Despite being discovered nearly 100 years ago, insulin’s list price has been going up, not down, with trade secrets and other protections preventing researchers from pinpointing who is receiving profits from its sale. Meanwhile, the net price — what manufacturers receive after accounting for all discounts and payments to distribution system entities — has been falling. So, why aren’t patients seeing the savings?

USC researchers analyzed the flow of money across all distribution system participants — manufacturers, wholesalers, pharmacies, pharmacy benefit managers (PBMs) and health plans. They found that middlemen in the distribution process now take home more than half — about 53% — of the net proceeds from the sale of insulin, up from 30% in 2014. Meanwhile the share going to manufacturers has decreased by a third.

To continue reading this story, click here.