Insulin Prices Are Rising Unchecked. New Biosimilar Insulins May Cost You Less.
Editor’s note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can build custom plans based on your personal circumstances through our tool at GetInsulin.org.
Insulin has come a long way in recent decades—there are new formulas available and expanding options for insulin delivery. From inhaled insulin to tubeless pumps and smart pens, diabetes management can be highly personalized to your insulin body, needs and lifestyle now more than ever.
Despite the fact there are more options, your insulin may be more expensive than ever.
The United States is facing a drug cost crisis, and people who use insulin to manage their diabetes are some of the hardest hit.
Biosimilar insulins make up some of the newest insulin products available. Kind of like a generic drug, biosimilars are often cheaper, and in some cases are interchangeable at the pharmacy if it will cost you less out of pocket.
If you rely on insulin to manage any type of diabetes, you may be concerned about the escalating costs of insulin—especially if you pay for your diabetes care without insurance. In this article, we’ll look back at how we got here.
The $1 insulin patent
When insulin was discovered in the 1920s, Frederick Banting and his two fellow patent-holders agreed to sell the patent for insulin—a life-sustaining drug for many people with diabetes—to the University of Toronto for just $3 Canadian dollars. A whopping $1 profit each (or about $16 in today’s dollars).
The University then allowed pharmaceutical companies to produce insulin and patent any products that improved upon the original formula. You could say that this is where runaway insulin pricing started.
A provision allows for patents to be extended for improvements to the original product. This is how a medication that was first patented in 1921 is still under patent over a century later.
Decades of insulin price hikes
Insulin prices haven’t always been so high. In fact, the retail price of insulin has soared in the U.S. in the last two decades. Meanwhile, in many other countries prices have stayed the same.
One vial of Humalog cost $21 in 1999 (or about $37 today, adjusted for inflation). Today it costs $275 in the U.S., and it reached $332 in 2019.
In the U.S., the average insulin-dependant person spent $3490 on insulin in 2018, compared with $725 among Canadians who use insulin, according to an analysis by the Mayo Clinic.
In the span of just 3 years that the study analyzed price data—from 2016 to 2019—the average cost per unit of insulin in the United States increased by 10.3 percent compared with only 0.01 percent in Canada.
Why isn’t there more price competition?
You may have heard of the “Big Three” insulin manufacturers who account for more than 90 percent of the global insulin market: Eli Lilly (Humalog, Basaglar), NovoNordisk (Novolog, Levemir) and Sanofi Aventis (Lantus). The “Big Three” have a trend of raising prices of insulin in lockstep with one another.
As far back as the 1940s, insulin manufacturers, including Lilly, have been accused of price-fixing. Though in some instances companies have paid settlements, price-fixing is hard to prove or fight.
Pharmaceutical companies set the list price for insulin, and are incentivized by profits to continue to raise those prices.
Though the Big Three have monopolized the insulin market for many years, Mylan, now a part of Viatris, entered the field with the launch of biosimilar insulin Semglee in 2020. This is a step in the right direction for people who want to see insulin become more competitive.
According to experts, even in a capitalist but competitive market, an insulin-dependent person should be paying $130 or less per year for their insulin needs.
But this is based on there being an active and competitive biosimilar market.
What role do biosimilars play in affecting insulin prices?
So how exactly might biosimilars impact current insulin prices? To understand that, it’s important to understand what biosimilars bring to the existing insulin market.
Biosimilars are treatments or medications proven to work similarly in the body to existing medications on the market.
They aren’t generics—which are generally reserved for small-molecule, synthetic drugs—because they aren’t identical to their brand-name counterpart. Biosimilars belong to a class of drugs called biologics, which include large, complex molecules, including insulin.
In some cases, biosimilar insulins are even approved to be interchangeable with your current insulin prescription. For example, your pharmacist may be able to substitute the interchangeable biosimilar Semglee for your prescription Lantus if it will cost you less.
The benefit of biosimilar insulins is that it gives people who need insulin more options at the pharmacy. Biosimilars are typically sold at a discount compared to the reference drug.
When Semglee launched it was listed at a steep 65 percent discount in a bid to get Lantus users and their doctors to try it.
Thanks to changes the Food and Drug Administration (FDA) made in recent years, there are at least nine biosimilar insulins under development today.
Any new biosimilar insulins stand to expand the existing landscape—only two have been approved so far. In addition to Semglee, Rezvoglar was approved in December 2021 but hasn’t yet been launched.
It’s worth noting that Basaglar also acts similarly to Lantus and may offer some savings. Though Basaglar is not technically a biosimilar, since it was approved before the FDA change that allowed for insulin biosimilars, it is effectively treated as such.
Experts hope the introduction of more biosimilar insulins will drive down prices. However, it seems biosimilars aren’t yet shaking up the insulin market as some hoped.
A complex system keeps insulin prices high
Current insulin pricing in the U.S. is not the result of a free-market economy. There’s almost no competition among manufacturers and there are multiple players ingrained in the drug-to-market system that contribute to high insulin prices.
In the U.S., that’s due in part to the unique role middle broker between drug manufacturers and insurance companies, called pharmacy benefit managers (PBM), play in the U.S. healthcare system.
PBMs are paid rebates, which can be over half the cost of a brand-name insulin’s list price—and rebates have increased exponentially in the last decade.
PBMs also play a role in shaping your insurance formulary and preferred drug list.
This unique and lucrative difference to the American drug pricing structure is why the retail price of your prescription in the U.S. is so much higher than what you might pay for the same exact brand-name medication elsewhere.
How you can lower your insulin costs today
Despite the fact that there haven’t been significant changes in how insulin is manufactured, list prices are soaring in the U.S., causing this readily available and life-sustaining drug to be out of reach for many people who need it.
If you live with diabetes, you deserve choices based on what types of insulin work best for you and your unique needs.
Hopefully, as more biosimilars become available, people with diabetes will see more opportunities to save on insulin at the pharmacy.
Though biosimilar options are still limited, don’t hesitate to talk regularly with you your doctor or pharmacist about cost-saving options and ask how you might benefit from new versions of insulin.
To find out if you’re getting the most cost-saving benefits available for your current insulin prescription, use our tool Getinsulin.org. You’ll find available resources to save on biosimilar insulins there too!
If you need insulin right now, use this guide to help you find emergency insulin.
Editor’s note: Educational content related to biosimilars is made possible with support from Mylan/Viatris, an active partner of Beyond Type 2 at the time of publication. Editorial control rests solely on Beyond Type 2.
