Why is insulin dominated by a few companies globally and if bacteria are used to produce human insulin, why can no other company replicate this?
In: Biology
In short, it simply isn’t profitable for new entrants. The market is dominated by the “big three” manufacturers, Novo Nordisk (Denmark), Sanofi (France) and Eli Lily (USA). There are smaller manufacturers based in developing countries, but they don’t sell to Western nations. There’s no Russian or Indian insulin in the US. Why not? Surely it would be cheaper?
Well, in the US the prices are set by middlemen companies called PBMs. They negotiate sales between manufacturers and insurance companies, and they get a cut of the sales. So, they have an incentive to negotiate *high* prices, and they actually force the big three insulin makers to raise their prices. [This practice was investigated by the Senate Finance committee](https://www.policymed.com/2021/05/senate-finance-committee-releases-insulin-investigation-results.html) which announced its findings earlier this year.
Recently, though, [Novo Nordisk started supplying rebranded insulin direct to Walmart](https://www.fiercepharma.com/pharma/agreement-novo-nordisk-walmart-to-revolutionize-insulin-access-deep-discounts) bypassing PBMs. The price is, naturally, much lower. In other countries, such as the UK, the prices are negotiated by the government and is a fraction of the US prices.
All this means that the price of insulin could drop at any moment if a new company tried to take market share. The business proposition is shaky, so it isn’t worth entering the market.
edit: for those saying that patents are the issue, I draw your attention to Sanofi’s patent on Lantus which expired in 2015, which led to a biosimilar insulin (basaglar) being introduced from Eli Lilly. However, the price of Basaglar is similar to Lantus. Clearly, increased competition from expired patents is not sufficient to lower prices in the US. Other mechanisms are controlling the price.
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