OBJECTIVES: The increase in the price of insulin in the USA has been a controversial issue over the last five decades. Manufacturers have been increasing the list price of insulin over the past 50 years, increasing both public and private healthcare expenditure. In order to investigate this issue we analysed the price fluctuation of four key brands of insulin in the USA: Apidra, Humalog, Humulin and Novolog to track the discounted Federal Supply Schedule (FSS) and Big4 price across the USA between July 2017 to July 2019.

METHODS: The products were analysed for price fluctuation over the period of July 2017 to July 2019. The price points used for the comparison are the FSS and the Big4 prices taken from the FSS Price List as published by the Veterans Affairs Department. The discounted FSS and Big4 prices were used to show the price fluctuation between discounted products.

RESULTS: When comparing product prices between July 2017 and July 2019 there was an average increase of price across the four products of ~30%. All products included in the analysis increased in price and there was a widespread percentage price rise of between 9% and 97% across all products. Products belonging to the same manufacturer showed similar levels of percentage price increase over the time period.

CONCLUSIONS: The price for insulin has increased over the last two years, and with no checks in place, it could continue to grow. This would result in an increase of healthcare expenditure to both Medicare/Medicaid and private insurers. In October 2018 the Trump administration and Senator Sanders proposed, in different bills, the implementation of International Reference Pricing. This could play a vital role in regulating price of essential drugs ensuring equal access to medication throughout the USA.