US Has Highest Insulin Costs of Any Developed Nation

Alicia Ault

October 08, 2020

UPDATED October 12, 2020 // Insulin prices in the United States are at least four times higher, and in some cases up to 30 times higher, than in 32 other nations with similar high-income economies, according to a new study conducted for the US Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation (ASPE).

US analogue insulin and human insulin prices were higher than those of the other nations. Prices were even higher when the study authors used active ingredient–level data rather than presentation-level data, suggesting that America offers a more expensive mix of insulins.

"This analysis provides the best available evidence about how much more expensive insulin is in the United States than in other nations around the world," said Andrew Mulcahy, PhD, MPP, lead author and a senior policy researcher at the RAND Corp, a nonprofit research organization, which conducted the study for the government.

"Prices in the United States are always much higher than other nations, even if you assume steep discounts to manufacturer prices in the US," added Mulcahy in a statement.

The database the study relied on did not reflect rebates or other discounts. However, the authors conclude that even had rebates and discounts cut net prices by as much as 50%, it is likely that the prices paid by US consumers would still be four times the average in other high-income nations.

US Prices Compared With Those in 32 Other OECD Countries

RAND used prescription-drug market data from IQVIA's MIDAS database for 2018 and compared the US data to those of 32 countries in the Organization for Economic Co-operation and Development (OECD).

These countries are Australia, Austria, Belgium, Canada, Chile, the Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Japan, Korea, Latvia, Lithuania, Luxembourg, Mexico, the Netherlands, New Zealand, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, and the United Kingdom.

The average US manufacturer price per standard unit for all insulins was $98.70, compared with $6.94 in Australia, $12 in Canada, $7.52 in the United Kingdom, and $8.81 for all 32 non-US countries.

Average prices in the United States were highest for rapid-acting insulins ($119.36 per standard unit, vs $8.19 in other nations) and lowest for intermediate-acting insulins ($73.56 vs $5.98). In the United States, the average manufacturer price per standard unit for human insulin was $85.21, compared to $7.11 in Canada and $5.13 in the United Kingdom.

The United States consumes more insulin and accounts for more sales than the other nations, with 32% of volume and 84% of sales. The next-closest nation is Germany, which accounted for 12% of volume and 3% of sales. Analogue insulin accounts for 91% of US volume and 92% of sales.

Long-acting insulins represent a higher share of volume — 54% — in the United States than in any comparison country except Finland and Chile. Long-acting insulins accounted for a smaller share of sales — 48% — than of volume in the United States. The United States is in the middle of comparison countries in terms of the share of sales for long-acting insulins.

The RAND authors note that nonprescription insulins may be less expensive.

Insulin is sold over the counter (OTC) only in the United States and Ireland. In the United States, it accounts for 7% of volume and 5% of sales; in Ireland, it accounts for 1% of volume and 1% of sales.

Half of the OTC insulin in the United States is short acting. The average US manufacturer price for those OTC short-acting insulins was $54.09 ― several times the price of prescription short-acting insulins in other countries ($6.46) and of the OTC price in Ireland ($12.24).

New Insulin Access Effort Panned

The results of the RAND study are no surprise to Americans with diabetes, who have been struggling for years to afford insulin.

"While is an important tool for immediate needs — one that can save lives immediately — the system must change," said Beyond Type 1 CEO Tom Scher in a statement on the organization's website. Scher added that the organization "worked with the drug manufacturers themselves to ensure that the action plans generated by the site best reflect current affordability solutions, and also worked with a coalition of partners to reach those who need this tool most.

The website directs users to build an action plan by directing them to the major US insulin makers ― Lilly, Mylan, Novo Nordisk, and Sanofi ― to see what co-pay cards, assistance programs, or state programs are available. These companies are also funding the effort. Beyond Type 1 says it partnered with the American Diabetes Association (ADA), the Association of Diabetes Care and Education Specialists (ADCES), the Endocrine Society, Feeding America, JDRF, the Leona M. and Harry B. Helmsley Charitable Trust, the National Association for the Advancement of Colored People (NAACP), and the National Hispanic Medical Association (NHMA).

But it is being widely panned by activists with diabetes who are seeking to lower the cost of the medication.

One advocate, Laura Marston, is not impressed. She tweeted, "Mark my words: this site created by @BeyondType1 and fully funded by @PhRMA is meant for non-diabetics to victim blame and say we're not trying hard enough to get $300/vial insulin. It's also yet another Phrma money grab by Orgs who claim to Congress they represent us. It's sick."

In response to a JDRF tweet about the new site, @andricheli tweeted, "@JDRF this is a joke. I tested the tool and was directed to @LillyDiabetes discount card. Card expires in 2 months, has an annual cap, and essentially would only work for 1 month of insulin. Last I checked, I need insulin every month, for the rest of my life."

"Yay, a site that tells me to call our insulin manufacturer for a coupon which we don't qualify for!!" tweeted @lwmichaud.


RAND Corp. "Comparing Insulin Prices in the United States to Other Countries." Full text

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