ADA White Paper Addresses Insulin Access, Affordability


The Working Group examined the insulin supply chain and the factors that impact the costs of and access to insulin products.

For millions of Americans living with diabetes, insulin affordability is a serious concern as list prices continue to surge. Current estimates show that diabetes is the most expensive chronic illness in the United States at a total of more than $327 billion per year, including $15 billion for insulin.1

The American Diabetes Association (ADA) convened an Insulin Access and Affordability Working Group to determine the full scope of the insulin affordability problem and provide recommendations on how to address the issue. The findings were published in Diabetes Care and presented by the ADA’s Chief Scientific, Medical, and Mission Officer William T. Cefalu, MD, in testimony before the US Senate Special Committee on Aging.2

According to the data, the average US list price of the 4 insulin categories increased by 15% to 17% per year from 2012 to 2016. The price that pharmacies paid for insulin increased at similar rates over the same period. Additionally, between 2006 and 2013, average out-of-pocket costs per insulin user among Medicare Part D enrollees increased by 19% per year for all insulin types.1

The Working Group interviewed more than 20 stakeholders who were representatives of pharmaceutical manufacturers, wholesalers, pharmacy benefit managers (PBMs), pharmacies, pharmacists, distributors, health plans, and employers, as well as people with diabetes and their caregivers.

Based on their findings, the Working Group determined that there is a consistent lack of transparency throughout the insulin supply chain, with many stakeholders reporting that more transparency is needed.

The Working Group found that although insulin manufacturers still control the list price of the products, substantial market power has shifted from the manufacturers to the PBMs. Overall, the group noted that the complexity of the system is a concern due to the variety of stakeholders involved and the multiple transactions that occur between them.

Although they indicated that the current pricing and rebate system encourages high list prices, the Working Group was unable to pinpoint a specific reason for the surging costs.

“The cost of insulin is a complex and multifaceted issue, yet it is imperative that we continue to advocate for affordable access to this lifesaving medication for people with diabetes and focus on approaches and recommendations to help lower costs,” Dr Cefalu said in a press release.2

Prescribing patterns have also shifted toward favoring newer, more expensive insulins. The Working Group suggested that human insulin may be an appropriate alternative to the more expensive analog insulins for some patients.

Overall, the Working Group recommended that providers and pharmacists communicate openly with patients regarding insulin costs and suggested that providers prescribe the lower price insulin required to effectively and safely achieve treatment goals.


1. Cefalu WT, Dawes DE, Gavlak G, et al. Insulin Access and Affordability Working Group: Conclusions and Recommendations. 2018. Diabetes Care.

2. American Diabetes Association Releases White Paper by Insulin Access and Affordability Working Group at Hearing of Senate Special Committee on Aging [news release]. ADA’s website. Accessed May 2018.

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