Insulin Prices: An Update
Tara O’Neill Hayes
- New generic and biosimilar insulin products have come to market and the competition they provide prices at roughly one-half of the brand name has caused average insulin prices to decline slightly.
- The impact on out-of-pocket spending in Medicaid and Medicare is quite limited, however, with the result that relatively few patients switch to the new products.
- As a result, average spending per claim is relatively flat in Medicaid and has continued to climb in Medicare Part D, up 6.8 percent from 2018 to 2020.
Prior research from the American Action Forum detailed the cost of insulin from the 1990s through 2018. New pricing data for 2019 and 2020 is now available from the Centers for Medicare and Medicaid Services for Medicaid and Medicare Part D. While data through 2018 showed insulin prices increasing each year, the new data show that average prices are finally coming down. This paper provides an updated analysis based on this new data.
Insulin Pricing Trends
Since 1991, growth in insulin prices has been accelerating, with a reprieve only in recent years. The list price of insulin per milliliter in the United States increased, on average, 2.9 percent annually from 1991-2001, 9.5 percent annually from 2002-2012, 20.7 percent annually between 2012-2016, and 1.5 percent annually from 2016-2018.
Explaining the Price Drop
Shaheen Collins Have Provisions To Help The Uninsured
Corrected 10:40 a.m. | Advocates and some lawmakers are hoping to add provisions for the uninsured to a Senate bill that would cap insulin copays for some insured patients and to do so before the chamber votes on the measure, possibly this month.
The critics endorse the $35-per-month cap on insulin copays for Medicare beneficiaries and the privately insured thats in the Senate bill but think Congress has a chance to do more for the uninsured, who pay as much as $1,288 out of pocket for insulin products each year. The House passed a bill last week that has the same cap on copays.
Both advocates and some lawmakers think legislation is needed to bring down the price of insulin from the manufacturer, calling the lack of such a provision a shortcoming in the bills, sponsored by Rep. Angie Craig, D-Minn., and Sen. Raphael Warnock, D-Ga. Some are even hoping they can bring down other drug prices.
I think it is something that is going to save lives, no matter what passes, and hopefully we can make it so that its going to have the biggest impact for the most people, said Shaina Kasper, policy manager for T1International, a nonprofit that advocates for people with Type 1 diabetes.
Neither the Craig bill nor Warnocks would address list prices, leading to criticism from some advocates and insurance companies that it lets pharmaceutical companies off the hook for high prices.
House Passes Bill To Limit Cost Of Insulin To $35 Per Month
The Affordable Insulin Now Act was approved 232-193 on Thursday, with 12 Republicans joining Democrats in voting for the bill, ABC News reported.
The bill now moves to the Senate, where it would need some Republican support to pass.
If the bill is signed into law, about 1 in 5 Americans who have large employer coverage and are taking insulin would save money, the Kaiser Family Foundation says. The cost of insulin for patients with insurance ranges from $334 to $1,000 a month, ABC News said, citing the Kaiser Family Foundation.
Republicans in the House and Senate have generally opposed the insulin bill because it could raise insurance premiums for consumers and costs for insurers, ABC News said.
The New York Times reported that the bill would help consumers but would not reduce the amounts paid to companies that make insulin. Insurance companies would have to pay a larger part of the cost, the Times said.
The insulin bill was originally part of President Joe Bidenâs “Build Back Better” agenda that sought to reduce prices for many prescription drugs. When Build Back Better stalled in the Senate, supporters made a standalone bill to address the costs of insulin.
The Times said pharmaceutical companies opposed the price limits in Build Back Better but have not been as vocal in opposing the insulin bill.
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Drugmakers Do This Because They Can
So insulins drug pricing problem is much bigger than anything one state or drug company alone can fix. But more changes in the market may be on the horizon.
The three major insulin makers Eli Lilly, Novo Nordisk, and Sanofi testified before the House Energy and Commerces oversight subcommittee last April, focusing more attention on the issue. Lawmakers, including Sens. Chuck Grassley and Ron Wyden , have also been investigating the problem and sending letters to drug companies asking them to account for their outrageous price hikes.
But while the pressure around insulin may be mounting, were also seeing the terrible impact of rising insulin prices on patients: people being forced to taper off insulin so they can pay their medical bills, and winding up with kidney failure, blindness, or even death.
Some are forced to head to Canada, where drug prices are more heavily regulated and, according to the new NEJM editorial, where a carton of insulin costs $20 instead of the $300 patients often pay in the US. Of course, there isnt enough insulin in all of Canada to make large-scale importation feasible, the editorial authors wrote.
But not all insulins are patent-protected. For example, none of Eli Lillys insulins are, according to the drugmaker. In those cases, Luo said, potential manufacturers may be deterred by secondary patents on non-active ingredients in insulins or on associated devices .
Supplying Insulin Linking To Inflation
Lawmakers have offered other options to help the uninsured that are also now being considered. Sens. Tina Smith, D-Minn., and Kevin Cramer, R-N.D., introduced a bill in 2019 that would offer a 90-day supply of insulin for uninsured or underinsured people, penalize drug companies for increasing prices faster than the rate of inflation, and shorten patent exclusivity for insulin and other biologics from 12 years to seven years. Smith is still advocating her proposal.
The Warnock and Craig bills would affect significant numbers of people. A Kaiser Family Foundation analysis found that among enrollees in the individual and small-group markets taking insulin, more than 25 percent paid more than an average of $35 per month out of pocket in 2018.
High costs can lead to patients rationing the use of insulin, with about 26 percent of Type 1 diabetics doing so in 2017, according to a survey by T1International. Rationing insulin can lead to medical complications, including loss of a limb, or even death.
Insurers say they would like Congress to focus on other drug pricing changes, such as preventing drug prices from rising faster than the rate of inflation, or changing the payment structure in Medicare Part D so drugmakers contribute more in the catastrophic phase.
The bills would also potentially lead to higher premiums in employer-based coverage, which could lead to decreased wages and less tax revenue for the government.
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Traditional Insulins Are Cheaper Than Modern Insulins
Average retail prices of Novolin and Humulin have gone down, or held steady, while prices of modern rapid- and long-acting insulins continue to go up. On average, traditional insulins now cost less than half of what modern insulins cost.
Why? Traditional insulins have historically been cheaper than their newer competitors. Modern insulins offer better blood sugar control but are synthetic analogs of traditional insulins, which makes them more difficult to produce.
Additionally, when patents on Humulin and Novolin expired around 2000, manufacturers Eli Lilly and Novo Nordisk had to test new pricing strategies to remain competitive.
In 2017, for example, Novo Nordisk partnered with CVS to offer Novolin at roughly 80% less than its list price. Both Novo Nordisk and Eli Lilly have also worked with Walmart to heavily discount Novolin and Humulin under Walmarts ReliOn line of insulin products.
Retail partnerships havent been their only strategy, though. Eli Lilly had been increasing prices for Humulin every 6 months until May 2017, when they decided to stop further increases. In fact, prices of traditional Humulin and Novolin insulins have held fairly steady since then.
and are currently the cheapest traditional insulins, with average unit prices as low as $0.03.
Average Price Per Unit Across All Types Of Insulin In 2018
- United States: $98.70
- UK: $7.52
- Australia: $6.94
The average price in America, across all types of insulin, was more than ten times higher than the average for all of the other countries combined. In fact, the closest any country came to paying the $98.70 American average was the $21.48 average that Chile pays.
The differences were especially stark when the researchers looked at rapid-acting insulin, which makes up about a third of the U.S. market. Its average price in other countries was just over $8. In America, it was $119.
It comes at a high cost, and not just financially, but in terms of your life, said Mila Clarke Buckley, 30, whose autoimmune diabetes is slowly shutting down her pancreas. She runs a top-rated blog for fellow diabetics, Hangry Woman, from her home in Houston. She has more than 30,000 readers.
It’s not like one day you can just stop taking insulin, she said. You really have to manage your life thinking, OK, this is my No. 1 priority, to be able to get this little pen of liquid so that I can live.
Insulin prices in the United States are higher than prices in nearly three dozen other countries RAND researchers examinedand it’s not even close.
The prices RAND used in its studythe list prices, set by drug manufacturerswere the most available for comparison across different countries. They’re a good starting point for understanding the true cost of insulin. In the cryptic world of drug-price setting, the list price is like an opening bid.
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The discount program is in effect while the suit is pending. The drug manufacturers keep showing us who they really are, said state Rep. Mike Howard, one of the sponsors.
In a statement, PhRMA told FairWarning that it supports policy changes that make the system work better for patients, and listed ideas that stop short of reducing the price of insulin.
The American Diabetes Association, a major advocacy group for patients with the disease, has supported copay caps, but did not endorse Alecs law and has faced criticism for not calling out insulin manufacturers by name. Unlike the smaller T1International group, which refuses donations from the drug industry, the diabetes association lists all three insulin manufacturers as leading corporate sponsors on its website and has accepted millions of dollars in contributions from drug companies, according to a database compiled by Kaiser Health News in 2015. A spokesperson told Kaiser Health News in 2018 that the diabetes association prefers to focus on all entities in the supply chain rather than individual drug companies.
The American Diabetes Association has not responded to repeated interview requests from FairWarning.
PhRMA has also sued Nevada over a requirement to justify insulin price hikes.
In 2017, Gov. Brian Sandoval, a Republican, signed a strict drug transparency bill. Focusing on diabetes medication, it required drug manufacturers to explain in writing the reason for any price hike exceeding the inflation rate.
Insulin Cost And Pricing Trends
Tara O’Neill Hayes, Josee Farmer
- Diabetes cost the United States $327 billion in 2017, becoming the most expensive chronic disease in the nation.
- Insulin costs, before accounting for any rebates or discounts, comprise an estimated $48 billion of the direct costs of treating diabetes after rebates, insulin accounts for 6.3 percent of costs.
- The average list price of insulin increased 11 percent annually from 2001 to 2018, with average annual per capita insulin costs now nearing $6,000. Because patients out-of-pocket costs are typically based on list price, their expenses have risen substantially despite the decrease in net price for many of the most commonly used insulin products over the past several years.
- If the trends of the past decade continue, gross insulin costs in the United States could reach $121.2 billion in total spending by 2024, but if more recent trends of much slower price growth prevail, insulin spending could total $60.7 billion in 2024 .
The Rising Cost of Diabetes
Given the rising costs, it is worth understanding what is driving these increases. This analysis first details increases in insulin prices and offers a projection for how much insulin will cost in the coming years. It then examines what is driving these increases.
The Price of Insulin
Past Price Growth
Insulin Spending in Medicaid
Source: American Medical Association
Insulin Spending in Medicare Part D
Typical Insulin Spending per Patient
Estimating Future Costs
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Vials Are Cheaper Than Newer Dispensers
In 1985, Novo Nordisk introduced the first insulin pen, making it more convenient for patients to store and self-inject insulin but it came at a price. Today, retail prices of rapid-acting insulins can be almost 40% more expensive if you opt for pens instead of vials.
New dispensers make insulin more expensive. Were seeing that again with Afrezza, the only insulin to be delivered as an inhalable powder. One unit of Afrezzas insulin can cost as much as 20 times the price of other rapid-acting insulins. Average retail prices for Afrezza have also continued rising through the pandemic. Afrezzas manufacturer, MannKind, offers the medication at reduced costs through its direct purchase program.
Here are retail prices of rapid-acting insulins as of October 2021:
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 certified diabetes care and education specialist about other options.
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Democrats To Lower The Price Of Insulin To $35/month
Video of Schumer:
Majority Leader Schumer announces that insulin will cost $35/month under the agreement to lower prescription drug prices.
Sarah Reese Jones
Schumer said on the Senate floor:
For too many Americans, all it takes is a sudden serious illness and you can find yourselves spending hundreds if not thousands and several thousands of dollars per year, just to afford things like insulin or vitally-needed cancer treatments. Its profoundly unfair and wholly un-American. Imagine the strain you can face: someoneyou or a loved oneis ill and you cant afford the medicine, and you see them, their condition getting worse and worse. I cant think of things that are worse than that.
Yesterday, we took a large step forward in helping alleviate that problem. For the first time ever, Medicare will be empowered to directly negotiate prices in Part B and Part D. This will directly reduce out-of-pocket drug spending for millions of patients every time they visit a pharmacy or a doctor.
Our agreement does other things as well. It will cap out-of-pocket spending at $2,000 per year, ending the dilemma I just spoke about where a life-changing diagnosis could mean thousands upon thousands of dollars in new expenses that an individual cant afford.
And it will reform the pharmaceutical industry to stop price gouging and make sure our countrys drug pricing system benefits patients, not corporations.
Democrats Pass Bill To Reduce Insulin Costs With Nearly No Gop Votes
The Affordable Insulin Now Act, which would take effect in 2023, would limit cost-sharing under private health insurance for a months supply of certain insulin products at $35, or 25 percent of a plans negotiated price, whichever is less.
Rep. Dan Kildee, D-Mich., said the rising cost of insulin and other drugs is proving to be a financial burden on patients.
“As a father of a Type 1 diabetic, I have seen firsthand how the high price of prescription drugs like insulin can harm patients and harm families, Kildee, one of the bill’s sponsors, said on the House floor before the vote. When my daughter turned 26 and got her own health insurance, there were months where she spent a third of her take home pay because shes diabetic on staying alive.”
“Imagine what its like to look at your child who needs insulin and have no idea how youre going to pay for it,” Biden said. “Lets cap the cost of insulin at $35 a month so everyone can afford it. Drug companies will still do very well.”
But the overwhelming majority of House Republicans opposed the bill, underscoring the steep climb it faces when it arrives in the Senate, where it will need support from at least 10 GOP senators to pass if all Democratic-voting senators back it.
The measure also faces industry opposition.
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Executive Orders Going Nowhere
In July, Trump announced four new executive orders that he believes have the potential to impact insulin pricing in a positive way:
We also cant overlook the fact that Pharma companies are sure to file legal challenges to some of these proposals. Then it would be up to the courts to decide whether these orders, or any subsequent policy changes or law revisions, are actually allowed.