Insulin prices: How much does insulin cost?

Cost of a bottle | Cost per month | Increasing prices | Generics and biosimilars | How to save | FAQs

Diabetes is no small issue in the United States. There are approximately 30.3 million people with diabetes in the U.S., according to the Diabetes Research Institute. Five percent of them—or about 1.5 million people—have Type 1 diabetes and require insulin to survive. Some people with Type 2 diabetes can control blood sugar with diet and activity. Still, many need insulin, especially as the condition progresses.

And unfortunately, insulin prices have risen dramatically over the past 10 years. Between 2012 and 2016, the price almost doubled, according to the Health Care Cost Institute. In 2012, the average cost of insulin per diabetes patient was $2,864 per year. By 2016, it had risen to $5,705. Today, one vial of insulin can cost $250, and some people need six vials per month.

In addition, there are other diabetes supplies, such as a glucose monitor, test strips, lancets, and a safe place to store used syringes or pens. Care for the condition could easily cost someone without insurance $1,300 per month. Even with insurance, copayments and supplies can affect your monthly budget. Luckily, there are savings options.

How much is a bottle of insulin?

The cost of one insulin vial varies depending on the type of insulin you use and how you pay for it. But, no matter the cost, there are alternatives to paying the cash price.

“If you do not have insurance, the pharmaceutical companies that make insulin products offer patient assistance programs,” explains Michael Carnathan, MD, a board-certified family physician in Bethlehem, Pennsylvania. “Most of the time, the patient can get the insulin for free or at a very reduced cost.”

For those without health insurance, the older human insulins cost anywhere from $25 to $100 per vial; for example, Walmart has human insulin available at $25 per vial. The newer human analog insulins cost between $174 to $300 per vial, according to a report published in 2018.

How much does a bottle of insulin cost with insurance?

It is difficult to say how much a vial of insulin costs when paying through your health plan. Each insurance plan covers insulin products differently.

“It is when you actually have health insurance coverage that getting the insulin for a decent price becomes a problem,” says Dr. Carnathan. “In those cases, the patients are sometimes forced to switch to a different and cheaper type of insulin called NPH or 70/30, among a few others. These insulins have been around for a long time and are affordable. The patient needs a primary care doctor or endocrinologist comfortable using these older insulins and adjusting them safely.”

Each health plan has varying copays and deductibles, too. For example, for people with a high-deductible plan, the cash price for insulin is paid until you meet the deductible. Some copays can be as high as 50% of the cost of the medication.

It can also sometimes be difficult for people on Medicare to afford insulin. “Many patients who are faced with the high cost of insulin find themselves caught in the Medicare donut hole,” says Gail Trauco, RN, the principal CEO of The PharmaKon LLC.

Like uninsured customers, patient assistance programs might help Medicare customers. However, these programs require an application, which can take 30 to 60 days for review and approval, and documentation with receipts to confirm your monthly cost-of-living expenses.

Due to the public uproar concerning the high insulin prices, some insurance companies and drug companies are taking steps to lower the monthly cost. For example:

• Cigna and Express Scripts are capping the monthly out-of-pocket costs at $25 per month. Express Scripts estimates around 700,000 people with diabetes will be eligible for these savings. However, employers must opt into this program.
• Sanofi, one of the major suppliers of insulin, is creating a program for cash payers. This program costs $99 per month and provides either 10 vials, 10 boxes of pens, or a combination of the two. People with Medicare, Medicaid, or other federal and state programs are not eligible for this program. Regardless of whether they have health insurance, anyone can participate if they pay cash for their insulin. The $99 may not cover all the costs, and supplies might cost extra.
• Eli Lilly recently came out with a generic version of Humalog that sells for half the price, at $137.35 per vial.

Are insulin vials cheaper than pens?

There is a significant difference in insulin prices between insulin vials (via syringes) and insulin pens. Using vials is less expensive than pens. However, some feel that using pens as a delivery system provides a higher quality of life. The pens come prefilled, and the number of doses could be lower when using analog medications. The pens make it easier to take insulin with you, providing more freedom.

Using pens is safer, more convenient, and offers better glycemic control, according to a study published in 2018. However, this study also noted that people who use pens spend significantly more each month on diabetes control. In some cases, it was three times more expensive to use pens.

How much does a month of insulin cost?

Everyone has different insulin needs. There isn’t a “one size fits all” approach to determining how much insulin you need. Those taking analog insulin take a background or basal dose once or twice daily. In contrast, those taking regular human insulin take it three to four times daily.

This cadence is the only insulin some people with Type 2 diabetes need. But for Type 1 diabetes and some with Type 2, additional insulin is needed at mealtime. Depending on which insulin you are using, it should be taken 10 to 30 minutes before your meal. The amount of insulin depends on what you plan to eat. For example, you might need 1-3 units per carbohydrate portion (15 grams).

People with Type 1 diabetes generally use two different types of insulin per day. They start with two daily injections and progress to three to four doses per day, according to the American Diabetes Association (ADA). People with Type 2 diabetes might start with 0.5-0.8 units per kilogram of body weight per day and eventually take 1-2 units per kilogram of weight. For a person weighing 150 pounds, this would be 68 to 136 units per day. For a person weighing 175 pounds, this would be 80-160 units per day.

One vial of insulin contains 1000 units, and pens contain 300 units.

The following table compares drug prices of different types of insulin for a 30-day supply based on three vials or 10 pens per month. The table includes average insulin prices, though you might pay a different amount based on your area, your pharmacy, and what you require.

* Based on three vials or 10 pens

In addition to the above costs, you might also require additional supplies, such as:

• Syringes: $15-$20 for a box of 100
• Test strips: $25-$60 for 50 test strips (may require anywhere from one to 10 per day)
• Pumps: Can cost $6,000 to purchase a pump plus $3,000 annually for supplies such as batteries

What’s fueling the rapid increase in insulin prices?

There is no doubt that insulin prices have reached a tipping point where some people can’t afford their medication. In a presentation for the ADA, Irl B. Hirsch, MD, explains that from 2013 to 2016, a vial of glargine insulin had a price increase of 593%, and a box of five insulin lispro pens rose 522%. During that time, inflation rose by only 8.3%. In 2014, drugmakers increased the price of insulin twice, each time by approximately 16%. That means insulin prices rose by over 30% in one year.

There isn’t just one reason for the high cost of insulin. Pharmaceutical companies complain that pharmacy benefit managers (PBM) administering prescription benefits for commercial insurance companies drive the cost up by requiring rebates to have their brand of insulin included in the insurance formulary. They claim their net price is lower than the list price. But the PBMs say it’s the pharmaceutical companies who set the list price.

Several factors keep insulin prices high:

•  Most of the new insulins on the market today which are referred to as “generic” are not truly generic by definition, but are actually considered “biosimilar” or “follow on.” This is determined by the manner in which they are approved by the Food and Drug Administration (FDA). Insulins are biologic products that are large, unstable compounds. These are not as simple to replicate as chemical drugs which are traditionally small, stable molecules which can be replicated exactly and be expected to perform exactly as the branded product did in the body. Biosimilar products can still offer significant savings over the original branded product, but they may still be very costly for some.
• Pharmaceutical companies may revisit their products’ approvals and add to their patents which can extend their patent life and exclusivity time on the market. This delays the point at which a directly equivalent product can enter the market to compete with it.
• As with the pharmaceutical companies, there is a lack of competition in the PBMs, giving companies, such as CVS Caremark and Express Script, the ability to make their own rules. Hirsch indicates that in 2013, CVS Caremark had revenues of $123 billion, and Express Script was at $94 billion.

Higher levels of competition would lower prices, increasing the affordability of insulin.

The rising cost of insulin has real-world consequences. A group in Minneapolis reportedly take a bus to Canada to purchase insulin at a fraction of the price as it sells for in the United States.

Some people are also rationing their insulin by either splitting or skipping doses. Both have serious health consequences. After aging out of his mother’s health insurance, one 26-year-old man was informed by his pharmacist that his insulin and supplies would be $1,300 per month. It was more than he could afford on his restaurant manager’s salary. Less than a month after losing his insurance, he died. His family believes he started rationing his insulin, and that is what killed him.

A few state governments are also trying to lower the prices of insulin. Colorado capped the insulin copay at $100 per month for insured people. Nevada passed a law to increase transparency in drug pricing, looking to combat not only the rising cost of insulin but the increasing cost of all prescription medications. Twenty-three other states have proposed legislation aimed at tackling the high costs of prescription drugs.

How much does it cost to produce insulin?

A 2018 study estimated that one vial of human insulin costs $2.28-$3.42 to produce, and one vial of analog insulin costs $3.69-$6.16 to produce. At those production rates, a year’s supply of human insulin could cost $48-$71 per patient, and analog insulin could cost $78-$133 per patient per year.

The study measured the manufacturing cost only. It did not include administrative fees, sales, and research and development for improving medications. However, insulin manufacturers have not provided an adequate explanation for this large discrepancy between production costs and retail costs.

How are generic and biosimilar insulins affecting prices?

Generic competition in the insulin marketplace has historically been very limited. The molecular structure of insulin is complex, and how it interacts with the body can be unique. The FDA does not approve similar biologic drugs in the same manner that it does small molecule chemical drugs like your oral blood pressure medication in tablet form, for instance. As a component of the Affordable Care Act, Congress enacted the Biologics Price competition and innovation Act (BPCIA). This is an abbreviated drug approval pathway that is specific to biologics. There are two types of approvals. The first is a “biosimilar” drug which is highly similar to the original biologic product with no clinically meaningful differences in safety, purity, or potency. Biosimilars can not be automatically substituted for the original biologic product at the pharmacy in most instances. They require the order to be written for them directly. The other type of product approval which has only recently become relevant is an “interchangeable biologic” and what we more traditionally think of as a generic alternative. This type of product can be expected to have the same clinical effect in any patient and poses no additional safety risks as compared to the original branded product. The key difference is that in most states, the automatic substitution of the interchangeable biologic is allowed at the pharmacy unless the prescriber has indicated that it must be dispensed as written.

Believe it or not, interchangeable biosimilar insulin products have only recently come to market. The first to come to market was Semglee in mid-2021 when it was approved by the FDA as a substitutable product for Lantus, both being insulin glargine. Basaglar was a biosimilar insulin glargine product that had been available for several years before the release of Semglee. One box of brand-name Lantus Solostar insulin pens can cost $350 – $450, even with a discount card. The same size box of Semglee pens could be less than $100, which is a significant savings. An insured patient will likely save even more. As more and more interchangeable biosimilar insulins come to market, insulin will likely become more and more affordable. This will lead to better compliance and outcomes for all diabetes patients.  

How to save on insulin prices

Contact your insurance company (for those who are insured) and find out how your policy pays for insulin. Do they pay more for certain types of insulin? Do they exclude certain types? If their payments or exclusions don’t work with what you are taking, talk to your healthcare provider about options. Some insurance companies will accept what is called a prior authorization, which means your doctor writes a letter explaining why you need a specific type of insulin. Find out what your deductible is and how you will need to pay out of pocket. Ask if they have any special programs for insulin, such as the one offered by Cigna.

If paying cash, take advantage of programs offered by pharmaceutical companies, such as the one provided by Sanofi. Add in additional supplies costs to see what you will need to pay each month.

Look into patient assistance programs offered by most major pharmaceutical companies, like Eli Lilly and Novo Nordisk, and some nonprofit assistance programs, such as Rx Hope, that provide free or low-cost prescriptions to low-income and uninsured.

Take advantage of a prescription savings card from SingleCare. Over 35,000 pharmacies accept SingleCare coupons. You can enter your zip code online or on our mobile app to find the pharmacy with the lowest price for your insulin. Then, bring in your prescription and SingleCare card to receive the discount. Joining SingleCare is free.

Insulin cost FAQs

Are there generic versions of insulin?

In the category of insulin, there are biosimilar insulins and interchangeable biosimilar insulins. While both are typically less expensive than the original biologic insulin product, the interchangeable biosimilar insulin products are substitutable at the pharmacy if the doctor writes for the branded product, similar to traditional generic drugs. Introducing interchangeable biosimilar insulins to the marketplace creates competition and drives lower pricing, which is beneficial to the end user, similar to the traditional generic drug marketplace.

Why is insulin so expensive?

The insulin market is dominated by three primary manufacturers: Eli Lilly, Novo Nordisk, and Sanofi. Even with biosimilars, they control the vast majority of the market. Less competition means fewer factors to drive down prices. Another important factor is we have spent a lot of time and money making insulin better- faster acting, longer lasting, creative delivery devices. The research involved in developing these things takes time and money, and there are patents that protect them for a while. Drug creation is a complicated matter, but it appears we are getting to a place where insulin is more affordable than it has been in a long time.

Is it okay for me to skip insulin doses?

You should always take your insulin as your doctor has prescribed and never skip a dose. Missed doses allow your blood sugar to rise, and over time, your A1C measurements will increase. You will be at risk for long-term complications such as kidney failure, heart disease, blindness, or amputation of extremities. If you are considering skipping doses because you can’t afford your insulin, talk to your doctor or pharmacist about your options for more affordable insulin or patient assistance programs.

What is the Affordable Insulin Now Act? 

The Affordable Insulin Now Act is a bill introduced into the Senate in early 2022 aimed at limiting cost-sharing for insulin under private health insurance and Medicare prescription drug benefits. The goal was to cap prices for a patient at $35 or 25% of an insurance plan’s negotiated rate, whichever was lowest. Ultimately, the benefit was only passed to cap the cost for medicare beneficiaries at $35 per month in late 2022, and the bill went into effect in 2023.

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