Insulin prices are more than eight times higher in the United States than in 32 high-income comparison nations combined, according to a new RAND Corporation study.
The study compared how much different types of insulin sold in the U.S. would cost if bought at prices in other countries. The average price per unit across all types of insulin in the U.S. was $98.70. Other countries would have paid a fraction as much for the same insulins.
U.S. prices were higher than each of the 32 comparison countries individually, ranging from 3.8 times higher than those in Chile to 27.7 times those in Turkey. U.S. prices were 6.3 times higher than those in Canada, 5.9 times higher than those in Japan, and 8.9 times higher than those in the United Kingdom.
The study used manufacturer prices for the analysis. The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.
But even if such rebates and discounts drive down prices by as much as 50%, the prices paid by U.S. consumers are likely to be four times the average paid in other high-income nations, according to the study.
"This analysis provides the best available evidence about how much more expensive insulin is in the U.S. than in other nations around the world," said Andrew Mulcahy, the study's lead author and a senior policy researcher at RAND, a nonprofit research organization. "Prices in the U.S. are always much higher than other nations, even if you assume steep discounts to manufacturer prices in the United States."
Insulin list prices in the United States have increased dramatically over the past decade. 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.
Another study found that among adults with employer-sponsored health insurance, annual insulin spending per person doubled between 2012 and 2016, increasing from $1,432 to $2,853 even after accounting for a 50% rebate.
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.
RAND researchers compiled their estimates of international insulin prices by examining industry-standard IQVIA MIDAS data on insulin sales and volume for 2018, comparing the U.S. to 32 nations that belong to the Organisation for Economic Co-operation and Development.
Although the ratio of U.S. prices to other-country prices varied depending on the comparison country and insulin category, U.S. prices were always higher and often 5 to 10 times higher than those in other countries.
The study found that U.S. prices were relatively higher for analog versus human insulins and for rapid-acting rather than short or long-acting insulins. U.S. prices were even higher when researchers compared prices pooling similar insulin products together, suggesting that the United States uses a more-expensive mix of insulin products.
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 http://www.rand.org.
Other authors of the report are Daniel Schwam and Nate Edenfield.
RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.