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Photo: Kerem Yucel/AFP via Getty Images

The three drug companies that control the insulin market have seen their net sales climb over the past 12 years even as they have had to agree to bigger discounts, according to an Axios analysis of insulins sold by Eli Lilly, Novo Nordisk and Sanofi.

The big picture: Drug manufacturers have largely blamed the broken insulin market — where many people with diabetes are rationing their medication — on other actors within the supply chain. But insulin makers have still been able to collect more money overall and retain their power over the market.

Expand chart
Data: Company documents; Chart: Andrew Witherspoon/Axios

By the numbers: Net global insulin sales, after accounting for rebates, rose by at least 80% from 2008 through 2019 for each of the big three companies.

  • There's a lot of variation in sales by brand (see all of them).
  • For example, revenue from Sanofi's Lantus fell in 2016, after its patent expired and CVS and UnitedHealth excluded it from their coverage lists. Sales shifted to a competitor, Eli Lilly's Basaglar.

Between the lines: Revenue is a function of price and quantity, and both have risen.

  • Insulins' list prices have gone up drastically over the past two decades. List prices matter a lot for the uninsured and people with less generous health plans.
  • Net prices have not increased as much, and for some insulins they have dropped, because pharmacy benefit managers have extracted higher discounts, called rebates, in exchange for giving certain insulins preferred coverage status.
  • The growing prevalence of diabetes has led to higher insulin use, but outside data shows total prescriptions and daily insulin use have grown modestly over the past several years. Eli Lilly, Novo Nordisk and Sanofi all declined to say how many insulin vials and pens they have sold.

The intrigue: Insulin sales are rising even though many of the drugs' patents have expired.

  • Humalog, NovoLog and Lantus all lost patent protection over the past several years. Their revenues have dipped, but they still generate more than $2.5 billion each in net sales.
  • Patents for Humulin and Novolin expired more than 15 years ago, but they still generate more than $1 billion each in net sales.
  • Even though some patents have lapsed, developing cheaper insulins is difficult and costly, and the incumbent players are fighting regulatory agencies to delay competition.

What they're saying: Eli Lilly, Novo Nordisk and Sanofi submitted statements but did not address some questions about their net sales.

  • Eli Lilly attributed higher sales to more people getting diagnosed with diabetes.
  • Novo Nordisk said "a lot of factors like increase of prevalence" contributed to higher sales.
  • Sanofi focused on its lower net price and lower sales in recent years, but not factors that led to higher sales over time.

The bottom line: Discounts and price negotiations have inconvenienced, not fundamentally hurt, insulin makers. And patients, along with the public, are footing the bills.

Go deeper

Cedric Richmond: We won't wait on GOP for "insufficient" stimulus

Top Biden adviser Cedric Richmond told "Axios on HBO" the White House believes it has bipartisan support for a stimulus bill outside the Beltway.

  • "If our choice is to wait and go bipartisan with an insufficient package, we are not going to do that."

The big picture: The bill will likely undergo an overhaul in the Senate after House Democrats narrowly passed a stimulus bill this weekend, reports Axios' Kadia Goba.

Updated 8 mins ago - Politics & Policy

Cuomo asks for “independent” investigator into sexual harassment claims

New York Governor Andrew Cuomo at a press conference on Feb. 24. Photo: Seth Wenig/pool/AFP via Getty Images

A top aide to Gov. Andrew Cuomo said that he would authorize and "voluntarily cooperate" with an independent investigation run by New York's attorney general into claims he sexually harassed several women.

The state of play: The statement comes after a day of competing statements from Cuomo and AG Letitcia James over who would oversee an independent investigation into the governor.

Cuomo scandal snares Dems on #MeToo

Illustration: Eniola Odetunde/Axios. Photo: Ray Tamarra/Getty Images   

The searing sexual harassment allegations made against Gov. Andrew Cuomo are trouble for Democrats far beyond Albany and New York.

Why it matters: They hammered Donald Trump after the "Access Hollywood" tape. Pilloried Brett Kavanaugh over Christine Blasey Ford. Defended President Biden when he was accused of inappropriate touching. Now, Democrats have to show whether they walk the "#MeToo" talk.