Like his fellow Type 1 diabetics, Alec Smith took insulin every day to regulate his blood sugar. Costs to treat his condition topped $1,000 per month, most of that going to insulin, and Alec made the difficult decision to ration his insulin to save money after aging off his mother’s health insurance plan.
Rationing insulin is a delicate process for diabetics. The body’s insulin needs can fluctuate significantly due to changes in diet, exercise, stress, poor sleep, or other medications, and diabetics must constantly monitor their glucose levels even when taking insulin as directed. When a person’s blood sugar gets too high, the body goes into diabetic ketoacidosis, which releases dangerous amounts of acid into the bloodstream and, if left untreated, can result in death — as it unfortunately did for Alec Smith in 2017. His mother, Nicole Smith-Holt, told CBS News, “I think if the price of insulin in 2017 had been $35, Alec would still be alive today.”
Alec was not alone. A 2022 study from the Annals of Internal Medicine found that one in six Americans who take insulin have rationed their dosage due to cost concerns. Some brands of insulin have been in shortage multiple times since 2023, leading to congressional inquiries of major insulin producers in the country. Nearly 30 million Americans have diagnosed diabetes (Type 1 or Type 2), and more than 7 million require daily insulin.
The problem isn’t limited to insulin. Across the U.S. biopharma industry, supply chain gaps and delays and impaired coordination have led to rising consumer costs and mounting shortages. The American Society of Health-System Pharmacists counts more than 200 U.S. drug shortages, with critical medications used to treat cancer as well as sterile injectables and generic drugs among the deficiencies.
“Make no mistake, drug shortages are not a passing storm that will soon blow over,” said Allan Coukell, senior vice president of public policy for pharmaceutical manufacturer Civica Rx, during a 2023 congressional hearing. “After a dozen years, shortages must now be understood as a built-in and permanent outcome of our current system.”
Civica, a nonprofit generic drug company with a growing presence in the central Virginia cities of Richmond and Petersburg, is one of an increasing number of forward-thinking Virginia companies focused on making medicine like insulin more accessible — targeting shortages while making biopharmaceuticals more affordable for consumers. Across Virginia, innovation and collaboration have transformed the Commonwealth into a thriving ecosystem that’s making a difference nationally.
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