U.S. Insulin and Drug Prices Far Above Other Rich Nations

Author: RAND Corporation
Published: 1 Feb 2024 - Updated: 8 Nov 2026
Publication Details: Peer-Reviewed | Reports and Proceedings

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research presents two RAND Corporation reports, sponsored by the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services, that compare U.S. drug prices with 33 other high-income OECD countries using 2022 sales data. Manufacturer gross prices for insulin in the U.S. averaged 9.71 times those abroad and were still 2.33 times higher after estimated rebates, while overall prescription drug prices averaged 2.78 times higher and brand-name drugs 4.22 times higher. The findings matter to people with diabetes, seniors and people with chronic conditions who pay for medicines, and to policymakers weighing price controls.*

At a Glance

• 1 - Generic drugs make up 90 percent of U.S. prescription volume.
• 2 - U.S. insulin gross prices ranged from 4.57 times those in Mexico to 37.99 times those in Turkey.
• 3 - U.S. prices for unbranded generic drugs were about 67 percent of the average in comparison nations.
• 4 - The U.S. accounted for 62 percent of drug sales in the countries studied but only 24 percent of the volume.

Topic Definition

Gross Versus Net Drug Price

The gross price of a drug is the list price a manufacturer sets before discounts, while the net price is what the manufacturer actually keeps after rebates and other price concessions paid to insurers, pharmacy benefit managers and government programs. Patients who are uninsured or paying a deductible or coinsurance often pay amounts based on the higher gross price.

Overview

Study 1: Insulin Prices in U.S. Are Nine Times Higher Than In Other Wealthy Nations

The gross price of insulin in the U.S. is more than nine times higher than in 33 high-income comparison nations, depending on type of insulin, some U.S. prices can be even higher, according to a new RAND report.

Although the cost differences of insulin between the U.S. and other nations varied depending on the comparison country and the type of insulin, U.S. prices were always higher - often five to 10 times higher - than those in other countries. The new report updates findings from earlier RAND work about U.S. insulin prices.

After accounting for rebates and other discounts often offered by drug manufacturers, the price of a unit of insulin remained 2.3 times higher in the U.S. than in comparison nations, according to the study.

"Insulin prices in the U.S. have been increasing for many years and are substantially higher than in other middle and high-income nations," said Andrew Mulcahy, the study's lead author and a senior health economist at RAND, a nonprofit research organization.

Insulin is a drug most commonly used to control blood sugar levels in people who have insulin-dependent diabetes. The drug is sold in many different forms, with different chemical properties and different duration of effects.

Insulin list prices in the United States have increased dramatically since the early 2010s. For example, one federal analysis found that the average U.S. wholesale-acquisition price for rapid-acting, long-acting, and short-acting insulin increased by 15% to 17% per year from 2012 to 2016.

Medicare enrollees' financial exposure to out-of-pocket spending for insulin is changing dramatically. Under the Inflation Reduction Act, Medicare cost-sharing for a monthly supply of insulin has been capped at $35 since 2023, from January 1 under Part D and from July 1 for insulin used with pumps under Part B. Congress has also considered proposals to extend the cap to individuals with employer or individual market coverage.

RAND researchers compiled their estimates of international insulin prices by examining industry standard IQVIA MIDAS data on insulin sales and volume for 2017 through 2022, comparing the U.S. to 33 nations that belong to the Organisation for Economic Co-operation and Development (OECD).

The analysis presents separate comparisons using manufacturer gross prices, which may be more relevant to U.S. patients without drug coverage or otherwise paying out of pocket for insulin, and estimated manufacturer net prices after applying rebates paid by manufacturers.

The report presents volume and sales by type of insulin separately for the United States and 33 comparison OECD countries.

Researchers found that U.S. manufacturer gross prices per 100 international units of insulin were on average 9.71 times those in OECD comparison countries combined. After estimating gross-to-net discounts for insulins, U.S. net prices remained 2.33 times of those in comparison countries combined.

U.S. manufacturer gross prices ranged from 4.57 times those in Mexico to 37.99 times those in Turkey. Comparisons of U.S. insulin prices to prices in other countries were fairly constant from 2017 through 2022.

Study 2: US Prescription Drug Prices Are 2.78 Times Those In Other Wealthy Nations

Prescription drug prices in the U.S. are significantly higher than in other nations, with prices in the U.S. averaging 2.78 times those seen in 33 other nations, according to a new RAND report.

The gap between prices in the U.S. and other countries is even larger for brand-named drugs, with U.S. prices averaging 4.22 times those in comparison nations.

The RAND study found that prices for unbranded generic drugs - which account for 90% of prescription volume in the U.S. - are about 67% of the average cost in the comparison nations.

The new report updates findings from earlier RAND analysis about U.S. drug prices. That analysis compared 2018 manufacturer gross drug prices in the U.S. with other nations using a price index approach.

The new report uses updated information through 2022. It also includes additional analysis that focuses on price comparisons for biosimilars and changes in price comparison results over time.

"These findings provide further evidence that manufacturers' gross prices for prescription drugs are higher in the U.S. than in comparison countries," said Andrew Mulcahy, lead author of the study and a senior health economist at RAND, a nonprofit research organization. "We find that the gap is widening for name-brand drugs, while U.S. prices for generic drugs are now proportionally lower than our earlier analysis found."

The RAND analysis provides the most up-to-date estimates of how much higher drug prices are in the U.S. compared to other countries in the Organisation for Economic Co-operation and Development (OECD).

Researchers calculated price indexes under a wide range of methodological decisions. While some sensitivity analyses lowered the differences between U.S. prices compared to those in other nations, under all the scenarios examined overall prescription drug prices remained substantially higher in the U.S.

The analysis used manufacturer gross prices for drugs because net prices -- the amounts ultimately retained by manufacturers after negotiated rebates and other discounts are applied -- are not systematically available. Even after adjusting U.S. prices downward to account for these discounts, U.S. prices for brand name drugs remained more than three times higher than those in other countries.

RAND researchers compiled their estimates by examining industry standard IQVIA MIDAS data on drug sales and volume for 2022, comparing the U.S. to 33 OECD nations. The data include most prescription drugs sold in the U.S. and comparison countries.

Across all 33 comparison countries, U.S. drug prices ranged from 1.72 times the prices in Mexico to 10.28 times prices in Turkey.

Researchers estimated that across all of the OECD nations studied, total drug spending was $989 billion in 2022. The U.S. accounted for 62% of sales, but just 24% of the volume.

Recent estimates are that prescription drug spending in the U.S. accounts for more than 10% of all health care spending. Retail prescription drug spending in the U.S. increased by 91% between 2000 and 2020, and that spending is expected to increase by 5% annually through 2030.

Study 1 - About the Insulin Prices in US Are Nine Times Higher Than In Other Wealthy Nations Study

The study was sponsored by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services.

The report, "Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis," is available on the website of the U.S. Department of Health and Human Services. Other authors of the report are Daniel Schwam and Nate Edenfield.

Study 2 - About the US Prescription Drug Prices Are 2.78 Times Those In Other Wealthy Nations Study

The study was sponsored by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services.

The report, "International Prescription Drug Price Comparisons Estimates: Using 2022 Data," is available on the website of the U.S. Department of Health and Human Services. Other authors of the report are Daniel Schwam and Susan L. Lovejoy.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.

List of Generic Equivalents for Brand Name Drugs

More on this topic: Pharmaceuticals Publications - Diabetes Publications

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

What is a biosimilar insulin?

A biosimilar insulin is a near-identical, lower-cost version of a brand-name biologic insulin, approved after showing no meaningful differences in safety or effectiveness.

Is insulin capped for people with private insurance?

There is no national cap for most private plans, but several states have passed their own caps, and some manufacturers offer programs that limit monthly costs.

Why are U.S. drug prices higher than in other countries?

Many other countries negotiate or regulate drug prices nationally, while U.S. prices are largely set through negotiations between manufacturers, insurers and pharmacy benefit managers.

What is a pharmacy benefit manager?

A pharmacy benefit manager is a company that manages drug benefits for insurers and employers, negotiating rebates with manufacturers and setting which drugs are covered.

Where can people get help paying for insulin?

Options include manufacturer patient assistance programs, community health centers, state programs, Medicare plans and pharmacy discount programs.

Is it safe to ration insulin to save money?

No. Skipping or reducing insulin can lead to dangerously high blood sugar and diabetic ketoacidosis. Anyone struggling to afford insulin should speak with their doctor or pharmacist.

What is the OECD?

The OECD is an international group of 38 mostly high-income member countries that works together on economic and social policy and publishes comparable data.

Does Medicare now negotiate drug prices?

Yes. The Inflation Reduction Act allows Medicare to negotiate prices for a limited number of high-cost drugs, with the first negotiated prices taking effect in 2026.

Insights, Analysis, and Developments

Editorial Note: For people who depend on insulin or several daily medicines, the gap between U.S. and international prices is not abstract: high list prices drive up costs for anyone who is uninsured, in a deductible period or paying a percentage of the price. The reports show that rebates narrow the gap for insulin but do not close it, and that brand-name drugs account for most of the difference while generics are relatively cheap. Patients struggling with costs can ask about generic or biosimilar options, manufacturer assistance programs and caps such as the Medicare insulin limit.*

Attribution/Source(s): This peer-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally issued as a press release by RAND Corporation and published on 1 Feb 2024. Last updated on 8 Nov 2026. This content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.