Report: Insulin Prices in US Substantially Higher than Other Countries

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In a recent study published by the Rand Corporation, investigators found that insulin prices have seen significant increases since the early 2010s. Despite this, net prices have seen minimal growth and, in some cases, declines on account of the competitive insulin market and the significant rebates offered by manufacturers. Additionally, there’s a discrepancy between gross and net insulin prices in the United States. Influenced by pharmacy benefit manager (PBM) strategies and competing manufacturers, the situation has led to a complex pricing structure that obscures the true cost and savings associated with insulin, according to the report.¹

“Insulin prices in the US have been increasing for many years and are substantially higher than in other middle and high-income nations,” said Andrew Mulcahy, the study’s lead author, in a press release.²

As a result of the increasing list prices for insulin, many patients have had to endure higher out-of-pocket (OOP) costs as well, especially those without an insurance plan or currently in the deductible phase of their plan. In order to counter these issues, the US government announced implementation of the Inflation Reduction Act (IRA). Through the IRA, new measures could significantly impact insulin pricing and patient OOP expenses in Medicare, with potential broader implications if these policies are extended to other types of coverage.

“The (IRA) authorizes the Secretary of the Department of Health and Human Services (HHS) to negotiate prices directly with participating manufacturers for selected drugs that are high expenditure, single source drugs without generic or biosimilar competition,” explained HHS in a statement released last August.³

In October 2021, Rep. Glenn Grothman [R-WI-6] introduced the Insulin Cost Reduction Act. According to congressional records, the bill “Prohibits the negotiation of price concessions between insulin manufacturers and prescription drug plans under the Medicare prescription drug benefit unless the price concessions are either provided at the point of sale to beneficiaries or are reflected in cost-sharing requirements.” However, the bill hasn’t made any progress since its initial introduction.⁴

Early last year, the Biden Administration announced that OOP costs for insulin would be capped at $35. While the act officially took effect on New Year’s Day, Sanofi, Novo Nordisk, and Eli Lilly have all moved to drop their insulin prices significantly, with Sanofi officially establishing a $35 cap for Lantus and a 78% price drop overall.^5,6

“Sanofi believes that no one should struggle to pay for their insulin, and we are proud of our continued actions to improve access and affordability for millions of patients for many years,” said Olivier Bogillot, head, US general medicines, Sanofi, in a company press release. “We launched our unbranded biologic for Lantus at 60% less than the Lantus list price in June 2022 but, despite this pioneering low-price approach, the health system was unable to take advantage of it due to its inherent structural challenges. We are pleased to see others join our efforts to help patients as we now accelerate the transformation of the US insulin market. Our decision to cut the list price of our lead insulin needs to be coupled with broader change to the overall system to actually drive savings for patients at the pharmacy counter.”

Despite these measures, US insulin prices remain significantly high compared to other developed nations, usually around five to ten times higher. Even after accounting for gross-to-net discounts, US prices remain roughly double those in other countries, the Rand study finds. As a result, the study authors suggest that those in charge of the US pricing system should make room for adjustments similar to international standards. However, they also acknowledged that recent efforts by insulin manufacturers toward lowering list prices could lead to a more transparent and possibly more competitive market, potentially affecting market share, patient access, and regulatory scrutiny.¹

References

1. Comparing Insulin Prices in the United States to Other Countries. Rand. February 1, 2024. Accessed February 3, 2024. https://www.rand.org/pubs/research_reports/RRA788-2.html

2. Insulin prices in US are more than twice as high as in other wealthy nations. EurekAlert. February 1, 2024. Accessed February 5, 2024.

3. Inflation Reduction Act Research Series: Understanding Development and Trends in Utilization and Spending for Drugs Selected Under the Medicare Drug Price Negotiation Program. HHS. August 29, 2023. Accessed February 5, 2024. https://aspe.hhs.gov/reports/ira-research-series-medicare-drug-price-negotiation-program

4. H.R.5623 - The Insulin Cost Reduction Act. Congress.gov. October 20, 2023. Accessed February 5, 2024. https://www.congress.gov/bill/117th-congress/house-bill/5623

5. More Americans Will Only Have to Pay $35 a Month for Insulin in 2024. US News. January 2, 2024. Accessed February 5, 2024. https://www.usnews.com/news/health-news/articles/2024-01-02/more-americans-will-only-have-to-pay-35-a-month-for-insulin-in-2024

6. Press Release: Sanofi cuts U.S. list price of Lantus®, its most-prescribed insulin, by 78% and caps out-of-pocket Lantus costs at $35 for all patients with commercial insurance. Sanofi. March 16, 2023. Accessed February 5, 2024. https://www.sanofi.com/en/media-room/press-releases/2023/2023-03-16-20-06-43-2629188