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• Although the ratio of U.S. to other-country prices varied depending on the comparison country and insulin category, U.S. prices were always higher (often five to ten times higher) than those in other countries.
• U.S. prices were higher for analog versus human insulins in nearly all comparison countries.
• The overlap between the presentations of insulin sold in the United States and comparison countries was generally high, although 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. However, U.S. manufacturer prices were still much higher than those in comparison countries even in categories in which U.S. distribution is entirely over the counter.
• Although the authors focused their analysis on manufacturer prices rather than on net prices after potential rebates, the analysis suggests that U.S. insulin prices would still have been considerably higher — about four times higher — than those in other countries even when accounting for potential rebates.

Insulin prices have increased dramatically over the past decade in the United States. In this report, the authors compare international prices for insulins using a price index approach. They describe the shares of volume and sales for all insulins and different categories of insulin (including insulin type and timing characteristics) in the United States and 32 comparison Organisation for Economic Co-operation and Development (OECD) countries in 2018. For the market basket of insulins sold in both the United States and comparison countries, the authors report ratios of U.S. insulin prices to insulin prices in other countries. They found that manufacturer prices in the United States were considerably higher (often five to ten times higher) than those in other OECD countries for all insulins combined and for different types of insulin. Although the authors focused their analysis on manufacturer prices rather than on net prices after potential rebates, the analysis suggests that U.S. insulin prices would still have been considerably higher — about four times higher — than those in other countries even when accounting for potential rebates.

• Chapter One

  Background and Analysis

• Chapter Two

  Results

• Chapter Three

  Summary of Findings

• Appendix

  Exhibits