Over the past few months, many insulin manufacturers and other entities have announced that they will be lowering the price of insulin in the United States. So, why is insulin still so expensive?

We recently released our Policy Playbook that goes through all of the details and gives advocates the information to push for change locally and nationally. Why insulin is so expensive can be boiled down to three main points:

1. Patients cannot access insulins that are supposed to be more affordable. Many insulins remain unaffordable – while some insulin manufacturers have agreed to lower the prices of some, most insulins will not be impacted by these price reduction announcements. Other insulins are inaccessible – while patents on the most commonly used insulins and devices have expired, patients are ‘product hopped’ to newer insulins that are not covered by promised price reductions. While these products may be covered by insurance formularies or coupons for now, patients will be locked into using these insulins when these programs end and patients only have prescriptions for these newer, patented, and more expensive insulins. And getting and filling new prescriptions can be expensive and onerous, especially when more affordable insulins are often not in stock at the pharmacy counter – many insulins are unavailable to too many.

That’s why, at T1International, we are prioritizing advocating for federally regulated price caps on all insulins, as well as advocating for emergency access to insulin policies (Alec’s Laws), for pharmacist prescribers (Kevin’s Laws), and regulating intermediaries including prohibiting non-medical mid-year insurance formulary switching.

2. There is not enough competition. While there are more insulin options on the market, and while more entities are entering the insulin manufacturing market (California is contracting with non-profit drug manufacturer Civica Rx to make some insulins), The Big Three still control over 90% of the insulin market, meaning that they get to buy up other potential competitors (killer acquisitions), ‘pay-for-delay’ schemes, and other patent thickets and anti-competitive behavior. Newer insulins entering the market, biosimilars, and generics, are all still mostly being held captive by The Big Three! Because there isn’t real competition, while the Big Three insulin manufacturers have agreed to lower the prices of some insulins, they can raise them again at any time. And there is not enough competition in the rest of the drug market as well, meaning that Pharmacy Benefit managers, wholesalers, and other intermediaries can act in lock step. And vertical integration among all of these players leads to high drug prices as well.

That’s why, at T1International, we advocate for patent reform and public pharma to promote competition in the market.

3. Big Pharma has undue power and influence. They influence patients and prescribers directly through advertising, and indirectly through capture of benevolent institutions including patient advocacy organizations, running awareness campaigns, and offering samples and coupons. Pharmaceutical lobbying and direct influence on elections and campaign spending remains extensive, and the revolving door between Big Pharma and government regulators impedes us achieving our other goals.

That’s why, at T1International, we advocate for corporate tax reforms.

To learn more about any of these points and see stories of how they impact patients in real life—and more!—check out our Policy Playbook today.

"As a long-time patient advocate in the Iowa #insulin4all Chapter and as a member of T1International's Federal Working Group and State Working Group, being able to answer the question ‘Why is insulin so expensive?’ is essential. Time and time again, patient advocates testifying against Big Pharma have been discredited because they have lived experience, but not professional expertise. Patients are the experts, and the Policy Playbook is a great tool for those fighting for #insulin4all to have answers to the tough questions at their fingertips." - John Tagliareni, #insulin4all Advocate

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