Baldeep Singh: The True Costs of Pricey Insulin

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American diabetics pay far more for insulin than others and Dr. Baldeep Singh sees the true costs for his patients of the expensive but life-sustaining drug.

At a recent free clinic visit, David returned for help with his poorly controlled diabetes. We had maximized his oral medication, so I told him we should consider insulin next. As with many patients, he felt reticent, given the scary specter of daily finger sticks and battling needles. But the cost of the insulin deterred him even more. Fortunately, I was able to order it from a patient assistance program, but that took time and delayed his care.

Insulin, although first released in the 1920s, costs on average $100 per month in the United States, compared to an average of just $10 per month in other developed countries. In the chaos of our health system, some drug companies claim to offer lower-priced insulins and discount cards to help those struggling to pay. But nearly a third of insulin-dependent people who responded to published surveys say they have postponed doctors' appointments or put off paying bills to afford their insulin. A quarter had skipped a rent or mortgage payment, and more tragically, some patients have died.

You might wonder why a drug released so long-ago costs so much today. The answer involves many factors including a three-company monopoly on manufacturing insulin, legal maneuvers to keep generics off the market, the complexity of insulin production, and lax federal regulation around drug pricing. Meanwhile, Congress has lacked the political will to influence drug prices…until now.

With the passage of the Inflation Reduction Act, we received a little good news. On the horizon, at the start of next year, the Act will cap the price of insulin at $35 per month for Medicare recipients, although not for patients with private insurance; and likely not for the uninsured. So it remains to be seen how much this bill will help the millions currently spending astronomical amounts to pay for a life-sustaining medication.


In the meantime, I filled out the paperwork for David, and he started his insulin three weeks later, after the shipment arrived. Hopefully, this new federal legislation will be a small step in easing some the burden on patients like David, putting us on our way to righting a 100-year-old wrong.

With a Perspective, I’m Dr. Baldeep Singh.

Dr. Baldeep Singh is a South Bay physician.