Insulin costs rose exponentially, regardless of formulation or patent

1. Based on Medicaid reimbursement data on insulin from 1991 to 2014, there has been a nearly exponential rise in the cost of insulin, regardless of the type of insulin formulation or presence of a patent.

2. This suggests that the insulin market in the United States lacks price competition, and as a result, is burdening the health care system.

Evidence Rating Level: 2 (Good)

Study Rundown: Insulin is one of the greatest therapeutic discoveries in medicine. The earliest preparations were inexpensive, but were not as pure or predictable in regards to efficacy. In the last few decades, synthetic analogs of insulin have become more popular because of ease of use and more predictable changes in blood sugars. However, their costs have been astronomically high. Part of the reason for this has been lack of market competition. This study was conducted to evaluate the trends in Medicaid payment for commercially available insulin to determine changes in cost with the introduction of newer insulin formulations.

The results of the study showed that, regardless of the type of insulin formulation or presence of a patent, the cost of insulin has increased nearly exponentially from 1991 to 2014. This suggests that the insulin market in the United States lacks price competition, and as a result, is burdening the health care system. The strength of this analysis includes the long time period covered and the inclusion of a variety of insulin formulations. The weakness is that there was no information included about rebates offered by the manufacturers, which do offset some of the cost.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Costs associated with using different insulin preparations

In-Depth [time-series analysis]: The data was collected from the United States Food and Drug Administration’s National Drug Code (NDC) Directory from 1991 to 2014. The investigators collected reimbursement data on the different formulations of insulins during this time period, and adjusted for inflation. The insulin costs were placed in clinical context by using the WHO mean daily insulin of 40 IUs (0.4 NDC units) per day, which is 14,400 IUs per year.

For this average, the cost of premixed insulin was $370 in 1991, but rose to $2852 in 2014 for rapid-acting insulin. Since the introduction of glargine in 2001, the annual cost of intermediate-acting insulin increased by 284%, and the cost of premixed insulins increased by 455%. This increase was seen in all types of insulin formulations, regardless of whether there was a patent.

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