Journal / Essay · International Comparison

The Math of the Prescription

Same drug, same molecule, same manufacturer, sometimes the same factory. The healthcare piece in this journal covered the system broadly. This is about one specific line item inside it — and the part of the story that's genuinely gotten better is worth including honestly, not just the part that hasn't.

And Then You're Dead · August 2026 · 6 min read

Insulin makes the clearest case study because it isn't a new drug, a luxury drug, or a drug with real substitutes. It's a century-old treatment that people with Type 1 diabetes die within days without. The price a country lets it be sold for is a direct measure of how that country treats a non-negotiable need.

What It Costs, Compared to Everyone Else

The same insulin, made by the same handful of global manufacturers, is priced by market — and the U.S. market has been treated very differently from every other one.

Canada: about $12. France, the UK, Australia, Turkey: all under $10. The United States: $98.70. Same drug.

What That Means for a Person

Zoom out from insulin specifically to prescription spending generally, and the pattern holds — high enough that a meaningful share of the country manages it by simply not taking what's been prescribed.

Rationing insulin specifically isn't a matter of discomfort — under-dosing it is a documented cause of preventable death among people with diabetes. The price isn't just a budget problem. For a meaningful number of people, it's the actual mechanism.

The Genuinely Good News

This is worth stating plainly because it's true and because this journal tries not to cherry-pick only the worst number available: out-of-pocket insulin costs have fallen substantially in the past several years.

That's real progress, and it happened because the manufacturer price — the $98.70 figure above — got capped for what patients actually pay out of pocket, even though the underlying list price barely moved. It's a solvable problem when there's the political will to cap it. Most other prescription drugs still don't have that cap.

And Then You're Dead

The same vial of insulin costs ten times more to be sold in America than in almost any other wealthy country, for no difference in the drug itself. One narrow slice of that gap — what patients pay at the counter — got fixed by policy in the last few years. The rest of the gap, and the rest of the pharmacy, is still priced the old way. That's the plan. That's the math.

That's it. That's the whole thing.

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