RAND report: Insulin prices in the U.S. are substantially higher than in high-income nations

The gross price of insulin in the U.S. is more than nine times higher than in 33 high-income comparison nations, according to a new RAND report.

Although the cost differences of insulin between the U.S. and other nations varied depending on the comparison country and the type of insulin, U.S. prices were always higher -- often five to 10 times higher -- than those in other countries. The new report updates findings from earlier RAND work about U.S. insulin prices.

After accounting for rebates and other discounts often offered by drug manufacturers, the price of a unit of insulin remained 2.3 times higher in the U.S. than in comparison nations, according to the study.

Insulin prices in the U.S. have been increasing for many years and are substantially higher than in other middle and high-income nations."

Andrew Mulcahy, study's lead author and senior health economist at RAND

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. 

Insulin list prices in the United States have increased dramatically since the early 2010s. 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.

Medicare enrollees' financial exposure to out-of-pocket spending for insulin is changing dramatically. Under the Inflation Reduction Act, insulin cost-sharing will be capped at $35 per month beginning in 2024. Congress also is considering proposals to extend the cap to individuals with employer or individual market coverage.

RAND researchers compiled their estimates of international insulin prices by examining industry standard IQVIA MIDAS data on insulin sales and volume for 2017 through 2022, comparing the U.S. to 33 nations that belong to the Organisation for Economic Co-operation and Development (OECD).

The analysis presents separate comparisons using manufacturer gross prices, which may be more relevant to U.S. patients without drug coverage or otherwise paying out of pocket for insulin, and estimated manufacturer net prices after applying rebates paid by manufacturers.

The report presents volume and sales by type of insulin separately for the United States and 33 comparison OECD countries.

Researchers found that U.S. manufacturer gross prices per 100 international units of insulin were on average 9.71 times those in OECD comparison countries combined. After estimating gross-to-net discounts for insulins, U.S. net prices remained 2.33 times of those in comparison countries combined.

U.S. manufacturer gross prices ranged from 4.57 times those in Mexico to 37.99 times those in Turkey. Comparisons of U.S. insulin prices to prices in other countries were fairly constant from 2017 through 2022.

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.

The report, "Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis," is available on the website of the U.S. Department of Health and Human Services and on www.rand.org.

Other authors of the report are Daniel Schwam and Nate Edenfield.