Don’t forget that insulin is not just a single generic drug/formulation. The big players are constantly updating their products, which allows them to maintain a monopoly on their flagship products. A third party generic would inevitably be a substitute for an old version, not the latest. So then the question is how much value consumers place on the improved clinical outcomes of the newest, best insulin products.
Clearly a lot of consumers value them enough that they don’t buy the generics which are available.
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