Comparing Insulin Prices in the United States to Other Countries

Research Questions

  1. How did manufacturer gross prices for insulin in the United States compare with those in 33 other OECD countries in 2022?
  2. Did these relative prices differ across different types of insulin?
  3. How did prices compare after adjusting U.S. prices to reflect rebates paid by drug companies to drug plans and their pharmacy benefit managers?

Manufacturers’ list prices for insulin have increased dramatically over the past decade in the United States. In this report, the authors present results from a comparison of U.S. and international prices for insulins using a price index approach. They compare prices for all insulins and different categories of insulin in the United States and 33 comparison Organisation for Economic Co-operation and Development countries. They present separate comparisons using U.S. manufacturer gross prices reflected at pharmacies and estimated manufacturer net prices after applying rebates paid by manufacturers.

This report updates a prior RAND Corporation report, Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis, with more-recent data and includes new supplementary analyses, editorial changes, and updates to reflect the evolving insulin market landscape.

Key Findings

  • Manufacturer gross prices for insulins in the United States were considerably higher than those in other countries for all insulins combined and for different types of insulin.
  • When comparing prices for a market basket of insulins sold in the U.S. and comparison countries, U.S. manufacturer gross prices ranged from 457 percent of those in Mexico to 3,799 percent of those in Turkey and 971 percent of those in all non-U.S. OECD countries combined.
  • Although the ratio of U.S. to other-country gross prices varied depending on the comparison country and insulin category, U.S. prices were always higher, and often five to ten times higher, than those in other countries.
  • After applying a U.S. gross-to-net discount, overall U.S. prices were 233 percent of those in other countries combined.
  • The overlap between the presentations of insulin sold in the United States and in comparison countries was generally high. However, there were differences in market shares across categories of insulin.
  • The United States was unusual among comparison countries in permitting distribution of several types of insulin over the counter, which is likely driven by access concerns.

Research conducted by

This research was sponsored by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation and conducted within the Payment, Cost, and Coverage Program within RAND Health Care.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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