Understanding the High Cost of Insulin: What Family Physicians Can Do to Help Our Patients With Type 2 Diabetes Mellitus

Randi Sokol, MD, MPH, MMedEd


Am Fam Physician. 2019;99(7):416-417. 

In This Article

Why are Insulin Prices so High?

Only three manufacturers market insulin in the United States, and no generic versions are available despite human insulin being commercially available for more than 50 years. In addition, other intermediaries—pharmacy benefit managers and health insurance plans—negotiate rebates, discounts, and fees, which drives up the list price. Pharmacy benefit managers negotiate with manufacturers to get insulin on a health plan's formulary and at a low tier; hence, the manufacturer benefits from increased sales volume. In turn, the manufacturer pays rebates to the pharmacy benefit manager. To compensate for the money lost by paying these rebates, the manufacturer increases the list price for the drug. The results are catastrophic for pricing: over the past few decades, 50% of the cost increase for insulin was related to the rebates paid to pharmacy benefit managers.[3–5]

As a result of these cost pressures, insurance companies have shifted the expenses to patients through higher copayments. Although the usual copayment for a vial of insulin is $10 to $50 per month, patients with high deductibles could pay out-of-pocket costs up to $240 to $300 per month for glargine insulin (Lantus, Basaglar) or $80 to $100 per month for isophane insulin (NPH).