# Why Your Insulin Costs $300
Hook: Insulin was discovered in 1921. The patent was sold to the University of Toronto for $1. Over 100 years later, a vial of insulin in the United States can cost $300. The same vial, made by the same company, costs $30 in Canada and $8 in India.
The Same Molecule, 10x the Price
Insulin is not new. It is not rare. It is not difficult to manufacture. It is one of the most well-understood biological products in the world. And yet, between 2002 and 2013, the price of insulin in the United States tripled.
Here's what insulin costs in other countries for the same product:
- **United States:** ~$98.70 per unit (average)
- **Canada:** ~$12 per unit
- **United Kingdom:** ~$7.52 per unit
- **India:** ~$3.71 per unit
The molecule is identical. The manufacturing process is nearly identical. What's different is the system.
How They Keep Generics Out
Insulin should be cheap. The original patent expired decades ago. But the three companies that control 90% of the global insulin market — Eli Lilly, Novo Nordisk, and Sanofi — have used a strategy called evergreening to maintain effective monopoly pricing.
Evergreening works like this: you don't patent the molecule (that patent expired long ago). You patent the delivery device. Then you patent a slight reformulation. Then you patent the manufacturing process. Each minor patent extends your effective exclusivity, creating a "patent thicket" that makes it prohibitively expensive for competitors to enter the market.
The result: as of 2023, there are over 70 active patents associated with insulin products in the United States.
What Changed (and What Didn't)
The Inflation Reduction Act of 2022 capped insulin copays at $35 per month — but only for Medicare recipients. If you have private insurance or no insurance, the cap doesn't apply to you.
In 2023, Eli Lilly voluntarily cut the list price of some insulin products to $35. This was widely praised. What received less attention: the move came after sustained public pressure, Congressional hearings, and the threat of expanded federal price negotiation. The market didn't self-correct. Public action forced the correction.
The Key Insight
Insulin pricing is a case study in what happens when the market fails and government doesn't intervene. The product is 100 years old. The science is settled. The manufacturing is routine. The only thing keeping the price high is the legal and regulatory infrastructure that allows it. Every argument that "the market will fix it" has had a century to prove itself. The evidence is in.