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U.S. insulin prices 8 times higher than in other countries

Even with rebates and discounts, the U.S. consumer pays up to four times the average paid in other high-income nations.

Jeff Lagasse, Associate Editor

Insulin prices are more than eight times higher in the United States than in 32 high-income comparison nations combined, according to a new RAND Corporation study.

The study compared how much different types of insulin sold in the U.S. would cost if bought at prices in other countries. The average price per unit across all types of insulin in the U.S. was $98.70. Other countries would have paid a fraction as much for the same insulins.

U.S. prices were higher than each of the 32 comparison countries individually, ranging from 3.8 times higher than those in Chile to 27.7 times those in Turkey. U.S. prices were 6.3 times higher than those in Canada, 5.9 times higher than those in Japan and 8.9 times higher than those in the United Kingdom.

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The study used manufacturer prices for the analysis. The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.

But even if such rebates and discounts drive down prices by as much as 50%, the prices paid by U.S. consumers are likely to be four times the average paid in other high-income nations.


Insulin list prices have increased dramatically over the past decade. For example, one federal analysis found that the average U.S. wholesale-acquisition price for rapid-acting, long-acting, and short-acting insulin increased by 15% to 17% per year from 2012 to 2016.

Another study found that among adults with employer-sponsored health insurance, annual insulin spending per person doubled between 2012 and 2016, increasing from $1,432 to $2,853 even after accounting for a 50% rebate.

Insulin is a drug most commonly used to control blood sugar levels in people who have insulin-dependent diabetes. The drug is sold in many different forms, with different chemical properties and different duration of effects.

RAND researchers compiled their estimates of international insulin prices by examining industry-standard IQVIA MIDAS data on insulin sales and volume for 2018, comparing the U.S. to 32 nations that belong to the Organisation for Economic Co-operation and Development.

Although the ratio of U.S. prices to other-country prices varied depending on the comparison country and insulin category, U.S. prices were always higher and often five to 10 times higher than those in other countries.

U.S. prices were relatively higher for analog versus human insulins and for rapid-acting rather than short or long-acting insulins. U.S. prices were even higher when researchers compared prices pooling similar insulin products together, suggesting that the United States uses a more expensive mix of insulin products.

The study was sponsored by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services.


In May, the Centers for Medicare and Medicaid Services on Tuesday announced a partnership with the nation's three largest insulin makers -- Eli Lilly, Novo Nordisk, and Sanofi -- to cap the copay cost of insulin in the Part D coverage gap at $35.

The Part D Senior Savings Model, beginning January 2021, will see participating pharmaceutical manufacturers continuing to pay their current 70% discount in the coverage gap for their insulins. Based on the model's waiver of current regulations, those manufacturer-discount payments will be calculated before the application of supplemental benefits under the model -- which will reduce the out-of-pocket cost of insulin for Medicare beneficiaries, CMS said.

Beneficiaries who use insulin and join a plan participating in the model could see average out-of-pocket savings of $446, or 66%, for their insulins, funded in part by manufacturers paying an estimated additional $250 million of discounts over the five years of the model.

President Trump signed four executive orders in July, one of which was meant to authorize the re-importation of insulin products made in the U.S. and create a pathway for widespread use of personal importation waivers at authorized pharmacies in the U.S.

Twitter: @JELagasse
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