS some money and cut my costs of long acting insulin usage by a quarter. However, it worries me how far this cost-cutting will go.

The figures I have give above are from here, of course, you cannot buy insulin without a prescription. If you want to know how much my insulin costs per day, here are the figures.

3 x 0.24 ml @ £2.00 per ml = £1.44
0.70 ml @ £1.80 per ml = £1.26
Total = £2.70

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