Why Is Insulin So Expensive 100 Years After Its Discovery?
This is a review article written for the 100th anniversary of insulin’s discovery, not an original experiment or a patent-database analysis. The authors, based at the University of Michigan, trace how insulin therapy evolved, pull together published data on what insulin costs and who can get it, and recommend clinical and policy steps to improve access. The core problem they describe: the average price of insulin in the United States has nearly tripled over the past decade, and on insulin’s centenary this life-saving treatment is financially out of reach for as many as one third of people with diabetes.
Dr. Kumar’s Take
Frederick Banting said insulin did not belong to him, it belonged to the world, and he and his colleagues sold the patent to the University of Toronto for $1 each specifically to keep the drug affordable. A century later, three manufacturers control 99% of the global insulin market by value and 96% by volume, and a treatment that is useless if you skip it is out of financial reach for up to a third of the people who need it. I read that as a distribution failure, not a science failure. The chemistry got better every decade. Access did not keep pace.
Key Findings
The global insulin market was valued at approximately $21 billion in 2012, and it is dominated by three multinational manufacturers: Eli Lilly, Novo Nordisk, and Sanofi. Those three companies control 99% of the market by value and 96% by volume. A major driver of rising prices and spending has been the shift toward more expensive insulin analogs in place of less expensive human and animal insulins, which has hurt affordability for both health systems and individuals.
The ACCISS study, covering 26 countries, found a wide spread in government procurement prices for human insulin. A 10-ml, 100-IU/ml vial cost between $1.00 and $18.10, with a median of $4.30 in 1996 US dollars. The highest median prices were in the poorest countries: $6.90 in low-income countries (range $2.50 to $11.50) and $4.70 in lower middle-income countries (range $1.00 to $12.50), compared with $4.00 in high-income countries (range $3.20 to $18.10) and $3.10 in upper middle-income countries (range $1.50 to $7.10).
The PURE study, a prospective cohort across 22 countries, found insulin stocked in 48% of pharmacies overall: 94% in high-income countries, 40% in upper middle-income countries, 29% in lower middle-income countries, 10% in low-income countries excluding India, and 76% in India. Affordability tracked the same gradient. An estimated 37% of households that included someone with diabetes could not afford insulin, ranging from 3% in high-income countries to 35% in lower middle-income countries, 47% in upper middle-income countries, 51% in India, and 63% in low-income countries excluding India.
In the United States, expenditures for insulin and non-insulin antihyperglycemic medications among adults 18 years and older with diabetes rose from $10 billion to $22 billion between 2002 and 2012. That increase was driven primarily by insulin, whose expenditures rose from a starting point of $2.6 billion.
Brief Summary
This is a centenary review of insulin: where it came from, how the therapy and its delivery technology changed, what it now costs around the world, and why so many people cannot get it. Banting and Best prepared a pancreatic extract in August 1921 that lowered blood glucose in a pancreatectomized dog. In January 1922, Leonard Thompson, a 14-year-old boy with type 1 diabetes, responded to injections of the glucose-lowering component that James Collip purified from that extract. In January 1923, Banting, Best, and Collip received an American patent and sold the rights to the University of Toronto for $1 each, explicitly to keep the treatment accessible and affordable. By the end of 1923, other laboratories and industry had made large-scale commercial production possible.
Study Design
This is a narrative review and policy analysis rather than a trial. The authors summarize a century of insulin development, then draw on published market and pricing data, including the ACCISS study of government procurement prices across 26 countries and the PURE prospective cohort study across 22 countries, along with United States expenditure data, to explain the drivers of insulin cost. From that, they propose clinical and policy interventions aimed at access and affordability.
Results You Can Use
Insulin therapy has been improved repeatedly. Longer-acting formulations arrived between the 1920s and the 1970s. Genetic engineering brought human insulin to market in the 1980s. Rapid-acting and long-acting analogs followed in the 1990s, inhaled insulin in the 2000s, and ultra-rapid acting, ultra-long acting, and biosimilar analogs in the 2010s. Delivery and monitoring improved alongside: vials and glass syringes gave way to pens and pumps, and fingerstick testing gave way to continuous glucose monitoring, real-time CGM, and flash glucose monitoring. In September 2016, the FDA first approved artificial pancreas systems that automatically adjust basal insulin rates and deliver bolus corrections from CGM readings.
The practical point for cost: those newer analogs are the expensive end of the market, and the move away from human insulin is a documented reason spending has climbed. Biosimilar rapid-acting and long-acting analogs are now on the market as well.
Why This Matters For Health And Performance
Insulin is not optional therapy. When a third of households affected by diabetes in a global cohort cannot afford it, and when a drug given to the world for $1 has become financially out of reach for as many as one third of people with diabetes, the barrier to treatment is economic rather than medical. Availability compounds the problem in poorer countries, where insulin was stocked in as few as 10% of pharmacies while the median procurement price ran higher than in wealthy countries.
How to Apply These Findings in Daily Life
- Know that insulin cost is a pricing and policy problem, not a limit of the science
- Ask your physician whether human insulin is a reasonable option for you, since analogs are the more expensive class
- Ask whether a biosimilar rapid-acting or long-acting analog is available for your regimen
- Compare insulin coverage specifically when you choose a health plan, not just the premium
- Tell your clinician if you are rationing or skipping doses because of cost, so the regimen can be changed rather than abandoned
- Support policy work on insulin access and affordability
- Connect with advocacy organizations working on insulin affordability
Limitations To Keep In Mind
This is a review with policy recommendations, so its conclusions rest on the studies it summarizes rather than on new data. The ACCISS figures are government procurement prices expressed in 1996 US dollars, which is not what an individual pays at a pharmacy counter. The PURE availability estimates come from surveyed pharmacies across 22 countries, and both studies group countries by income band, which averages over very different national health systems. The United States expenditure trend covers 2002 to 2012.
Related Studies
- Insulin in America: A Right or a Privilege?
- Expenditures and Prices of Diabetes Medications 2002-2013
- Medicare Beneficiaries and Insulin Affordability
- The Internal Secretion of the Pancreas
- Episode 24: The Discovery of Insulin
FAQs
Who controls the global insulin market?
Three multinational manufacturers, Eli Lilly, Novo Nordisk, and Sanofi, control 99% of the global insulin market by value and 96% by volume. The market was valued at approximately $21 billion in 2012.
Why has insulin spending risen?
One documented driver is the increasing use of more expensive insulin analogs in place of less expensive human and animal insulins. That shift has raised insulin prices and spending and has worsened affordability for health systems and individuals worldwide.
Is insulin harder to get in poorer countries?
Yes, on both counts. In the PURE study, insulin was stocked in 94% of pharmacies in high-income countries but 10% in low-income countries excluding India. Unaffordability ran from 3% of affected households in high-income countries to 63% in low-income countries excluding India.
Conclusion
Banting sold the insulin patent for $1 so the drug would stay within reach of everyone who needed it. One hundred years on, the molecule is better, the pumps and sensors are better, and the price is the obstacle. The authors of this review put the task plainly: make sure insulin is available to every person with diabetes who needs it, through the clinical and policy levers that shape what patients actually pay.
