The Cost of Insulin

The price of insulin has more than tripled in ten years. Not everybody pays full price, but many find the cost of insulin complicates their life. This week, we’ll cover why insulin prices are so high. Next week, we’ll address what to do about it.


According to this story on CBS News, people with diabetes are “cutting back [on their insulin doses] or even going without the drug,” putting them at greater risk for complications.

Insulin costs have soared from $100–$200 per month a few years ago to $400–$500 a month now. CBS News quotes a college student saying her bill for insulin has risen from $130 to $495 per month. She has given up her insulin pump and gone back to injections because of expense.

One of her friends has cut her dose down to 80% of what’s ordered to save money. This has become common practice for many. A doctor in Montana reported that insulin prices greatly complicate people’s care. “I have patients who tell me that they have to make a decision between food and insulin, and their rent and insulin.”

Why is this happening?
When insulin was discovered the 1920s, the doctors who found it gave it away. It immediately started saving lives for people with Type 1 diabetes. Now insulin has become a $24-billion-a-year market globally and is predicted to pass $48 billion in only five more years. And people around the world who need it can’t afford it.

There are several causes for the price spikes, but many of them come down to America’s pretend “free market” approach to health care. We are seeing these problems now with the controversy over one brand of epinephrine injections, whose manufacturer increased their price by 500% and then paid their CEO a nearly $19 million salary.

Here are some ways American economics are making insulin unaffordable:

• Captive market. People with Type 1 diabetes, and maybe some with Type 2 diabetes, can’t live without insulin. How are they supposed to negotiate or use their buying power when they need the product to live? You have to pay what the seller demands.

• No competition. There are only three manufacturers of all the insulin used in the U.S., so there’s no real competition.

• No generics. Generic insulins could lower the price, but they are not allowed. Insulin is classed as a “biologic” drug. Anyone wanting to manufacture a “biosimilar” insulin has to pass extremely strict tests to be allowed to sell it. For this reason, cost savings, if someone wants to compete, are estimated at only 20%–40% lower than the brand names, not 90% as often happens with generic pills.

Even so, drug companies are resisting the introduction of biosimilars, according to this article in Diabetes Forecast. There is currently only one expected to be available soon in the U.S.

• Newer insulins. Insulins are getting better. With long-acting basal and rapid-acting insulin “analogs” for meals, patients should have fewer hypos and be able to achieve tighter control than on human insulin. But the analog insulins are seven to eight times more expensive.

The older, cheaper human insulins are now rarely prescribed in the U.S. The even more-affordable animal-derived insulins are still available in much of the world, including Canada, but not in the U.S.

Some experts, like Dr. Kasia Lipska of Yale, say the benefits of analogs aren’t so impressive. “When you compare…analog versus human insulin, there aren’t big differences in terms of [blood glucose control] or safety.”

Analogs’ advantages may not be worth the price, certainly not if they are too expensive for patients to buy. A ten-year study coauthored by the University of Michigan’s William Herman, MD, MPH, says “Although the newer, more expensive insulin analogs appear to have incremental benefits compared to older, less expensive insulin preparations, their premium price requires us to ask whether they are really necessary, and if so, for whom?”

• Medicare is forbidden by law from negotiating prices paid for drugs. So manufacturers can charge whatever they want to the government.

• Like many other drugs, insulin is far more expensive in the U.S. than in most other countries. According to the advocacy group T1International, one type of rapid-acting insulin costs roughly four times as much in the U.S. as in Canada.

• The U.S. medical system is so complex and wrapped in secrecy that nobody knows how drug prices to consumers are actually set. Pharmacies, insurers, drug companies, and health-care providers all negotiate to get the best deals. A whole industry called “pharmacy benefit managers” work for insurers to get the best price, but they keep a commission for themselves. Whatever price benefit they win from a manufacturer may not be passed on to consumers.

How these price hikes affect you depends on your insurance. With the best insurance, they may not be a problem. A spokeswoman for the Pharmaceutical Research and Manufacturers of America (PhRMA) told CBS News that list prices don’t represent what patients actually pay, because insurers and pharmacy benefit managers negotiate discounts.

“In fact, an analysis by SSR Health found that net prices for insulins actually declined in 2015,” she said. “With that said, we recognize too often patients struggle with access to their medicines at the pharmacy.”

If your drug coverage is not so good, like if you have a high-deductible plan through the Affordable Care Act, you might find the cost of insulin a serious burden. What can you do to lower the cost and maintain both your health and your budget? We’ll look at some ways next week, including assistance plans, cheaper insulins, pharmacy coupons, insulin alternatives, and diet changes, and we would benefit from hearing your experiences, as well.

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  • Biglew

    This is a major issue. My insulin, on my insurance, a huge deductible plan, jumps to $1000/month at the beginning of every year. I cut way back on insulin trying to stretch it out. Lost total control of bgl. Now being back on track. Since I need to lose weight, I just look at it as forced diet, don’t eat out, so I can buy insulin, until deductible is met after about five months. Affordable health care plan, bah humbug. We need to get back to a true free market health care, but it will never happen since Obama has given the aristocratic class unfettered access into our wallets.

    • RAWLCM

      We need single-payer health care like the rest of the civilized world.

      • Dallas

        If you do not mind waiting a few years for general surgery move to Europe and get in line for their single payer systems

        • RAWLCM

          That’s a total myth. Britain and Canada had some problems with delays back in the 1980s when they first started Universal care, but the latest data shows you wait longer in the U.S. for many procedures. I have good insurance and go to a major university health center. I have to make an appointment 12 months out to see an endocrinologist, six months if I’m willing to settle for talking to her nurse. The wait for a colonoscopy is 6-9 months. I have a 9 week wait to see a doctor at the sports medicine center for a painful shoulder injury. I waited three days for urgent heart surgery, and they said I was lucky it wasn’t seven. So much for the superiority of private health insurance.

          • watcherofolde

            I got a colonoscopy one week after seeing the doctor and I have Canadian friends who come here for many procedures.

          • RAWLCM

            Sure. Lots of people would pay thousands of dollars for a procedure in a foreign country that they could get for free at home. In your dreams.

          • Steph

            Your waits for private health care seems to be your region or specific selection of doctors. No wait here in the Midwest.

          • RAWLCM

            Really? Because they sure make you wait in Wisconsin. Might have something to do with all the cuts to the University budget.

        • Paullwrt


    • Steph

      If you are type 2 and still produce insulin yourself, get yourself to normal weight and eat very low carb or Keto. Also, Walmart carries older insulin by Lily. No prescription required so not covered by insurance or Medicare but about $30 a vial. Your needles would be covered by insurance.

  • Craig

    Even if you are fortunate enough to have an insurance plan that helps to defray the cost of insulin it doesn’t help when you hit the medicare donut hole and have to pay the bulk of the cost yourself. Why does medicare have the donut hole. It doesn’t make sense and is tough on fixed income seniors

    • Steph

      The donut hole was the Republican plan. Without it, they would not support part D coverage.