Because almost nobody actually pays those prices > One key limitation of this study is that most of our analyses used manufacturer gross prices, not manufactu

Because almost nobody actually pays those prices > One key limitation of this study is that most of our analyses used manufacturer gross prices, not manufacturer net prices after rebates and other discounts are applied.16 Given the generally competitive insulin market, rebates in the United States are substantial (Mulcahy, Schwam, et al., 2021; Dickson et al., 2023). After applying a 76 percent manufacturer gross-to-net reduction, U.S. prices were roughly twice as high as those in other countries (compared with nearly ten times as high without the discount). We caution that these results likely underestimate the magnitude of the price differential because we were unable to estimate similar gross-to-net discounts in other countries. If manufacturer net prices in at least some non-U.S. OECD countries are lower than their manufacturer gross prices, the ratio of U.S. to other-country prices would be higher. In addition, because of data limitations, we applied a single U.S. gross-to-net reduction across all insulins. Actual product-specific gross-to-net discounts likely vary along product characteristics (for example, prescription versus over the counter and timing category). As a result, our estimated ratios of U.S. to other countries’ prices for specific insulin categories likely reflect measurement error. As far as I can tell they also aren't attempting an apples to apples comparison, they're lumping all "long lasting" insulin drugs together. There is no such drug as "insulin", or even "long-lasting insulin". There are dozens of insulin analogs being sold at an incredible range of prices, easily over 10x from the most expensive to the cheapest. https://www.goodrx.com/healthcare-access/research/how-much-does-insulin-cost-compare-brands https://www.goodrx.com/healthcare-access/research/how-much-d... My default take on this kind of analysis is that people in the US are wealthier and are therefore paying for the newer, more effective, more expensive insulin drugs than people in other countries. I'm happy to be proven wrong on this but I haven't ever seen that analysis, they always conspicuously avoid direct comparisons of the same drugs.