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Many people with diabetes need to monitor their blood sugar levels. Andriy Onufriyenko/Getty Images
  • The United States has the highest price of insulin of any country in the world.
  • The Inflation Reduction Act caps the cost of insulin at $35 per vial for people on Medicare, but a provision to place the same cap on people with private insurance wasn’t included in the legislation.
  • Experts say more needs to be done to reduce the price of this life-saving drug needed by many people with diabetes.

Diabetes is the seventh-leading cause of death in the United States.

Yet, access to insulin, the life-saving drug that helps regulate blood sugar among people with diabetes remains a financial burden for many Americans.

The Inflation Reduction Act, which was signed today by President Joe Biden, would have included a provision to cap insulin co-pays at $35 per vial for insured Americans, but that measure failed when the majority of Senate Republicans blocked its passage.

The new law caps out-of-pocket costs among Medicare recipients at $35, a provision that takes effect on January 1.

The United States has the highest insulin prices in the world, at an average of $98.70 per vial across all forms of the drug. That’s nearly seven times higher than the country with the next most expensive insulin, Japan, which averages $14.40 for the drug, according to a recent RAND Corporation report.

“More than 7 million people in the U.S. use insulin and for the vast majority, having consistent access to insulin is nothing short of a life-or-death issue both in the short-term and long-term,” Keri Hurley-Kim, PharmD, MPH, an associate clinical professor at the University of California at Irvine’s College of Health Sciences, told Healthline.

“Patients with type 1 or advanced type 2 diabetes can experience very severe complications that require hospitalization and, in some cases, can be fatal,” she added. “In the long term, insufficient insulin use can cause diabetes to be more difficult to control and lead to complications such as amputations, kidney disease, heart attack, stroke, and loss of vision.”

As the government struggles to rein in insulin costs, people with diabetes have turned to taking caravans to Canada to buy lower-cost insulin. Some researchers are also trying to “open source” complex insulin formulations for public consumption.

But neither effort represents a near-term solution to the problem.

The average retail price for insulin has risen 54 percent between 2014 and 2019, according to research from prescription drug outlet GoodRx.

Prices declined slightly – by 5 percent – in 2020 and 2021, but not enough to make up the difference.

And as prices have risen, so have deaths.

In 2019, 87,647 Americans died from diabetes. By 2020, that number had risen to 102,188, according to data from the Centers for Disease Control and Prevention.

In 2021, deaths where diabetes was the underlying cause topped 100,000 again.

But how did a drug whose creator gave away the patent to the University of Toronto nearly for free 100 years ago in the hopes it wouldn’t be exploited for profit end being the subject of decades of price-gouging and patient desperation?

One reason is that not all insulins are created equal. There are many different formulas and the most effective treatments often carry the highest price tag.

“Without insurance, most patients in the U.S. have to pay hundreds if not thousands of dollars per month for standard-of-care insulins,” Dr. Arti Thangudu, an endocrinologist in private practice in San Antonio, Texas, told Healthline.

“Insulin pens are safer and more convenient but often 10 times the cost of vials,” Thangudu explained. “Some insurance companies have pharmacy deductibles, forcing patients to pay high amounts before their insulin is covered despite paying monthly premiums. This forces patients to ration insulin leading to unnecessary hospitalizations, complications, and even death.”

Another reason is that there is no genuinely generic insulin in part because manufacturers often tweak their formulas in a process called “evergreening” to prevent their patents from expiring.

While the Inflation Reduction Act represents a step in the right direction, experts say more is needed to rein in insulin prices.

“The people most impacted by the price of insulin are those who do not have coverage and so must pay in cash for medications, as well as those with certain commercial plans that may have low premiums in exchange for very high deductibles,” Hurley-Kim explained. “These patients can pay hundreds of dollars per month for insulin alone, particularly if they require high doses. Many people with diabetes use two different types of insulin, which can double the cost.”

Even capping co-pays doesn’t do much for millions of uninsured Americans and critics of co-pay capping say that insurers will simply pass the costs on to consumers through increased premiums.

“The most salient argument against price capping revolves around the idea that the cost of insulin is simply one symptom of our broken healthcare system,” Hurley-Kim said. “It does not ensure access to comprehensive diabetes care, address the myriad other medications that are unaffordable, or acknowledge the ways the U.S. ignores the importance of effective preventative medicine and chronic disease management.”

Generic insulin should be available in the United States in 2024, she said, but even that will “not offer a complete solution.”

“It will still cost more than insulin in other countries. Even $30 or $100 a month can force a decision between enough medicine and enough food for some families,” Hurley-Kim said.