I’ll never forget the first time I witnessed a child hoard food. It was my 3-year-old foster sister, who had just been living with my family for a few months. Despite having regular meals and snacks and a fridge full of food, she gobbled each meal like it was her last and hid food in the palms of her tiny hands. Neglect and abuse often leave people scarred for years, if not for life. It’s hard to learn to trust anyone when your most basic needs for existence have been neglected.

I’ve been thinking about this since the pharmaceutical maker Eli Lilly announced it was lowering the price of several insulin products by up to 70%, capping out-of-pocket costs at $35, including guaranteeing uninsured individuals access to $35 insulin.

Lilly, along with the other two major insulin manufacturers Novo Nordisk and Sanofi, has abused patent laws to prevent the introduction of competition insulins and raised the list price of the life-saving insulin by more than 1,200%. While the manufacturing cost for a vial of insulin has been estimated between $3.69 and $6.16, it now sells for over $300 (patients need several per month). Consequently, insulin-dependent patients have been held hostage by manufacturers and many have died from insulin rationing.

For years the insulin crisis has made headlines. I’ve helped pass several pieces of insulin legislation in Maine, including a bill providing Mainers with emergency access to insulin. Eli Lilly, as well as diabetes organizations that receive funding from insulin manufacturers, tried to block it. While there have been investigations  and some action, advocates have been fighting for federal regulation. The Biden administration did pass legislation to help some seniors, but the most vulnerable remain helpless.

I understood how last week’s announcement might have felt like a victory to some. But for me, I felt a bit like my little foster sister sitting at the table not believing she’d get fed the next day. I said to myself, “It’s a PR stunt. They’re lowering the price. But for how long?”

Was I too cynical? Had my experience in politics, advocacy, and policy jaded me so much that I couldn’t even take a win when it was right in front of me? I asked my two teenagers (one of whom is insulin-dependent) for their thoughts.


It took them fewer than five minutes to ask and conclude the following: If Eli Lilly lowers the prices today, might people not abandon any legislative efforts at the state and federal levels thinking they’re no longer necessary? (Yes.) What prevents Eli Lilly from raising prices in the future? (Nothing) Who will notice? (Anyone who uses insulin.) Will allies still be around to help? (Unlikely, because they’ll think the problem has been solved.) So, what is really needed? (A federal price cap on the list price of insulin.)

This doesn’t diminish the importance of Eli Lilly lowering their pricing. In fact, in doing so, Eli Lilly has done advocates a favor by making the case for a federal price cap. For years, manufacturers have claimed they couldn’t lower their price – that they weren’t really profiting from insulin, that the middlemen Pharmaceutical Benefit Managers (PBMs) were. Moreover, drugmakers insisted high prices were necessary for research and development of new drugs. Such arguments have always been labeled as bogus by advocates as year-end reports have told a different story.

Now that Lilly has lowered its prices, it’s tipped its hand. Lilly can afford to sell insulin at a lower price, keep its shareholders happy, and continue research and development. And it will still make a profit. Therefore, nothing should prevent them from supporting federal regulation that guarantees insulin can remain affordable.

That’s why Sen. Bernie Sanders of Vermont and Rep. Cori Bush of Missouri introduced the Insulin for All Act of 2023 on Thursday. (I worked with Bush’s office on an earlier version of this bill, and I volunteer with a nonprofit that endorsed the Sanders-Bush bill.) Unlike the proposal from Missouri Sen. Josh Hawley, the Cap Insulin Price Act, which only covers people with insurance, this bill covers everyone and caps the list price of insulin at $20.

While the federal government works on passing this critical legislation, what should states do? They should pass anything they have in the pipeline. Maine politicians on both sides of the aisle recognize price-gouging when they see it. Senate Minority Leader Trey Stewart, a Presque Isle Republican, introduced legislation last year to form a commission investigating Maine producing generic insulin. (I helped Sen. Stewart with the amendment and served on the commission.) This session, Senate President Troy Jackson, a Democrat from Allagash, plans to propose a bond for the construction of a facility to manufacture and distribute insulin.

Was Eli Lilly’s move an act of benevolence? Of course not. We now know that by lowering prices, Lilly avoided paying big rebates to Medicaid. Novo Nordisk and Sanofi may yet follow suit, but advocates aren’t going away. They want more, and so should you.


Hilary Koch lives in Waterville. She can be reached at: hilarykoch@pm.me

Comments are not available on this story.