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<ul class="summary-list"><li>The main love interest in <keyword id="128682" type="COMPANY" weightage="60" keywordseo="Netflix">Netflix</keyword>'s controversial comedy "<keyword id="7496509" type="UNKNOWN" weightage="60" keywordseo="emily-in-paris">Emily in Paris</keyword>" has said that he partly understands why critics have panned the show. </li><li>"I think they're right in a way," Lucas Bravo said <a href="https://www.cosmopolitan.com/entertainment/celebs/a34314614/lucas-bravo-gabriel-emily-in-paris-interview/">during an interview with Cosmopolitan</a> about French critics panning the show. "We're portraying clichés and we're portraying one single vision of Paris. Paris is one of the most diverse cities in the world. We have so many ways of thinking, so many different nationalities, so many different neighborhoods."</li><li>He continued: "A lifetime wouldn't be enough to know everything that's going on in Paris. It's an entire world in a city. At some point, if you want to tell a story about Paris, you have to choose an angle. You have to choose a vision. French critics, they didn't understand the fact that it's just one vision."</li></ul>The main love interest in Netflix's controversial comedy "Emily in Paris" said he partly understands why critics have panned the show."I think they're right in a way," Lucas Bravo, who plays chef Gabriel in the show, said <a href="https://www.cosmopolitan.com/entertainment/celebs/a34314614/lucas-bravo-gabriel-emily-in-paris-interview/">during an interview with Cosmopolitan</a>."We're portraying clichés and we're portraying one single vision of Paris. Paris is one of the most diverse cities in the world. We have so many ways of thinking, so many different nationalities, so many different neighborhoods. A lifetime wouldn't be enough to know everything that's going on in Paris. It's an entire world in a city."The 32-year-old French actor continued: "At some point, if you want to tell a story about Paris, you have to choose an angle. You have to choose a vision. French critics, they didn't understand the fact that it's just one vision. They're like, 'Oh, this is not what Paris is.' Of course. Paris is many things."<div type="image" title="lily collins emily in paris" height="2400" width="3600" msid="78641219" hostid="261"></div>Despite being a huge hit for Netflix, critics across the board (particularly French critics) have slammed the show for indulging in outdated and offensive stereotypes that present Parisians as rude, sexist, and elitist.The show follows Emily Cooper (Lily Collins) a young marketing executive who, despite not being able to speak any French, moves from Chicago to Paris to join the ranks of a high-end digital marketing firm, and she stumbles her way through the city failing to connect with her colleagues or adapt to French culture.Even though Netflix has yet to officially renew the show, fans as well as the show's creator Darren Starr who is best known for his work on "Sex in the City," are already talking about a second season.<a href="https://www.oprahmag.com/entertainment/a34150827/emily-in-paris-season-2-release-date-cast-news/">Speaking with Oprah Magazine Star said</a>: "In season 2, she's going to be more of a part of the fabric of the world she's living in. She'll be more of a resident of the city. She'll have her feet on the ground a little more. She's making a life there."Read More: <a href="https://www.insider.com/emily-in-paris-unrealistic-moments-season-one-netflix-2020-10#gilbert-group-a-large-marketing-corporation-sends-an-employee-who-doesnt-speak-french-to-work-at-a-parisian-marketing-firm-1">The 23 most unrealistic moments from Netflix's 'Emily in Paris'</a><a href="https://www.insider.com/netflix-original-tv-shows-ranked-2020">The 41 best Netflix original TV shows of 2020 so far, ranked</a><a href="https://www.insider.com/netflix-tv-shows-cancelled-ending-2020-9">Netflix has a TV show problem</a>

'Emily in Paris' star says he partly understands why critics panned the 'cliché' Netflix show

<ul class="summary-list"><li>Several leading <keyword id="1754604" type="PERSON" weightage="60" keywordseo="coronavirus">coronavirus</keyword> clinical trials are focusing on testing experimental combinations of medicine to treat COVID-19.</li><li>These studies are building on top of the early success of <keyword id="8775508" type="UNKNOWN" weightage="60" keywordseo="remdesivir">remdesivir</keyword>, an <keyword id="107523" type="PERSON" weightage="60" keywordseo="Antiviral">antiviral</keyword> drug developed by Gilead Sciences that helped hospitalized COVID-19 patients recover modestly faster.</li><li>On Friday, the US National Institutes of <keyword id="6354750" type="UNKNOWN" weightage="60" keywordseo="health">Health</keyword> launched a massive study that will test three drugs seeking to tamp down a runaway immune response in COVID-19 patients. These drugs will be tested in addition to giving remdesivir to the trial participants.</li></ul>The US National Institutes of Health is launching its latest round of clinical trials, announcing plans on Friday to test three immune-modulating drugs in combination with the antiviral treatment remdesivir. <a href="https://www.gilead.com/news-and-press/press-room/press-releases/2020/4/gilead-announces-results-from-phase-3-trial-of-investigational-antiviral-remdesivir-in-patients-with-severe-covid-19">On April 29</a>, an <keyword id="204101" type="ORGANIZATION" weightage="60" keywordseo="NIH">NIH</keyword> trial found remdesivir helped hospitalized COVID-19 patients recover modestly faster. The typical patient given <a href="https://www.businessinsider.com/coronavirus-treatment-gileads-remdesivir-clinical-testing-timeline-2020-3">remdesivir</a> showed improvement in 10 days, five days sooner than the typical patient given a placebo IV infusion. On its own, remdesivir is not a transformative treatment for COVID-19. A World Health Organization study found it <a href="https://www.who.int/news/item/15-10-2020-solidarity-therapeutics-trial-produces-conclusive-evidence-on-the-effectiveness-of-repurposed-drugs-for-covid-19-in-record-time">didn't prevent people with the novel coronavirus from dying,</a> which aligns with the weak benefit found in the NIH study. But ever since those remdesivir results were first announced, researchers <a href="https://www.businessinsider.com/coronavirus-treatment-gileads-remdesivir-combination-research-2020-4">have eyed combinations</a> of <keyword id="395015" type="PERSON" weightage="60" keywordseo="Treatments">treatments</keyword> to ultimately be a medical breakthrough. That would mimic the playbook used to treat HIV, where three-drug cocktails led to dramatic improvements in patients."We know clearly, as instructed by the global experience in HIV, that combination therapies often have advantages compared to single-drug therapy," Dr. Andrew Badley, director of the Mayo Clinic's HIV Immunology Laboratory, <a href="https://www.businessinsider.com/coronavirus-treatment-gileads-remdesivir-combination-research-2020-4">said in an April 30 interview with Business Insider</a>.<a href="https://www.businessinsider.com/coronavirus-vaccine-timeline-what-to-watch-leading-research-2020-3"></a>In the latest NIH trial, said Friday, researchers will recruit 2,100 hospitalized patients to test three immune-modulating drugs in combination with remdesivir.The three treatments being tested are Johnson &amp; Johnson's anti-inflammatory drug Remicade, Bristol Myers Squibb's arthritis treatment Orencia, and AbbVie's experimental treatment called cenicriviroc. Patients will be randomized to receive either one of those three drugs or a placebo."These are the therapeutic we are betting on most strongly," said NIH Director Dr. Francis Collins on a Thursday call with reporters.Read more: <a href="https://www.businessinsider.com/coronavirus-vaccine-timeline-what-to-watch-leading-research-2020-3">2 drugmakers just hit setbacks in the coronavirus vaccine race, while 2 others forge ahead. Here's everything we know about the timeline for a COVID-19 vaccine and when you might be able to get a shot.</a>All participants will also receive remdesivir. Physicians can also give convalescent plasma or dexamethasone to trial participants, based on their own discretion.<h2>Shutting down an overactive immune system</h2>This latest study is specifically geared to fight the <keyword id="2747516" type="PERSON" weightage="60" keywordseo="cytokine">cytokine</keyword> storm associated with severe COVID-19 cases. Collins likened the virus to a small kitchen fire and the immune system to a sprinkler system. The goal is for the sprinklers to extinguish the flames.But when the sprinklers don't shut off, the water damage can be even more extensive. For critically ill COVID-19 patients, the worst of the disease is often caused by the body's own overactive immune response instead of the actual virus."These three drugs are aiming to try to get the balance just right for those people where the sprinklers seem to be going much too strong and they're in the ICU with serious lung issues," he added. "You want to try to rescue them from what otherwise could be a really terrible outcome."<h2>We could know in a few months if one of these combinations works</h2>The trial will likely need until next spring to fully complete, with the study requiring about six to eight months to enroll all the volunteers, monitor them, and analyze the data, said Dr. Christopher Austin, an NIH center director who helped design the research. But an independent board of experts will be able to take early looks at the data when the trial recruits 25%, 50% and 75% of the total trial population.If one of the drugs is overwhelmingly effective, that could be known in a couple of months, Austin estimated.The NIH's infectious disease unit previously tested a combination of remdesivir and Olumiant, an arthritis drug marketed by Eli Lilly. <a href="https://investor.lilly.com/news-releases/news-release-details/baricitinib-combination-remdesivir-reduces-time-recovery">Results announced in September</a> showed a slight but statistically meaningful benefit in adding Olumiant: a one-day reduction in median recovery time. The Indianapolis-based drugmaker <a href="https://investor.lilly.com/news-releases/news-release-details/baricitinib-has-significant-effect-recovery-time-most-impactful">is in talks with the US Food and Drug Administration</a> about potential emergency approval for Olumiant as a COVID-19 treatment. The NIH considered more than 130 immune modulators and selected these three based on "several factors including their relevance to COVID-19, strong evidence for use against inflammatory reaction and cytokine storm and availability for large-scale clinical studies."Read more: <a href="https://www.businessinsider.com/coronavirus-treatment-gileads-remdesivir-clinical-testing-timeline-2020-3">Here's how the biotech giant Gilead created the first effective coronavirus treatment and positioned it to be a blockbuster drug</a><h2>The NIH has a number of COVID-19 drug trials underway</h2>The NIH has launched a wide range of studies to test potential COVID-19 treatments. Ongoing NIH-ran coronavirus trials include: <ul><li>Testing a monoclonal antibody developed by Eli Lilly in two studies, respectively in hospitalized and non-hospitalized patients. The hospitalized trial was recently paused by a board of independent experts overseeing the research. Collins said that board will meet on October 26 to determine if enrollment should resume.</li><li>A trio of studies testing blood thinners in COVID-19 patients, hoping to prevent blood clots. These studies are testing Bristol Myers Squibb's Eliquis and aspirin in non-hospitalized patients, as well as heparin in hospitalized patients.</li><li>Two mid-stage studies for hospitalized patients, respectively testing AbbVie's psoriasis drug Skyrizi and Humanigen's experimental antibody treatment lenzilumab. Both these drugs are given in conjunction with remdesivir and will be tested against a group of patients only getting remdesivir.</li></ul>

Remdesivir proved to be the first useful tool we have in treating COVID-19 patients. Now, the US government wants to find out more about how it could be supercharged with other drugs.

<div class="KonaFilter image-container display-table"><div><div class="image on-image"></div></div></div>The <keyword id="79969" type="ORGANIZATION" weightage="100" keywordseo="insider">INSIDER</keyword> Summary: &#xa0;Legendary Hollywood figure Warren Beatty has been trying to make a Howard Hughes movie for decades.&#xa0; &#xa0;"Rules Don't Apply" is finally in theaters Nov. 23. &#xa0;It feels like a movie from a different era. And it's overcooked.&#xa0;<a href="http://www.vanityfair.com/hollywood/2016/07/warren-beatty-howard-hughes-rules-dont-apply">For&#xa0;40 years</a>, Warren Beatty has been trying to make a movie about the billionaire eccentric business mogul and artist Howard Hughes.&#xa0;It finally hits theaters Nov. 23."Rules Don't Apply" is Beatty's first movie since 1998's "Bulworth," the&#xa0;political satire that best predicted&#xa0;of Donald Trump's rise to power. It stars Beatty himself - now 79, the glory of "Reds," "Bonnie and Clyde," and "Bugsy" behind him - as Hughes. Lilly Collins stars as Marla Mabrey, a devout&#xa0;Baptist actress from Virginia who comes to Hollywood to become one of Hughes's many starlets.&#xa0;<a href="http://www.businessinsider.com/alden-ehrenreich-han-solo-2016-7">Alden Ehrenreich, soon to be known as Han Solo in a "Star Wars" spin-off</a>, stars as&#xa0;Frank Forbes, one of Hughes's many assistants.<a href="http://www.nytimes.com/2015/03/07/movies/if-warren-beatty-is-directing-shooting-can-wait-for-years.html">In</a> <a href="http://www.nytimes.com/2016/10/30/movies/warren-beatty-rules-dont-apply.html">interviews</a>, Beatty has talked about his painstaking, patient approach to writing and directing "Rules Don't Apply." He tinkered with the screenplay for decades and <a href="http://www.nytimes.com/2015/03/07/movies/if-warren-beatty-is-directing-shooting-can-wait-for-years.html">delayed the movie for years</a> as he perfected it in the editing room, occasionally re-shooting a scene he wasn't satisfied with.<div class="KonaFilter image-container display-table"><div><div class="image on-image"></div></div></div>As a finished film, "Rules Don't Apply" appropriately feels like a work&#xa0;from a different era. It's an old-fashioned movie with old-fashioned concerns. Beatty&#xa0;puts a couple of religious people in the setting of Hollywood's "loose" sexual morality, and lets the conflict play out. Mabrey&#xa0;and Forbes strike up a young romance, putting Forbes in conflict with his fiancée&#xa0;and Mabrey in conflict with her piety.It has long takes and long scenes. No actor's expression goes wasted. Every character has their say before the scene ends and the movie moves on. It's more a charming movie from&#xa0;1950s or&#xa0;'60s than a movie of 2016."Rules Don't Apply"&#xa0;is also, decidedly, a minor work. Beatty is ambitious - he attempts to plumb Hughes's psychological depths like few movies have done before, and the film takes place over the course of a decade - but still, it is small. The movie&#xa0;doesn't track the growth of Hughes's empire, like Martin Scorsese's biopic "The Aviator," or ever focus on more than just a few characters. Its closest cousin in Beatty's oeuvre is his gangster film, "Bugsy," in its portrait of an eccentric, ambitious, megalomaniacal rich man exhibiting power in&#xa0;Los Angeles. But while the main character in "Bugsy" tried&#xa0;to tackle the vast expanse of the Mojave Desert in an attempt to make a casino, Hughes in "Rules Don't Apply" is decidedly less ambitious. He isn't&#xa0;building anything. He's past the peak of his business acumen, at a point where he's just trying to maintain control of his company.<div class="KonaFilter image-container display-table"><div><div class="image on-image"></div></div></div>Not that being a minor work is necessarily a bad thing. "Rules Don't Apply" resembles "Café Society," Woody Allen's film from earlier this year&#xa0;starring Jesse Eisenberg, Kristen Stewart, and Steve Carrell. It's also a story about love and power in Hollywood (though this one is in the 1930s). The difference is that Allen's movie took a year to make while Beatty's is his first in 18. Allen's is kind of better.There are two types of scenes in "Rules Don't Apply": the Hughes scenes, and the romance scenes. The former&#xa0;show off the billionaire being eccentric, trying the patience of everyone around him. Sometimes he goes silent and unresponsive, like a sulking child, and sometimes he has&#xa0;outlandish demands for&#xa0;his underlings. The romance scenes, between Mabrey and Forbes, are on a totally different register than the Hughes scenes. They sometimes feel like they're from two different movies. And when either of them are in a room with Hughes, Beatty's performance dominates them both. He becomes the center of attention, not them. It's as if the movie is struggling between being a romance, and being a Howard Hughes biopic. It tries to be both, but the two elements don't work well together.And that's strange. For a movie that took decades to make, "Rules Don't Apply" - for all its charms - doesn't feel like the work of a perfectionist. The chemistry between Ehrenreich and Collins isn't totally convincing, especially by the end of the film.&#xa0;It feels overcooked."Rules Don't Apply" will be released November 23.&#xa0;You can watch the trailer below:<div></div> <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/austin-doughnut-truck-2016-11">These are the fattest doughnuts in Texas</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="k2YzBqNzE6hFKSOzl9RFPFA0L9aUjv_k" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div></hr>

Warren Beatty has been trying to make a Howard Hughes movie for 40 years -and he still couldn't get it right

<div class="KonaFilter image-container display-table"><div><div class="image on-image"></div></div></div><ul><li>Pharmacy benefit managers play a critical role in //WHAT?//</li><li>They've been attracting scrutiny, with some suggesting they're partly to blame for increasing drug prices.//RIGHT?//</li><li>The PBMs have come out swinging, making a case for why they are the solution, not the problem.</li></ul>The drug industry's largest middlemen are starting to attract scrutiny&#xa0;for their role in drug pricing. Their response: to come out swinging, and point the finger elsewhere.//FAIR?//Pharmacy benefit managers are the companies&#xa0;<a href="http://www.businessinsider.com/prescription-drug-costs-explained-2016-10">responsible for negotiating rebates</a> to the prices drugmakers set, and are meant to favor the most effective drug. This is meant to help keep prices low.&#xa0;Many question how effective they are at doing that, however and some have said&#xa0;they could be part of the reason why prices are skyrocketing. //RIGHT? HYPERLINK?////WHY DO PEOPLE THINK THEY COULD BE TO BLAME? LACK OF TRANSPARENCY?//Right now, there are three big PBMs that cover most of the roughly <a href="http://kff.org/other/state-indicator/total-retail-rx-drugs/?currentTimeframe=0&amp;sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">4 billion retail prescriptions</a> that were filled in the US in 2015: Express Scripts, CVS Caremark, and OptumRx.&#xa0;On Wednesday February 8, the companies' lobbying group - the Pharmaceutical Care Management Association - released a video explaining why it thinks certain kinds of pricing transparency is good, while other types are bad.&#xa0;The debate breaks down like this: PBMs negotiate rebates with the different drugmakers.&#xa0;The terms of these rebate&#xa0;contracts are variable and secret. The more lives a PBM covers, the more leverage it tends to have in negotiating steeper rebates, which is why some PBMs may walk away with rebates twice as big as those of their competitors.The lack of transparency has its pros and cons. On the one hand, having these contracts under wraps keeps a drug manufacturer from knowing what its competitor is getting as a rebate. If it knew, the company could argue it shouldn't have to pay a bigger rebate than the other.That's the same argument the PCMA video makes: that drug companies would take that rebate information and use it to collude with competitors.&#xa0;&#xa0;Watch <a href="https://www.youtube.com/watch?v=r5xhkF81LlY">the video</a>:&#xa0;But there are some cons to this lack of transparency, too. Without a clear picture of the rebates, the public's understanding of why the prices of prescription drugs continue to climb is limited to just the price we see at the pharmacy counter, or data based on the list price. Those numbers don't tell the whole story, however, because //WHY?//Still, with little or no transparency on the rebates //FAIR?//,&#xa0;we don't know how big a cut each part of the supply chain gets.It's something drug companies are starting to tackle, by <a href="http://www.businessinsider.com/merck-reports-average-list-and-net-prices-2017-1">revealing their net prices</a> after rebates and discounts, which often paint a much different picture than routinely increasing list prices. For example, Lilly, which has <a href="http://www.businessinsider.com/insulin-prices-increase-2016-9">routinely taken list price increases to its insulins</a>,//TAKEN INCREASES? DO YOU PASSIVELY INCREASE?// told Business Insider <a href="http://www.businessinsider.com/what-if-drug-companies-no-longer-took-routine-price-increases-2017-1">that the net price for its&#xa0;insulin Humalog</a> was down 24% in the third-quarter of 2016, from the third-quarter of 2015. The numbers coming out, however, tend to be on average, so the exact rebate different PBMs are getting is still under wraps.<h2>Mounting political pressure</h2>Drug companies are still&#xa0;facing&#xa0;the brunt of the criticism for drug prices from President Donald Trump, who has called the prices"astronomical," and supports having Medicare negotiate drug prices.But PBMs are in focus too. Republican Rep. Doug Collins is one critic, <a href="https://www.axios.com/this-member-of-congress-wants-to-go-after-pharmacy-benefit-managers-2245945146.html">telling Axios</a> "I truly believe the PBM industry is one of the most detrimental pieces of health care."&#xa0;The PBM lobby is preparing to aggressively argue its point, even in the absence of a concrete policy agenda from the president.PCMA CEO Mark Merritt said in a memo <a href="https://www.buzzfeed.com/azeenghorayshi/pharmacists-freak-out-over-trump?utm_term=.fsRdLwpOe#.de9rdWzJq">obtained by Buzzfeed News</a> that the group made that decision "given the political uncertainty, headline risk, and other unique challenges that come with a President more inclined toward quick, instinctive action than the traditional, deliberative decision-making process."And the companies the lobby represents are speaking up as well.&#xa0;<ul><li>Express Scripts, one of the three major pharmacy benefits managers in the US, <a href="http://www.businessinsider.com/express-scripts-report-on-prescription-drug-spending-2017-2">said in a report Monday that for its&#xa0;clients</a>, spending&#xa0;on prescription drugs was&#xa0;up 3.8% in 2016, far lower than&#xa0;growth in average list prices, which were up about 11%.</li><li>"Any suggestion that PBMs are causing drug prices to rise is erroneous," CVS CEO&#xa0;Larry Merlo <a href="http://www.forbes.com/sites/brucejapsen/2017/02/09/pharmacy-services-boost-cvs-health-amid-drug-pricing-battle/#2bc361d050f7">said in a call Thursday</a>. "We are the solution, not the problem."&#xa0;</li></ul>It remains to be seen where the conversation will go from here, but as the number of people on high deductible plans facing near-list prices for drugs <a href="https://t.co/TLYkOKZynr">continues to rise</a>, there will likely be more finger-pointing to come for&#xa0;the <a href="https://www.google.com/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=1&amp;cad=rja&amp;uact=8&amp;ved=0ahUKEwib7tLYxoPSAhWJ7oMKHUjUDDEQFggaMAA&amp;url=http%3A%2F%2Fwww.businessinsider.com%2Fprescription-drug-costs-explained-2016-10&amp;usg=AFQjCNGK8mn4-0VJv5PIDfsOWF81ek8W2Q&amp;bvm=bv.146496531,d.amc">pharmaceutical supply chain and its many players</a>.&#xa0;<div></div> <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/michael-lewis-german-feces-obsession-dukatenscheisser-2016-12">Michael Lewis reveals why some Germans are obsessed with 'human feces'</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="phYnhtODE6X-6u8DRXnuYjpUsARkYHdZ" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div>

One of the largest middlemen in the drug industry just released a video showing why it should be able to remain secretive

<ul class="summary-list"><li>Type 1 <a href="https://www.businessinsider.com/category/diabetes">diabetics</a> need <a href="https://www.businessinsider.com/category/insulin">insulin</a> to survive. Due to drastic price increases, many <a href="https://www.businessinsider.com/insulin-price-fluctuation-conundrum-type1-diabetes-2019-1">diabetics are struggling to afford the lifesaving drug</a>. </li><li>In the past 15 years, insulin prices have tripled. There are only three manufacturers who make insulin and decide the price for insulin - their <a href="https://www.businessinsider.com/insulin-prices-could-be-much-lower-and-drug-makers-would-still-make-healthy-profits-2018-9">prices have risen</a> at the same rates.</li><li>The insulin supply chain, like other <a href="https://www.businessinsider.com/pharma-asks-for-rebate-reform-to-lower-drug-prices-at-senate-hearing-2019-2">pharmaceutical medications</a>, is extremely complicated and opaque, so the consumer cannot see where prices get set and where they change throughout the supply chain. </li></ul>Following is a transcript of the video.Narrator: Many people in the United States can't afford insulin. The average price for one vial of insulin is about $285. Most diabetics need two to four vials per month. But here's the thing. Insulin prices weren't always this high. "Inexpensive, easily accessible."Narrator: A Type 1 diabetes diagnosis was a death sentence before this life-saving discovery.Commercial: "The all-essential insulin."Narrator: Without insulin, an essential hormone that regulates blood sugar, your body can't regulate how much glucose enters your cells, and your cells starve. The medical researchers who patented their invention in 1923 wanted insulin to be affordable for even the poorest sufferers from diabetes. Sure, there have been major improvements.Commercial: "This new genetically-engineered insulin has two distinct advantages."Narrator: The most recent was about 15 years ago. Insulin's still an old drug. It's shocking that the price has increased so dramatically. When a drug has been on the market for enough time, its patent expires, ending its reign of market exclusivity and opening the door to generic competition. This should drive the prices down.Jeremy Greene: And what's happening with insulin is a real violation of our expectations, because this is an old drug that is now becoming inaccessibly expensive, long after its worth has been proven, and long after that cost of original innovation of these drugs has already been recouped.Narrator: There are only three manufacturers making insulin for the United States drug market and the prices of their competing products have risen at the exact same rate. Even though the manufacturers have said that they set their prices independently, this shouldn't happen in a competitive market. Even the newest variation of insulin has long been approved by the FDA. So you might think that some essential innovations happened in the past few years to warrant such a price increase, well think again.Nicholas Argento: The products that are out are not really new. They may have tweaked the manufacturing process and the like and they have better delivery pens and the like, but the increase in price has been astronomical.Narrator: So the product hasn't really changed, just the packaging and delivery. And the high prices have pushed people to crowdsource money, using sites like GoFundMe.Tan Mitchell: My son had started to not take his dosages as prescribed, because he knew we were struggling with trying to come up with the funds to get more insulin for him. We had not met the deductible.Narrator: A diabetic with a high deductible insurance plan could pay for months of insulin prescriptions out of pocket until their their insurance kicks in.Dylan Porteus: The part that was at the forefront of my mind was that I might die from this, I might not get what I need. The deductible was 5, 6 thousand dollars. Even with them covering half, six vials of insulin, they wanted $837.Narrator: So how are these skyrocketing prices determined? The manufacturers make the drug and set the price. This is part of the reason why insulin is so expensive. There's no limit to how high the price can be set, and they don't have to disclose how they set it. The manufacturers negotiate with Pharmacy Benefit Managers to be placed on PBM formularies in exchange for rebates. These rebates and negotiations also don't have to be disclosed. Formularies are a list of medicines that the PBM offers. The PBM negotiates on behalf of insurance companies, and the manufacturers give rebates to PBMs in exchange for lower placement on an insurance tier system. The lower placement usually leaves the patient with one option, as it's the most affordable. It's a good place for a brand to be, but it's not always great for the patient. It leaves them with one option, and that option might not even be what their doctor prescribed.Julia Lerner: It almost feels like insurance is working against us, in a way. I say, so I need X, and they only cover Y. Or I need a certain kind of insulin, and they just, they say that's tough, sorry.Greene: This is all wrapped in a web of secrecy.Narrator: Business Insider reached out to the three insulin manufacturers. and they each cited the complexity of the supply chain as a reason for their high list prices.William Cefalu: We think there are incentives at every level of the supply chain that facilitate or even encourage the high list price from the manufacturers, to the wholesalers, to the PBMs, to the health plans.Narrator: And at this point, it's safe to call what's happening an insulin crisis. So why isn't the FDA intervening?Lydia Ramsey: The FDA can't do anything around price. So the FDA can't say, "You have to charge $150 for this, "and you can't do anything different." That's just not how it works in the US. Other countries can have a little bit more sway.Narrator: The US does not regulate prices. So that's part of the answer. Insulin's expensive because it can be. There's no limit to how high the price can rise. The FDA regulates and approves drugs and grants patents. In the US, a patent excludes others from making an invention for a limited time, usually 20 years. Some critics think that manufacturers of insulin are abusing patents.Susan Collins: For insulin, a careful look is warranted to determine if minor modifications were used to just extend the patent protections and discourage competitors.Tahir Amin: What it becomes then is just the patent system has become strategy and defensive tool. How can I strategize to keep my competitors off? Forget about the patent system being about progressing the sciences and the arts, as the Constitution says. It's become a business strategy.Narrator: But patents aren't the reason why a generic insulin doesn't exist. Unlike chemical medications, like Advil and Zestril, there's no generic insulin.Ramsey: With a chemical drug, you have the same chemicals in it every single time. When it comes to a biologic-based drug, like insulin, that's a much more lengthy process. You have to figure out how to make living cells look and feel exactly the same as the original version.Narrator: The FDA approval process is lengthy and usually more expensive. In fact, out of all medicines in the US, there are currently only 17 FDA approved biosimilars. In 2016, a follow on biologic insulin, which is close to a biosimilar, was approved by the FDA. It was made by one of the three manufacturers, Eli Lilly, which didn't exactly add a new competitor, and it didn't really help the price decrease, which leads patients on their own to find another option.Lerner: Here's a group where people can go and say I don't have the supplies I need, and I really need help.Andrew Livingston: It's very surreal to live in the United States and to buy life-sustaining medicine on the black market, you know?Marina Tsaplina: You have a way to get it, somehow, somewhere. You have doctors who are giving their free samples away.Livingston: The endocrinologist I saw would just give me whatever free samples she had lying around. Tsaplina: You go to Canada and buy your insulin.Narrator: Recently, the public has been paying attention to the patient-led movement for affordable insulin.Elizabeth Rowely: We really wanted to see people living with it who truly understand it being a voice for change.Tsaplina: You don't know if you will have enough of a freaking liquid that your whole life depends on. You don't know if you have enough life. That's what being not sure if you can afford your insulin means.

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