Washington, D.C.—Insulin prices are a political flashpoint, with fights in Congress over price caps and several manufacturers coming out with lower priced products.

But what has been the actual trend of insulin prices over the past decade, considering actual costs?

“Despite the political salience of insulin prices, no study to date has quantified trends in insulin prices that account for manufacturer discounts (net prices),” wrote the authors of a report in the Journal of the American Medical Association Health Forum. They sought to describe trends in insulin list prices and net prices faced by payers from 2012 to 2019 and estimate changes in net prices after the 2015 to 2017 entry of new insulin products.

The longitudinal study included an analysis of Medicare, Medicaid, and SSR Health drug pricing data from January 1, 2012, to December 31, 2019, with data analyses occurring from June 1, 2022, to October 31, 2022.

“Net prices faced by payers were estimated for insulin products as list prices minus manufacturer discounts negotiated in commercial and Medicare Part D markets (i.e., commercial discounts),” the researchers explained. “Trends in net prices were evaluated before and after the entry of new insulin products.”

The study team was from the West Health Policy Center in Washington, D.C.; the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego; the Division of General Internal Medicine, University of Pittsburgh School of Medicine; and the Veteran’s Affairs Pittsburgh Healthcare System.

The results indicated that net prices of long-acting insulin products increased at an annual rate of 23.6% from 2012 to 2014, but they also decreased at an annual rate of 8.3% after the introduction of insulin glargine, such as Toujeo and Basaglar, and of degludec (Tresiba), in 2015.

“Net prices of short-acting insulin increased at an annual rate of 5.6% from 2012 to 2017 but then decreased from 2018 to 2019 after the introduction of insulin aspart (Fiasp) and lispro (Admelog),” the authors advised. “For human insulin products, which did not experience entry of new products, net prices increased at an annual rate of 9.2% from 2012 to 2019.”

At the same time, commercial discounts increased from 22.7% to 64.8% for long-acting insulin products, from 37.9% to 66.1% for short-acting insulin products, and from 54.9% to 63.1% for human insulin products, according to the report.

“In this longitudinal study of U.S. insulin products, results suggest that insulin prices substantially increased from 2012 to 2015, even after accounting for discounts,” the researchers concluded. “The introduction of new insulin products was followed by substantial discounting practices that lowered net prices faced by payers.”

The authors add that the 42.5% increase in mean list prices of common long-acting insulin products between 2014 and 2019 helped “foment insulin prices as a political issue.”

“A series of congressional investigations targeted insulin prices while manufacturers continued to argue that insulin prices are actually decreasing due to confidential discounts,” the researchers explained. “These discounts, which we refer to as ‘commercial discounts,’ are negotiated between pharmaceutical manufacturers and pharmacy benefit managers in the form of rebates for Medicare Part D and private insurance plans. Commercial discounts differ from mandatory discounts required by statute under the Medicaid and 340B programs; commercial discounts do not directly reduce patient cost sharing, nor do they reduce the prices faced by uninsured individuals.”

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