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Origins of the Crisis in Insulin Affordability and Practical Advice for Clinicians on Using Human Insulin


Purpose of Review

High insulin prices and cost-related insulin underuse are increasingly common and vexing problems for healthcare providers. This review highlights several factors that contribute to high prices and limited generic competition in the US insulin market.

Recent Findings

An opaque and complex pricing and reimbursement system for insulin, allegations of collusive practices by insulin manufacturers, and a lack of generic competition drive and sustain high insulin prices. When combined with increasing insurance deductibles and cost sharing, these factors contribute to cost-related insulin underuse and are associated with adverse clinical outcomes.


Healthcare providers facing patients with type 2 diabetes who struggle to afford insulin should consider initiating or switching from analogue to human insulin as one way to help address the challenges of access and affordability. However, it is also important to support initiatives to advocate for affordable pricing for insulin for patients who can benefit from the flexibility offered by many of the newer insulin preparations.

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Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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The authors would like to thank Dr. Mary Korytkowski, who provided comments on an earlier version of this manuscript.


Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR001856. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs.

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Correspondence to Jing Luo.

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Conflict of Interest

Jing Luo consults for Alosa Health and has received grant and travel support from Health Action International.

Walid F. Gellad declares that he has no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Economics and Policy in Diabetes

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Luo, J., Gellad, W.F. Origins of the Crisis in Insulin Affordability and Practical Advice for Clinicians on Using Human Insulin. Curr Diab Rep 20, 2 (2020). https://doi.org/10.1007/s11892-020-1286-3

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  • Insulin prices
  • Human insulin
  • Insulin switching