Analysis of Global Insulin Supply

Introduction

Millions of people in the United States live every day with diabetes, a condition that doesn’t take a break and doesn’t go away. For many, especially those who depend on insulin, managing diabetes is not a choice. Insulin is a life-sustaining medication that must be taken consistently, often multiple times per day. Our data shows that more than half of U.S. diabetics rely on insulin in some form, whether on its own or combined with oral medication. Because of this, access to insulin directly affects whether people can stay healthy, avoid emergency complications, or simply live their lives comfortably.

And yet, the U.S. has become known for having some of the highest insulin prices in the world. Many patients struggle to afford the medication they need every month. Some ration doses. Some go without. It raises a painful question: if insulin has been around for a century, why is it still so expensive in the United States?

To better understand this issue, we looked at insulin not only as a medical product, but as a traded global commodity. Insulin doesn’t magically appear in local pharmacies. It is produced in just a handful of countries and shipped all over the world. When we analyzed global insulin exports, a striking pattern emerged: - France produces and exports huge volumes of insulin every year but at relatively low prices per kilogram. - Germany exports much smaller quantities, but at much higher prices, bringing in far more revenue per unit. - Despite these cost differences, the United States consistently imports more insulin from Germany than from anywhere else.

In other words: America is buying expensive insulin.

We also compared price trends over time, and even as overall insulin prices have dropped, Germany’s pricing remains above the world average yet the U.S. continues to rely on them as a primary supplier. Meanwhile countries that depend more on France appear to pay far less for the same essential medication.

This leads us to the key question driving this project: How do international insulin trade patterns and pricing structures contribute to the affordability crisis facing American diabetes patients?

To dig deeper, we break that question into three parts:

1. How widespread is diabetes in the U.S., and how many people must use insulin to stay healthy?

2. Which countries control insulin exports, and what does that mean for pricing and access?

3. How much more is the U.S. spending by buying higher-priced insulin and how much could Americans save by shifting toward lower-cost suppliers?

By connecting the health needs of real patients to the economic pathways that deliver insulin into the U.S., this project shows that insulin pricing isn’t just a healthcare problem. It’s also a global trade and policy problem. Improving access may require the U.S. to rethink where it gets its insulin and how those decisions impact the millions of Americans who depend on it every single day.

Research Questions

General Research Question: How do international insulin trade patterns and pricing structures contribute to the affordability crisis facing American diabetes patients?

Sub-Questions:

1. What is the scope of diabetes in the United States, and what proportion of patients depend on insulin therapy for disease management?

2. Which countries dominate U.S. and World insulin imports, and how do their pricing strategies differ in terms of volume versus value?

3. How do current U.S. insulin import expenditures compare to what costs would be if the country shifted toward lower-cost suppliers?

Data Sources

World Integrated Trade Solution (WITS) Database Source

This source tracks the imports of “Medicaments of insulin, for retail sale” for a multitude of countries. The data originates from the UN Commodity Trade Statistics Database, maintained by the United Nations Statistics Division. The dataset spans from the 1990s to 2023. The data is collected through official customs records reported by national customs authorities following International Merchandise Trade Statistics standards, with values recorded on a cost, insurance, and freight (CIF) basis. Key limitations include that CIF pricing inflates values beyond actual product costs, data quality varies by reporting country, the dataset reflects only official customs declarations and may miss informal trade, and aggregated totals represent gross trade values without details on insulin types or end uses. This data provides insight into international supply chains but not the complete picture of U.S. insulin availability or pricing.

Visual Capitalist: “Visualizing the Rising Cost of Insulin in the U.S.” Source

This source compiles Humalog insulin pricing from Pharmaceutical Technology, NBC News, and Eli Lilly. The pre-processed data tracks list prices for Humalog 10 mL vials from 1996 through 2023, including the peak price of $275 in 2017 and the reduced price following a 70% price cut. Important limitations include that the data reflects list prices rather than actual patient costs—research shows Humalog’s net price after rebates decreased even as list prices rose between 2015-2019. The data focuses on a single brand rather than the broader market, uses the manufacturer as a data source raising transparency questions, and captures only specific time points rather than all price changes.

Health Care Cost Institute: “Insulin Prices in ESI Nearly Doubled from 2012-2021” Source

This source tracked average prices for a 30-day supply of insulin from 2012-2021. The data comes from HCCI’s commercial claims dataset representing approximately one-third of the U.S. employer-sponsored insurance population with over 1 billion claims annually. HCCI is an independent, nonprofit research institute collecting de-identified claims data from major national health insurers. Prices were calculated by dividing total allowed amounts by total days supplied, then multiplying by 30. Key limitations include that the data represents only employer-sponsored insurance populations, excluding Medicare, Medicaid, and uninsured individuals; prices reflect negotiated amounts rather than patient out-of-pocket costs; the data does not capture manufacturer rebates or assistance programs; and the dataset ends in 2021, missing subsequent price cuts and policy changes. This data provides insight into insulin cost trends within employer-sponsored insurance but does not represent complete affordability across all patient populations.

Describe Your Results

National diabetes surveillance data show considerable variability in disease burden across U.S. states. The highest prevalence is concentrated in the Southeast and Appalachian regions, where estimates exceed 12–14% of the adult population. Western and Mountain region states report substantially lower levels (≈6%). This geographic pattern underscores regional differentials in metabolic health risk profiles and implies uneven demand for diabetes-related pharmaceutical products, including insulin.

Figure 1. U.S. Diabetes Prevalence by State

Longitudinal medication data reveal sustained reliance on insulin therapy among U.S. diabetics. Between 2000 and 2022, insulin usage consistently accounts for 30–35% of all diabetes treatment regimens. Minor annual fluctuations do not alter the overall trend, indicating a stable insulin-dependent subpopulation. Based on national prevalence estimates, this represents approximately 12–14 million individuals requiring continuous access to insulin to maintain glycemic control. This demand is considered price inelastic due to the absence of clinically interchangeable non-insulin alternatives for this group.

Figure 2. Insulin Use Among U.S. Diabetic Patients (2000–2022)

Global export data further illustrate the structure of insulin supply availability. When examining export quantities across major supplier nations (Figure 3), France is the leading global source by volume, exporting between 8–11 million kilograms annually in recent years. Germany, China, and Italy export considerably smaller quantities. However, when evaluating exports by monetary value rather than quantity (Figure 4), Germany becomes the dominant global supplier generating over $6 billion USD in export revenue at peak levels despite its lower export volume. This contrast indicates that Germany operates within a premium-priced market segment, while France serves a high-volume, lower-cost segment. These distinctions establish structural pricing differences that have direct implications for countries dependent on imports.

Figure 3. Global Insulin Exports by Quantity (Million kg)

Figure 4. Global Insulin Exports by Value (Billion USD)

Trade dependency assessment indicates that U.S. insulin sourcing is significantly concentrated. Germany is the predominant supplier of U.S. retail-grade insulin imports, providing roughly 50% of total import volume in most evaluated years. A lack of diversification increases exposure to supply disruptions and foreign pricing policies.

Figure 5. U.S. Insulin Imports: Germany vs. the Rest of the World

Imported insulin prices fluctuate sharply—spiking as high as 180 on the index (2016)—while retail prices increase more steadily, revealing how international pricing volatility does not translate into lower costs for American consumers.The gap between import and retail prices shows that patients do not benefit from periods of falling import costs, suggesting a disconnect between trade prices and consumer affordability. The produced-price line, although hidden by default, remains more stable than import prices, indicating the potential value of greater domestic production as a buffer against global price swings. For the average U.S. insulin user, the steady climb in retail prices despite unstable import prices underscores why insulin remains financially burdensome, even in years when global market conditions should theoretically make it cheaper.

Figure 6. US Insulin Production Share of Total US Supply

Pricing evaluation shows that German export prices per kilogram remain consistently above the global mean, frequently by margins exceeding $50–$100 per kilogram depending on the year. This persistent premium, combined with dominant sourcing, results in a structural cost elevation for U.S. insulin imports. The purchasing pattern suggests prioritization of entrenched supplier relationships over procurement optimization.

Figure 7. Insulin Import Prices: Germany Compared to Global Average

Imported insulin prices fluctuate sharply—reaching nearly 180% of their 2015 index level—while retail prices rise steadily, indicating that U.S. consumers face increasing insulin costs even when international import prices drop. Using the standard assumption that a 30-day supply contains 1,000 IU, the graph implies a rise in consumer cost from about $0.27 per IU in 2012 to roughly $0.54 per IU by 2018, before falling slightly by 2021. This doubling of per-IU retail cost, despite inconsistent movement in import prices, shows that consumer affordability issues stem more from domestic pricing mechanisms than from global insulin markets. The comparatively stable produced-price (export-based) trend suggests that greater domestic production or pricing reform could reduce the per-IU financial burden on U.S. patients, providing a potential path to improved affordability.

Figure 8. Import Price Index

Figure 9. Price per 10mL of Insulin in America

Cross-supplier market positioning demonstrates divergent pricing and production strategies. France operates in a high-volume, lower-price market segment, while Germany occupies a lower-volume, higher-price segment. These structural differences indicate that France achieves economies of scale and cost efficiency, whereas Germany maintains a premium-value pharmaceutical export model. Such contrasts delineate clear alternatives for cost-containment strategies.

Figure 10. Germany vs France: Price vs Volume Trade-off

Further analysis of France’s export output confirms operational capacity sufficient to support supply demand from major importers. Export volumes generally range from 1.0M to 1.8M kilograms annually, with consistent distribution to economically comparable countries such as Germany, Italy, and Japan. This demonstrates that France serves as a robust supplier in the global insulin market and represents a viable alternative for the United States from a capacity standpoint.

Figure 11. Annual Insulin Export Volume from France to Major Importers

Conclusions

This analysis demonstrates that insulin affordability challenges in the United States are driven by a combination of high and geographically concentrated demand alongside structurally inefficient sourcing strategies. Approximately 30–35% of individuals diagnosed with diabetes rely on insulin therapy, representing an estimated 12–14 million insulin-dependent Americans. Export pricing data show that the U.S. imports a substantial share of its insulin from Germany, a supplier with consistently higher prices per kilogram than the global average. Meanwhile, other high-income countries source a greater proportion of insulin from lower-priced, high-volume exporters such as France. As a result, the U.S. pays meaningfully higher prices for the same medication than economic peers, indicating that trade structure not clinical need is a major contributor to national insulin expenditures.

Further work could improve precision and expand the scope of these findings. The inclusion of patient-level cost data, biosimilar market penetration, rebate structures, and insurance coverage variation would enable a more comprehensive assessment of affordability at the household level. Additionally, data on domestic production output, inventory reserves, and trade contract structures would strengthen evaluation of supply chain resilience. Linking trade data to clinical and demographic indicators across states could also help identify where cost savings would produce the greatest health and economic benefit. Overall, meaningful progress on insulin affordability will require integration of international trade optimization with domestic policy measures.

Attribution

All members contributed equally.

Appendix

Data Dictionary - Visual Capitalist Insulin Pricing Data

Variable Name	Description
Year	Calendar year of the price observation
10mL Humalog Price ($)	List price in U.S. dollars for 10 mL vial

Data Dictionary - WITS Insulin Import Data

Variable Name	Description
Reporter	Country reporting the trade data
TradeFlow	Direction of trade
ProductCode	HS classification code
Product Description	Description of traded good
Year	Year of trade data
Partner	Country of origin for imports
Trade Value 1000USD	Import value in thousands of US dollars
Quantity	Volume of imports in kilograms
Quantity Unit	Unit of measurement (Kg)

Data Dictionary - HCCI Insulin Pricing Data

Variable Name	Description
Year	Calendar year of price observation (2012-2021)
Price Per 30-day Supply ($)	Average price in U.S. dollars for a 30-day supply of insulin across all insulin types