Comparisons of Insulin Spending and Price Between Canada and the United States.

Insulin prices have been a hot topic in the United States, where there is a lack of price regulation on drugs, and there have been reports of Americans crossing the border to purchase insulin in Canada at much lower prices. We conducted a cross-sectional time-series analysis comparing insulin spending using IQVIA (Durham, North Carolina, USA) data on aggregate insulin prescription volumes dispensed in the United States and Canada from January 2016 to April 2019 to quantify insulin spending and pricing differences between the countries. We obtained data on diabetes rates from the US Centers for Disease Control and Prevention and Statistics Canada. The primary outcome of this study was the difference in total annual insulin spending and spending per insulin user between the United States and Canada. We also examined spending on the top 5 most used insulins per year in the United States and the percentage change of spending on insulin products from January 2016 to April 2019. In 2018, the US spent $28 billion (USD) on insulin compared with $484 million in Canada. The average American insulin user spent $3490 on insulin in 2018 compared with $725 among Canadians. Over the study period, the average cost per unit of insulin in the United States increased by 10.3% compared with only 0.01% in Canada. These findings demonstrate that the United States spent considerably more on insulin than Canada, and prices continue to increase. Implementing national legislation for drug pricing regulations using reference pricing could stabilize and potentially decrease insulin prices in the United States.