Key TakeawaysInsulin prices in the United States have tripled in the past decade.In July 2020, former President Trump signed an executive order aimed at lowering insulin, as well as other drug prices for Americans.On June 16, 2021 the Biden administration published their plan to rescind former President Trump’s 2020 rule for various reasons.On November 19, 2021, the House of Representatives passed the Build Back Better bill which would cap insulin prices at $35 for a 30 day supply beginning in 2023.There are drug-makers that rule the market on insulin—an issue that has driven cost.
Key Takeaways
Insulin prices in the United States have tripled in the past decade.In July 2020, former President Trump signed an executive order aimed at lowering insulin, as well as other drug prices for Americans.On June 16, 2021 the Biden administration published their plan to rescind former President Trump’s 2020 rule for various reasons.On November 19, 2021, the House of Representatives passed the Build Back Better bill which would cap insulin prices at $35 for a 30 day supply beginning in 2023.There are drug-makers that rule the market on insulin—an issue that has driven cost.
Over 37 million Americans havediabetes, a group of conditions where there is too much sugar in the blood.Of those patients, over 7 million require some form ofinsulin, a medication based on the naturally madehormonethat helps regulate blood sugar.One of the biggest concerns for patients and healthcare providers is the rising price of insulin.
In the past decade, the cost of insulin has tripled in the United States, with out-of-pocket costs doubling. One in four patients say that they ration their insulin because they can’t afford it.
Stephanie Redmond, PharmD, CDE, BC-ADMWithout a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
Stephanie Redmond, PharmD, CDE, BC-ADM
Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
“If someone has type 1 diabetes or if someone has had damage to theirpancreas, these are instances where their body doesn’t produce any insulin,”Stephanie Redmond, PharmD, CDE, BC-ADM, founder of Diabetes Doctor, tells Verywell. “Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.”
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How Has the Government Impacted Insulin Prices?
On July 24, 2020 former President Donald Trump signed an executive order that included language aimed at lowering insulin and other drug prices for Americans.This order became effective on January 22, 2021.
“As with any legal order, the devil’s in the detail,”Robin Feldman, Arthur J. Goldberg Distinguished Professor of Law at UC Hastings College of Law San Francisco, tells Verywell. She also noted that we are “…going to need some systemic changes to try to address the problems that are driving drug prices higher in general, and insulin prices higher specifically.”
On June 16, 2021, under the Biden administration, the Department of Health and Human Services published in the Federal Register their plan to rescind this 2020 rule. They cited various reasons for doing so:
On March 1, 2022 in the State of the Union Address, President Biden discussed capping insulin prices at $35 a month. He also mentioned lowering theprices of prescription medication.
What Factors Impact Treatment Costs for Diabetes?
People with diabetes have over two times thehealthcare costsof Americans who don’t have this condition. On average, the medical costs related to diabetes can reach over $9,500 per year.
One of the most influential factors driving that difference is the cost of insulin. How much people pay out of pocket for insulin depends on many variables. This includes whether they have insurance, what kind of plan they have, and coverage details such as theplan’s deductible. How much and whattypes of medicationan individual needs can also impact cost.
In her experience as a physician andpharmacist, Redmond says that most patients need about two vials of insulin per month or one to two packs ofinsulin pens. Each pen pack is equivalent to about one and a half vials. As of March 2022, the price for a vial of insulin ranges from $50 to over $1,000, and a pack of pens ranges from $45 to over $600.
“Prices are too high,” Redmond says. “Not just for insulin but for most diabetes medications. All of it is still insanely expensive.”
A person with diabetes who lives alone could be spending more than half of their annual income on out-of-pocket insulin costs.
Walmart Is Offering a More Affordable Brand of Insulin
What Is the Cost of Insulin With Insurance?
The American Diabetes Association Insulin Access and Affordability Working Group report found that nearly half of Americans have employer-sponsored health insurance. About 20% are insured through Medicaid, and 14% are insured through Medicare. Approximately 7% of Americans purchase health insurance on their own. About 9% of Americans remain uninsured.
Diabetes is considered apre-existing condition, which is a condition you have prior to applying for health insurance. According to research, about 1.9 million people with diabetes who didn’t have insurance gained coverage after theAffordable Care Act (ACA)went into effect in 2010.
Still, having insurance doesn’t mean insulin is affordable. Insured patients will often pay a copay or a percentage, rather than the list price, for their insulin. Redmond says that cost could range from $30 to $50.
In cases ofhigh-deductible health plans, patients have to pay the list price for their insulin until their deductible is met. This could mean thousands of dollars out of pocket. “Many patients just have a problem paying that much,” says Redmond.
How Have Drug Companies Responded to Criticism?
Pharmaceutical companies have responded to criticism about high prices. For example, some companies offerdiscount cards. However, Redmond explains that doesn’t help every patient. “You can’t use them if you have Medicare, and many of them cap at $100-$150,” says Redmond of the discount programs. “So if you have a high deductible of thousands of dollars, these coupons are not that helpful, because that patient may still be paying $300 out of pocket for their insulin or more until their deductible is met.”
Some drug companies haveassistance programsfor individuals with low-income. “These are good options but take a lot of time and a knowledgeable doctor who is willing to take that time and help them with the forms,” says Redmond, adding that many clinics don’t have certified diabetes care and education specialists (CDCES), social workers, or care coordinators who can help.
Many insulin makers created programs in response to COVID-19. As of March 2022, these programs were still in effect:
What This Means For YouYou or a loved one might be paying high prices for insulin. Check with your insulin manufacturer to see if you qualify for a patient assistance program. If you aren’t eligible for these programs, talk to your healthcare provider or CDCES about other options.
What This Means For You
You or a loved one might be paying high prices for insulin. Check with your insulin manufacturer to see if you qualify for a patient assistance program. If you aren’t eligible for these programs, talk to your healthcare provider or CDCES about other options.
Why Is Insulin More Expensive in America?
Three pharmaceutical companies—Novo Nordisk, Sanofi-Aventis, and Eli Lilly—control the market. “The big three produce 90% of the global insulin supply and close to 100% of the U.S. insulin supply,” says Feldman. “Observers have noticed that the big three tend to mirror each other’s insulin price increases. When one raises prices, the others quickly follow.”
Feldman says the companies have become adept at what’s called evergreening. “Evergreening involves various techniques to extend protection on a drug and block competition that can reduce prices.”
Evergreening includes both patent and non-patent rights exclusivities that shut out other drug makers from the insulin marketplace.
Many brand name drugs have agenericthat becomes the preferred, cheaper alternative. However, the Food and Drug Administration (FDA) has historically treated insulin as a drugandabiologic, which have different regulatory pathways.
Medications that are treated as highly similar to a biologic, or a medication made from living things, are calledbiosimilars, not generics. Biosimilars must go through a specific approval pathway.
The original brand name insulins went through the drug pathway rather than the biologic pathway. This meant competitors could not introduce a biosimilar insulin.
In March 2020, the FDA moved to label insulins as biologics, which opened the door for new biosimilars.However, hurdles remain. Feldman says that the approval process is more complicated for biosimilars than for generics, and the substitution process at the pharmacy is more difficult as well.
Robin Feldman, Professor of Law, UC Hastings College of Law San FranciscoInsulin is a very old drug. We’ve known about it for a long time. Patients shouldn’t be paying through the nose for it now a hundred years later.
Robin Feldman, Professor of Law, UC Hastings College of Law San Francisco
Insulin is a very old drug. We’ve known about it for a long time. Patients shouldn’t be paying through the nose for it now a hundred years later.
State laws allow pharmacists to automatically substitute a generic version for drugs, but that automatic substitution is not available for biosimilars unless certain conditions are met.
“It’s a huge impact,” says Feldman. “Because automatic substitution is the way that generic drugs traditionally make inroads in the market and bring prices down.”
The FDA approved a long-acting biosimilar insulin called Semglee in July 2021.However, patients and physicians must specifically request the biosimilar because of the lack of automatic substitution. Feldman says that historically, that doesn’t happen.
Additionally, intermediaries along the insulin supply-chain can drive up costs or keep new drugs from gaining a foothold. “Existing players with large market share can use volume discounts to discourage [pharmacy benefits managers] and health plans from covering the new entrant,” says Feldman.
The bottom line is that the three-company monopoly is hurting people with diabetes. “Insulin is a very old drug,” says Feldman. “We’ve known about it for a long time. Patients shouldn’t be paying through the nose for it now a hundred years later.”
Summary
Insulin prices have gone up significantly over the past decade. However, the government has responded in an attempt to make this medication more accessible.
Frequently Asked QuestionsResearch notes that one vial of insulin costs around $2 to just over $6 to produce depending on the specific type.Individuals may use about two vials of insulin or one or two packs of insulin pens per month. Per month, insulin vials range from $50 to over $1,000, and a pack of pens may range from $45 to over $600.Cost may vary but a copay may range from $30 to over $50.
Frequently Asked Questions
Research notes that one vial of insulin costs around $2 to just over $6 to produce depending on the specific type.
Individuals may use about two vials of insulin or one or two packs of insulin pens per month. Per month, insulin vials range from $50 to over $1,000, and a pack of pens may range from $45 to over $600.
Cost may vary but a copay may range from $30 to over $50.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on Covid-19, visit ourcoronavirus news page.
23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Herkert D, Vijayakumar P, Luo J, et al.Cost-related insulin underuse among patients with diabetes.JAMA Intern Med.2019 Dec;179(1):112-114. doi:10.1001/jamainternmed.2018.5008The White House.Executive order on access to affordable life-saving medications.Federal Register.Implementation of executive order on access to affordable life-saving medications; rescission of regulation.Library of Congress.H.R. 5376- build back better act.Rajkumar SV.The high cost of insulin in the united states: an urgent call to action.Mayo Clinic Proceedings. 2020;95(1):22-28. doi:10.1016/j.mayocp.2019.11.013Centers for Disease Control and Prevention.National diabetes statistics report.Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al.Insulin access and affordability working group conclusions and recommendations.Diabetes Care. 2018 June;41(6):1299-1311. doi:10.2337/dci18-0019Herkert D, Vijayakumar P, Luo J, et al.Cost-related insulin underuse among patients with diabetes.JAMA Intern Med.2019 Dec;179(1):112-114. doi:10.1001/jamainternmed.2018.5008The White House.Executive order on access to affordable life-saving medications.Health Resources and Services Administration.Final rule for the implementation of executive order 13937, “executive order on access to affordable life-saving medications.“Federal Register.Implementation of executive order on access to affordable life-saving medications; rescission of regulation.The White House.Remarks of president joe biden- state of the union address as prepared for delivery.American Diabetes Association.Economic costs of diabetes in the u.s. in 2017.Diabetes Care. 2018;41(5):917-928. doi:10.2337/dci18-0007U.S. Department of Health and Human Services.Poverty guidelines.Myerson R, Romely J, Chiou T, Peters AL, Goldman D.The affordable Care act and health insurance coverage among people with diagnosed and undiagnosed diabetes: data from the national health and nutrition examination survey.Diabetes Care2019 Nov; 42(11):e179-e180. doi:10.2337/dc19-0081NovoCare.Patient assistance program.Sanofi.Sanofi bolsters patient access due to COVID-19.Eli Lilly and Company.Lilly commits insulin value program, featuring $35 copay card, to suite of affordability solutions for people with diabetes.American Diabetes Association.Insulin is now a biologic- what does that mean?American Diabetes Association.Insulin is now a biologic—what does that mean?.National Conference of State Legislatures.State laws and legislation related to biologic medications and substitution of biosimilars.U.S. Food and Drug Administration.FDA approved first interchangeable biosimilar insulin product for treatment of diabetes.Gotham D, Barber MJ, Hill A.Production costs and potential prices for biosimilars of human insulin and insulin analogues.BMJ Glob Health. 2018;3(5):e000850. doi:10.1136/bmjgh-2018-000850
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Herkert D, Vijayakumar P, Luo J, et al.Cost-related insulin underuse among patients with diabetes.JAMA Intern Med.2019 Dec;179(1):112-114. doi:10.1001/jamainternmed.2018.5008The White House.Executive order on access to affordable life-saving medications.Federal Register.Implementation of executive order on access to affordable life-saving medications; rescission of regulation.Library of Congress.H.R. 5376- build back better act.Rajkumar SV.The high cost of insulin in the united states: an urgent call to action.Mayo Clinic Proceedings. 2020;95(1):22-28. doi:10.1016/j.mayocp.2019.11.013Centers for Disease Control and Prevention.National diabetes statistics report.Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al.Insulin access and affordability working group conclusions and recommendations.Diabetes Care. 2018 June;41(6):1299-1311. doi:10.2337/dci18-0019Herkert D, Vijayakumar P, Luo J, et al.Cost-related insulin underuse among patients with diabetes.JAMA Intern Med.2019 Dec;179(1):112-114. doi:10.1001/jamainternmed.2018.5008The White House.Executive order on access to affordable life-saving medications.Health Resources and Services Administration.Final rule for the implementation of executive order 13937, “executive order on access to affordable life-saving medications.“Federal Register.Implementation of executive order on access to affordable life-saving medications; rescission of regulation.The White House.Remarks of president joe biden- state of the union address as prepared for delivery.American Diabetes Association.Economic costs of diabetes in the u.s. in 2017.Diabetes Care. 2018;41(5):917-928. doi:10.2337/dci18-0007U.S. Department of Health and Human Services.Poverty guidelines.Myerson R, Romely J, Chiou T, Peters AL, Goldman D.The affordable Care act and health insurance coverage among people with diagnosed and undiagnosed diabetes: data from the national health and nutrition examination survey.Diabetes Care2019 Nov; 42(11):e179-e180. doi:10.2337/dc19-0081NovoCare.Patient assistance program.Sanofi.Sanofi bolsters patient access due to COVID-19.Eli Lilly and Company.Lilly commits insulin value program, featuring $35 copay card, to suite of affordability solutions for people with diabetes.American Diabetes Association.Insulin is now a biologic- what does that mean?American Diabetes Association.Insulin is now a biologic—what does that mean?.National Conference of State Legislatures.State laws and legislation related to biologic medications and substitution of biosimilars.U.S. Food and Drug Administration.FDA approved first interchangeable biosimilar insulin product for treatment of diabetes.Gotham D, Barber MJ, Hill A.Production costs and potential prices for biosimilars of human insulin and insulin analogues.BMJ Glob Health. 2018;3(5):e000850. doi:10.1136/bmjgh-2018-000850
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Herkert D, Vijayakumar P, Luo J, et al.Cost-related insulin underuse among patients with diabetes.JAMA Intern Med.2019 Dec;179(1):112-114. doi:10.1001/jamainternmed.2018.5008The White House.Executive order on access to affordable life-saving medications.Federal Register.Implementation of executive order on access to affordable life-saving medications; rescission of regulation.Library of Congress.H.R. 5376- build back better act.Rajkumar SV.The high cost of insulin in the united states: an urgent call to action.Mayo Clinic Proceedings. 2020;95(1):22-28. doi:10.1016/j.mayocp.2019.11.013Centers for Disease Control and Prevention.National diabetes statistics report.Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al.Insulin access and affordability working group conclusions and recommendations.Diabetes Care. 2018 June;41(6):1299-1311. doi:10.2337/dci18-0019Herkert D, Vijayakumar P, Luo J, et al.Cost-related insulin underuse among patients with diabetes.JAMA Intern Med.2019 Dec;179(1):112-114. doi:10.1001/jamainternmed.2018.5008The White House.Executive order on access to affordable life-saving medications.Health Resources and Services Administration.Final rule for the implementation of executive order 13937, “executive order on access to affordable life-saving medications.“Federal Register.Implementation of executive order on access to affordable life-saving medications; rescission of regulation.The White House.Remarks of president joe biden- state of the union address as prepared for delivery.American Diabetes Association.Economic costs of diabetes in the u.s. in 2017.Diabetes Care. 2018;41(5):917-928. doi:10.2337/dci18-0007U.S. Department of Health and Human Services.Poverty guidelines.Myerson R, Romely J, Chiou T, Peters AL, Goldman D.The affordable Care act and health insurance coverage among people with diagnosed and undiagnosed diabetes: data from the national health and nutrition examination survey.Diabetes Care2019 Nov; 42(11):e179-e180. doi:10.2337/dc19-0081NovoCare.Patient assistance program.Sanofi.Sanofi bolsters patient access due to COVID-19.Eli Lilly and Company.Lilly commits insulin value program, featuring $35 copay card, to suite of affordability solutions for people with diabetes.American Diabetes Association.Insulin is now a biologic- what does that mean?American Diabetes Association.Insulin is now a biologic—what does that mean?.National Conference of State Legislatures.State laws and legislation related to biologic medications and substitution of biosimilars.U.S. Food and Drug Administration.FDA approved first interchangeable biosimilar insulin product for treatment of diabetes.Gotham D, Barber MJ, Hill A.Production costs and potential prices for biosimilars of human insulin and insulin analogues.BMJ Glob Health. 2018;3(5):e000850. doi:10.1136/bmjgh-2018-000850
Herkert D, Vijayakumar P, Luo J, et al.Cost-related insulin underuse among patients with diabetes.JAMA Intern Med.2019 Dec;179(1):112-114. doi:10.1001/jamainternmed.2018.5008
The White House.Executive order on access to affordable life-saving medications.
Federal Register.Implementation of executive order on access to affordable life-saving medications; rescission of regulation.
Library of Congress.H.R. 5376- build back better act.
Rajkumar SV.The high cost of insulin in the united states: an urgent call to action.Mayo Clinic Proceedings. 2020;95(1):22-28. doi:10.1016/j.mayocp.2019.11.013
Centers for Disease Control and Prevention.National diabetes statistics report.
Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, et al.Insulin access and affordability working group conclusions and recommendations.Diabetes Care. 2018 June;41(6):1299-1311. doi:10.2337/dci18-0019
Health Resources and Services Administration.Final rule for the implementation of executive order 13937, “executive order on access to affordable life-saving medications.”
The White House.Remarks of president joe biden- state of the union address as prepared for delivery.
American Diabetes Association.Economic costs of diabetes in the u.s. in 2017.Diabetes Care. 2018;41(5):917-928. doi:10.2337/dci18-0007
U.S. Department of Health and Human Services.Poverty guidelines.
Myerson R, Romely J, Chiou T, Peters AL, Goldman D.The affordable Care act and health insurance coverage among people with diagnosed and undiagnosed diabetes: data from the national health and nutrition examination survey.Diabetes Care2019 Nov; 42(11):e179-e180. doi:10.2337/dc19-0081
NovoCare.Patient assistance program.
Sanofi.Sanofi bolsters patient access due to COVID-19.
Eli Lilly and Company.Lilly commits insulin value program, featuring $35 copay card, to suite of affordability solutions for people with diabetes.
American Diabetes Association.Insulin is now a biologic- what does that mean?
American Diabetes Association.Insulin is now a biologic—what does that mean?.
National Conference of State Legislatures.State laws and legislation related to biologic medications and substitution of biosimilars.
U.S. Food and Drug Administration.FDA approved first interchangeable biosimilar insulin product for treatment of diabetes.
Gotham D, Barber MJ, Hill A.Production costs and potential prices for biosimilars of human insulin and insulin analogues.BMJ Glob Health. 2018;3(5):e000850. doi:10.1136/bmjgh-2018-000850
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