It's an illustrative example. An article covering every drug sold in every country would be rather long and difficult to understand! They may have chosen German

It's an illustrative example. An article covering every drug sold in every country would be rather long and difficult to understand! They may have chosen Germany because it presents a similar population in terms of demographics, income, spending parity, etc... The article fails to mention the average price to the end patient in both countries, but this would still show a gap as in Germany the cost to the patient for their prescription insulin is, I think, about 10 euros. Rate of demand per country makes little difference due to global distribution but apparently Germany has 8.31% of adults with diabetes and USA has 10.79%. Many economists will tell you a larger market should equal more competition and cheaper prices, and not having those is a sign of unhealthy anticompetitive practises. The exercise comment would only apply to some diabetes patients. It is possible to spontaneously develop diabetes whilst being in peak physical health and diet. But, more importantly, the cause of a disease does not effect the price of the drugs to treat it.