* Keith Hernandez at the DeKalb Daily Chronicle…

The rising cost of insulin was not on Stacey Roman’s mind when her son Conner almost slipped into a diabetic coma last year, but now that she has learned the condition is treatable, the cost of treatment itself is her biggest concern.

“I understand you have a product and you need to make some sort of money out of it,” Roman said about the cost of insulin. “But it only costs a fraction of what they’re charging.”

The price of insulin between 2002 and 2013 about tripled for the 7.4 million Americans dependent on the hormone, according to the American Diabetes Association – a trend Roman said makes her worry for the financial future of her family.

* From Lee Enterprises Central Illinois…

“Daily, I’m hearing (from patients) that the cost of managing their diabetes is increasing and not affordable,” said Paige Beal, certified diabetes educator (CDE) and registered dietitian (RD) with Advocate BroMenn Medical Center in Normal.

“Last week, I saw a client who stopped taking his insulin because he couldn’t afford it after there was a change in his insurance plan,” Beal said. “The out-of-pocket cost was too great for him. He ended up in the emergency room because he wasn’t taking his insulin.”

He was treated and his fortunes improved because he now has different insurance and can afford to take his insulin again, Beal said. But not all patient stories take a positive turn.

Paula Enstrom, a CDE and RN with Sarah Bush Lincoln Health Center in Mattoon, had a type 1 diabetes patient last year who could no longer afford insulin medicine, stopped taking it and ended up in the emergency room where he received an emergency supply.

* Pharmacy benefit managers are apparently at least partly to blame here…

In order to secure market share in crowded treatment areas, drugmakers offer discounts to pharmacy benefit managers — middlemen who negotiate drug prices for health plans. Bigger rebates make the benefit managers happier, so firms have an incentive to boost prices. The result is an inflated list price for medicines such as Humalog that’s far higher than what’s actually paid in practice. The problem is, people who lack coverage, have high deductibles or pay co-insurance don’t benefit from those discounts. They’re exposed to the list price and face bruising costs at the pharmacy counter.

* Sen. Andy Manar has been especially critical of PBMs. From late May…

A bill moving through Springfield would cap co-payments for insulin at $100 per month, regardless of the supply someone needs.

State Sen. Andy Manar (D-Bunker Hill) is sponsoring Senate Bill 667. If passed, Illinois would become the second state to cap insulin payments.

Studies show the price of insulin tripled between 2002 and 2013.

“In the last 20 years or so we’ve seen the price of insulin rise to outlandish levels,” said Manar in a statement. “We have a responsibility as lawmakers to help get these prices under control and make this life-saving medication more available to those who need it.”

Manar’s legislation got stuck in the Senate during the spring session. Opponents included the Illinois Retail Merchants Association, insulin maker Novo Nordisk, the Illinois Manufacturers’ Association, BlueCross BlueShield of Illinois, Eli Lilly, the Illinois Biotechnology Innovation Organization, the Illinois Insurance Association, the Illinois Life Insurance Council and the Pharmaceutical Research and Manufacturers of America.

* Related…

* Walmart’s $25 insulin can’t fix the diabetes drug price crisis: Doctors and diabetes advocates point out that while ReliOn may help patients in a pinch, especially those without health insurance, it’s also a formulation (known as “human” insulin) that came on the market in the 1980s, more than a decade before more refined insulins started to emerge. The newer insulins, known as analogs, appear to be more effective at preventing dangerous blood sugar swings in people with Type 1 diabetes or those at a higher risk for severe low blood sugar. … There’s one more problem: Because it’s available without a prescription, patients can get the drug without the supervision of a doctor, and they sometimes get into trouble as a result. So stories have surfaced about patients who required emergency care because of severe blood sugar highs and lows after self-dosing with Walmart insulin, or even dying as a result.

* The cost of insulin drives diabetics and their families to Canada