Politicians and patients are demanding urgent action be taken to tackle America’s growing insulin crisis, which has seen the price of the lifesaving drug triple over the last decade.

But who is to blame for the skyrocketing costs and what can be done about it?

How big is the problem?

Insulin - a hormone people with type one diabetes need to survive - was invented nearly 100 years ago. The patent was sold for just $1 so that everyone who required the medication could afford it.

Now, retail prices in the US are around the $300 range, according to the BBC’s Ritu Prasad. “Even accounting for inflation, that’s a price increase of over 1,000%,” she says.

Many diabetics have resorted to crowdfunding in order to cover the out-of-pocket costs of their prescription, while others travel to Mexico or Canada where the drug is available at a fraction of the price.

Though most people in the US don’t pay the full list price for insulin because of insurance coverage and other rebates, some do, especially those who are uninsured, underinsured or facing a coverage gap through Medicare, the Washington Post magazine reports.

“People spend most of their life in fear of losing their insurance, of running out of insulin and the cost going up, or of having to stay in terrible jobs or relationships to ensure they keep their health insurance coverage,” says Elizabeth Rowley, founder of T1International, a non-profit advocating for affordable, accessible diabetes care worldwide. “That’s the best-case scenario.”

In other cases, diabetics are being forced to ration their insulin supplies which can lead to heart irregularities, seizures, loss of consciousness and death. According to a study by Yale University, one in four people with diabetes in America have cut back on their insulin use because of cost.

What has caused the crisis?

The three drug firms that control the market – Eli Lilly, Sanofi, and Novo Nordisk – have been accused of price fixing and several lawsuits against them are currently making their way through federal court.

However, the companies deny any wrongdoing and lay the blame at the door of insurers. “It’s almost like Kabuki theatre where one guy points to the other guy and says, ‘It’s not me, it’s him,’” says Jing Luo, an instructor at Harvard Medical School who studies insulin pricing.

Dr William Cefalu, chief scientific, medical and mission officer at the American Diabetes Association says the root cause of the crisis is complex.

“The system is dysfunctional. There are issues at each level, at each stakeholder in the insulin supply chain,” he says. “We can’t point the finger at one particular entity.”

What’s being done about it?

Lawmakers on both sides of the aisle say tackling the soaring cost of insulin and other prescription drugs is a top priority. In January, Congress began a series of hearings to investigate the issue.

On the campaign trail in 2016, Donald Trump “railed against high drug prices, and his administration has vowed to lower them, releasing a flurry of proposals in the past year,” says The Post.

But critics, including Dr David Nathan, director of the Diabetes Center at Massachusetts General Hospital, say the proposed reforms do not go far enough.

“There are no adults in the room,” he told Men’s Health. “There is no one telling the pharmaceutical industry, ‘You can’t do what you want.’”