America is home to many things – baseball, apple pie, and, unfortunately for diabetics, some of the highest insulin prices globally. Despite having over 35 million diabetic people in the United States, roughly a 3rd of which require insulin prescriptions, America still makes up only 15% of the global insulin market. Despite being such a small minority, however, they also account for nearly half of the insulin-based revenue generated throughout the entire global insulin manufacturing industry.
Alarmingly, things only seem to be getting worse. Average per-unit insulin prices have increased an average of 11% per year, every year, between 2001 and 2018 – a figure vastly outpacing regular economic inflation. Diabetes is now firmly entrenched as the most expensive chronic illness in the United States.
For those Americans fortunate enough to receive health insurance coverage or Medicaid, this burden is eased somewhat. In this article, we explore some of the factors driving up the costs of insulin, and how various forms of healthcare coverage can make a difference to diabetic Americans.
What factors influence the cost of insulin?
The pharmaceutical and healthcare industries are complex, being made up of many different stakeholders with competing interests and many different moving parts. Drug manufacturers, healthcare providers, insurance companies, and government entities all influence the cost of insulin in ways that can be difficult to detect for the average insulin consumer.
Pharmaceutical manufacturers have perhaps the most direct impact on insulin prices. A small group of only three pharmaceutical companies controls the vast majority of insulin production, and could therefore be described as having somewhat of a monopoly in the insulin market. Because monopolies eliminate the competitive market forces that would otherwise act as a downwards pressure on prices, the cost of monopolized goods like insulin tend to be much higher than others. This factor is particularly strong where the product in question is a life-saving necessity – there will always be a massive demand for insulin, and people will pay whatever is necessary to access it.
Insurance providers also play a massive role in setting insulin costs for consumers. Unlike in most other countries around the world, healthcare insurance in the United States is privatized, and coverage is not guaranteed or standardized whatsoever. This means that there is massive variability between the coverage afforded by different providers and different plans, not to mention between the insured, the under-insured, and the totally uninsured. Some plans will be far more comprehensive than others, meaning they will absorb most of the cost, give greater flexibility in terms of which prescriptions they cover, and will have little or no deductible payment required to access coverage. Less comprehensive plans may have such a high deductible amount that most or all of the insulin cost is actually paid out of pocket.
Finally, government organizations and regulators have the potential to play a massive role in determining insulin costs – for better or for worse. Ultimately, legislative bodies at the federal and state levels have the power to enact laws and regulations that could curb insulin costs for consumers. Recent examples of such initiatives include the Affordable Insulin Now Act, which sought to cap insulin prices at the lower of either $35 a month or at 25% of the negotiated insurance price. The bill made it through the house of representatives in March, 2022, but its progress has stalled in the senate, making it unlikely to become law. Still, this and other recent legislative attempts to make insulin more affordable represent a legislative trend that is welcomed by millions of Americans.
Conversely, government regulatory agencies also play a role in enabling pharmaceutical companies to continue charging absurd amounts for their products. In particular, the U.S. Patent and Trademark Office, through its willingness to extend patents on older insulin formulations that would otherwise have lapsed and made way for cheaper generics, has kept costs of certain formulations artificially high – this process of renewing old patents is known as “Evergreening” and is a major factor in the high cost of insulin.
Recent Trends in Prices
Insulin prices typically tend to only travel in one direction – upwards. This has certainly been the case from 2012 onwards, with insulin prices outpacing inflation by very wide margins. However, price increases have stalled in recent years, with the averages leveling out and even decreasing slightly. There are several explanations for this surprising – but welcome – change in trajectory.
Generics and biosimilars
Due to the aforementioned tendency for constant patent renewal to limit the existence of generic alternatives, generic and biosimilar versions of insulin have not been widely available until very recently. It was only in 2019 when the first generic insulin – insulin lispro by Eli Lilly – was released. Only then did several other generic and biosimilar insulin and insulin mixtures become approved and released to the market, such as insulin aspart and insulin glargine.
Generics are typically far more affordable than their brand-name counterparts. This is for a number of reasons, including that biosimilar and generic manufacturers do not need to recoup the research and development costs associated with their newly-patented formulation, and because manufacturers can get away with charging more for a brand name because people associate them with higher quality. Whatever the reason, the fact is that generic and biosimilar availability has acted as a sudden downward force in the insulin market. Insulin manufacturers now have to content with the availability of radically cheaper alternatives to their flagship brand-name products, making it much harder to justify the incessantly steep price hikes they have gotten away with in the past.
Traditional versus modern
Not all insulin formulations are created equal, and this is reflected in their cost. While pharmaceutical manufacturers undoubtedly deserve criticism for the steep price tags they put on their newest product releases, they also deserve credit for creating truly innovative new products with real and tangible improvements over older versions. Recent innovations include ultra-fast absorption and action, non-insulin medicinal additives, and ultra-long action. While it can be debated whether the improvements are proportional to the associated cost increase, there is no question that older insulin products do not carry all the benefits of newer ones.
Nevertheless, many consumers are not in a financial position to choose the newest and best insulin product on the market, and will opt for the older, more traditional formulations in order to save on costs. The persistently low cost of these traditional insulin formulations have made it more difficult for manufacturers to sell their newer, pricier alternatives. Many people just aren’t willing or able to shell out the additional cash for what may be perceived as a minor relative benefit.
Different Coverage Levels and Their Effects on Price
Many Americans receive insurance benefits through private insurers, typically through an employer insurance plan. The extent of their coverage under such a plan can vary widely depending on the insurer and the level of coverage the employer has selected. Therefore, it is difficult to generalize the cost of insulin for an insured diabetic patient. Another reason it can be difficult to generalize is because some drug manufacturers will provide payment assistance plans that can ease some of the burden associated with the list price of the insulin. However, generally speaking, the out-of-pocket costs for insured Americans can still be steep, as they are often calculated as a percentage of the list price (called a “co-pay”) which can be substantial. In fact, 9% of privately insured diabetics report being unable to afford insulin despite their coverage.
Americans without private insurance may either access some coverage through Medicare coverage, or may simply be uninsured. While some benefits may be available through manufacturer programs, 68% of uninsured Americans are be on the hook for the entire list price of insulin which can range from $175 to $300 per vial. With most diabetes patients requiring at least two vials or more per month, uninsured patients can quickly face unrealistic costs that bar them completely from accessing insulin.
How can you save on insulin?
Try different providers and formulations
If nothing else, this article has highlighted that massive price variability exists between the countless insulin formulations on the market. Doctors are most likely to prescribe the newest and best insulin formulations, which are also the most expensive. If you are finding yourself unable to afford the prescription you’ve been given, ask your doctor about trying another formulation that may give most of the benefit, while easing the burden on your wallet substantially.
Buy Insulin from Canada
Thousands of Americans cross the border every year to purchase insulin from Canada. Due to government price controls, medications such as insulin are a fraction of the cost when compared to US prices. In addition to government price controls, there are fewer “middlemen” in the Canadian pharmaceutical chain that can also cause higher prices. Rather than making the long drive, Americans can also buy insulin online from Canadian pharmacy partners such as Buy Canadian Insulin and SAVE UP TO 90% on their medication.
Convenience versus cost
One of the major cost distinctions in the insulin market is between products that come in bulk vial form versus in a ready-to-go dispenser like the KwikPen. To be sure, the latter make dosage, storage, and self-administration far more convenient and simple. However, if you are looking to cut costs, buying by the vial instead of insulin pens can equate to substantial savings.
The American insulin market is a very diverse landscape. It can often be difficult for patients to navigate the many options for formulations, insurance plans, and providers without feeling overwhelmed and desperate. Fortunately, the general trend towards increasing costs seems to have stalled at least for the moment, and their may be insurance coverage plans or manufacturer pricing programs to assist you in accessing your medication affordably. For those without medical coverage or have fallen into the insurance “donut hole“, buying insulin online can provide massive cost savings.