Insulin became a crisis symbol

A decade ago, insulin became the poster child for America's out-of-control drug prices. Alec Smith's 2017 death while rationing insulin sparked outrage.

Politicians passed price caps

Starting in 2019, 27 states passed laws capping out-of-pocket costs. Congress added a $35 monthly cap for Medicare in 2022.

The crisis isn't over

Millions still struggle to pay for insulin and have their health at risk. Advocates blame pharmaceutical greed for ongoing problems.

“There has been so much attention and promise to action around the insulin price crisis. … And shockingly, frustratingly, critically, the data from our 2024 survey showed that the rationing rates were worse than ever.”

One in three still ration

A 2024 Yale study found 38% of patients still had trouble keeping insulin on hand. Nationwide, 34% of insulin users reported rationing.

Rationing rates haven't improved

Yale patients rationed insulin at the same rate in 2024 as in 2017, about one in four. About 8.4 million Americans rely on insulin.

“I was surprised because I've been looking at the policy and advocating for policy change; you think things are moving, they should be really improving.”

Getting insulin is complicated

It's not as simple as showing up at the pharmacy. Who's covered and how they access insulin is extremely complicated.

Uninsured face discount nightmares

Millions remain uninsured and must pay cash prices. Enrolling for drugmaker discount cards is a nightmare with many restrictions.

Eli Lilly's promise fell short

Despite Lilly's pledge of $25 vials, uninsured patients paid nearly $100 on average in 2023. Discounted versions are often out of stock.

Federal cap excludes most people

The $35 cap applies only to Medicare, not the private insurance covering half the country. Bills to extend it haven't advanced.

State laws have loopholes

State caps typically exclude larger self-funded plans. Around 775,000 people with private insurance were protected in 2025, but over 1 million weren't.

Even $35 isn't always $35

Some struggle to afford $35 monthly. People need different amounts and types, and pharmacy substitutions can lead to higher costs.

One patient paid $140 monthly

Despite being on Medicare with a $35 cap, one of Dr. Lipska's patients ended up paying $140 per month for insulin.

“These things really add up…and frustrate people, because what seems like a great idea is not actually how things work on the ground.”

Rationing causes serious harm

Without enough insulin, blood sugar spikes can cause diabetic ketoacidosis, where your blood turns into acid. It feels like you're dying.

Long-term rationing damages health

Prolonged high blood sugar from rationing can lead to serious vision and nerve problems that insulin was supposed to prevent.

Advocacy momentum has slowed

The comprehensive insulin cap bill was delayed over a year this Congress. Advocates worry the issue has become less urgent.

Public manufacturing is the answer

Advocates are pushing for government to procure or produce insulin itself and make it available at the lowest possible cost.

“This idea that medicines should be for people and not for profit I feel like is really catching.”

Oklahoma funds private production

Oklahoma passed a bill offering government funding for private companies that pledge to produce insulin and sell it at low prices.

California is making its own

California launched a program to eventually produce insulin in government-owned facilities. It will take years before production begins.

Public production solves shortages

Only three insulin makers exist in the US. As they focus on GLP-1 production, nonprofit initiatives could fill supply gaps.

“The general communication that we've been hearing is that the insulin price crisis is over. As the data shows, as we've been talking about, that is just not true.”