Comparing Insulin Prices in the United States to Other ...

Research Report

Comparing Insulin Prices in the United States to Other Countries

Results from a Price Index Analysis

Andrew W. Mulcahy, Daniel Schwam, Nathaniel Edenfield

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Preface

Insulin prices have increased dramatically over the past decade in the United States. This report presents results from a comparison of international prices for insulins using a price index approach. The report describes the shares of volume and sales for all insulins and different categories of insulin in the United States and 32 comparison Organisation for Economic Cooperation and Development countries. For the market basket of insulins sold in both the United States and comparison countries, it reports ratios of U.S. insulin prices to insulin prices in other countries.

This research was funded by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation under Contract Number HHSP233201500038I and carried out within the Payment, Cost, and Coverage Program in RAND Health Care.

RAND Health Care, a division of the RAND Corporation, promotes healthier societies by improving health care systems in the United States and other countries. We do this by providing health care decisionmakers, practitioners, and consumers with actionable, rigorous, objective evidence to support their most complex decisions. For more information, see health-care, or contact

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NOTE: Page 2 of this report was updated in November 2020 to clarify the definition of a standard unit in the IQVIA MIDAS data.

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Contents

Preface ........................................................................................................................................... iii Figures and Tables...........................................................................................................................v Acknowledgments ........................................................................................................................ vii Abbreviations .............................................................................................................................. viii 1. Background and Analysis............................................................................................................1

Background ...............................................................................................................................................1 Data and Methods......................................................................................................................................1 2. Results .........................................................................................................................................5 Shares of Volume and Sales......................................................................................................................5 Average Prices per Standard Unit ...........................................................................................................10 Price Index Comparisons ........................................................................................................................12 3. Summary of Findings ................................................................................................................16 Appendix. Exhibits ........................................................................................................................18 References .....................................................................................................................................25

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Figures and Tables

Figures

Figure 2.1. Shares of Insulin Volume Versus Shares of Insulin Sales Among 33 OECD Countries, 2018........................................................................................................................5

Figure 2.2. Insulin Volume Shares, by Insulin Type, Selected Comparisons, 2018 .......................6 Figure 2.3. Insulin Sales Shares, by Insulin Type, Selected Comparisons, 2018 ...........................6 Figure 2.4. Insulin Volume Shares, by Insulin Timing Category, Selected Comparisons, 2018....7 Figure 2.5. Insulin Sales Shares, by Insulin Timing Category, Selected Comparisons, 2018 ........8 Figure 2.6. Prescription Versus Nonprescription Insulin Volume Shares, by Category, 2018 .......9 Figure 2.7. Prescription Versus Nonprescription Insulin Sales Shares, by Category, 2018 ...........9 Figure 2.8. Average Price per Standard Unit, by Insulin Type, Selected Comparisons, 2018......10 Figure 2.9. Average Price per Standard Unit, by Insulin Timing Category,

Selected Comparisons, 2018 .................................................................................................11 Figure 2.10. Price Index Comparison, by Insulin Type, Selected Comparisons, 2018.................12 Figure 2.11. Price Index Comparison, by Insulin Timing Category, Selected Comparisons,

2018 .......................................................................................................................................13 Figure 2.12. Price Index Results Comparison, Presentation Level Versus Molecule Level,

2018 .......................................................................................................................................15

Tables

Table A.1. Insulin Active-Ingredient Mapping .............................................................................18 Table A.2. Insulin Volume and Sales Shares, by Insulin Type, 33 Select OECD Countries,

2018 .......................................................................................................................................19 Table A.3. Average Price per Standard Unit, Overall and by Insulin Type, 33 Select OECD

Countries, 2018......................................................................................................................20 Table A.4. U.S. Prices Relative to Comparison Country Prices in Percentage Points,

Overall and by Insulin Type, 33 Select OECD Countries, 2018...........................................21 Table A.5. Share of Insulin Sales and Volume Contributing to Presentation-Level Bilateral

Price Index Comparisons, 2018.............................................................................................22 Table A.6. U.S. Prices Relative to Comparison Country Prices in Percentage Points at the

Active-Ingredient Level, Overall and by Insulin Type, 33 Select OECD Countries, 2018 .......................................................................................................................................23 Table A.7. Average U.S. Price per Standard Unit for Short-Acting Insulins, by Prescription Status, 2018 ...........................................................................................................................24

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Table A.8. U.S. Prices Relative to Comparison Country Prices in Percentage Points for Prescription Records, Overall and by Insulin Type, 33 Select OECD Countries, 2018 .......24

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Acknowledgments

We thank Amber Jessup, Kenneth Finegold, and Zeid El-Kilani at the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, for their contributions during the course of our research and the development of this report. We thank Christine Eibner, Christine Buttorff, and Chris Whaley of the RAND Corporation for their suggestions and comments as peer reviewers of a draft of this report.

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Abbreviations

ASPE I L NFC NPH OECD R RI S SI SU USD

Office of the Assistant Secretary for Planning and Evaluation intermediate-acting long-acting new form code neutral protamine Hagedorn Organisation for Economic Co-operation and Development rapid-acting rapid?intermediate-acting short-acting short?intermediate-acting standard unit U.S. dollars

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