Without insurance, the cost of medications for diabetes and asthma can be prohibitively expensive. Physician Jennifer Goldstein, a Program Director for Clinical Research at ChristianaCare in Newark noticed that some of her patients were finding less pricey alternatives. To understand more about unregulated market places, like Craigslist, Goldstein turned to Rosemary Frasso, PhD, program director of Public Health at Jefferson College of Population Health, a qualitative research scientist.
Life-Saving Drugs on Craigslist
Research shows a market for the sale of essential medications for asthma and diabetes, typically at lower prices on a popular online market-place.
Rosemary Frasso, PhD
With two of their students, Akram Ahamed (University of Delaware), and Kimberly C. Kullmann, Jefferson MPH graduate and current med student at Cooper, the team took a 12-day snapshot of all of the albuterol inhalers, insulin, and EpiPens being offered for sale across 50 states, in the summer of 2019. They compared the prices on Craigslist to the retail price of the medicine on Drugs.com and qualitatively explored the Craigslist posts to get a better understanding of this unregulated market place.
Their study was published in JAMA Internal Medicine on February 17th, 2020.
“I see the value in using the tools of population health research to find the stories hidden in the nooks and crannies of society,” says Dr. Frasso. “Sometimes we extract those stories from people, other times, as in this case, we look at artifacts of the modern world such as data from craigslist, to shed light on what it is like to live with a disease and deal with access to life saving medication.”
In some cases, the retail cost of a medication was 10 times greater than what could be found on Craigslist. “This is another argument for why these drugs needs to be more affordable,” says Dr. Frasso. “Patients who turn to cheaper, unregulated outlets are taking risks, and may not be getting the same benefit of clinical follow up. Insulin has to be stored appropriately, in order to be effective. Who knows if the insulin patients are buying is still good.”
We spoke with Dr. Frasso about the study and what it means for patients and clinicians.
Question - Why did you choose to look at these three life-saving medications?
Answer - Access to these medications is a huge challenge for people in our country and around the globe. These drugs save lives and being able to afford them is key.
Q Why do you think this phenomenon is as common as it is?
A - Many people who are selling insulin online, are motivated to do so, because they know how hard it is for others to gain access to this life saving medication others are desperate to make ends meet and sell some of their supply to address other more pressing needs. The real question here is, how did we end up in this place and what can be done?
Q What reaction do you expect from this paper?
A - We are not trying to get people in trouble, in fact, I have to confess I worry that this work could reduce access for some people and that, for very obvious reasons, is not good. We wanted to shed light on the fact that people are desperate, they need their medication, they can’t afford it, and they are forced to look elsewhere, take risks and compromise the quality to survive. It is simply wrong.
This paper is a cry for a policy response. Insulin brands that sold for about $40 in 2001 now sell for $289.
Q What lessons should the medical field take from this study?
Providers need to know this is happening so they can help patients gain access to safe medication and this should be a wake-up call for all of us.
Q What’s the right way to address this problem?
There are important policy solutions. The Governor of Illinois recently signed a law to cap the cost of insulin to no more than $100 per month. Patients ration their insulin supply to make it last longer, and that’s not an effective way to keep diabetes in check.
