$210 of Every $280 Vial

Seventy-five cents on the dollar.

That is what a Lilly executive’s testimony put on the rebate table for Humalog: of every $280 on the sticker, about $210 goes back out as rebates and discounts so the vial lands on a preferred formulary. Florida’s attorney general just sued the three manufacturers that supply more than ninety percent of the world’s insulin, the three pharmacy benefit managers that process about eighty percent of U.S. prescriptions, and the rebate aggregators that sit between them. The complaint’s claim is simple. Inflate the published price. Pay the middle for placement. Leave the patient holding the sticker.

I am not shocked. The rebate is not a discount you can spend at the counter. It is a kickback dressed as a savings. Cash patients, high-deductible patients, and anyone who hits the list price first pay the theater. The net price the manufacturer keeps is the real one. The published one is the prop.

I am not anti-insurance. Keep a policy for the wreck. Insulin is not a wreck. It is a monthly medicine people cannot live without. Direct care already walks around this maze. Wholesale meds. Cash prices you can read. Membership instead of a claim. The number on the door is the number you pay.

$210 is not a rebate. It is proof the sticker was always optional.