Insulin was discovered in 1921. The researchers who isolated it sold the patent to the University of Toronto for one dollar each, because they believed a life-saving medicine should not be a commercial product. Frederick Banting said that explicitly. The patent belonged to the public, not to any company. That was the intent.
What followed over the next hundred years is one of the more instructive stories in American pharmaceutical history, because it shows exactly how a system built to encourage innovation can be turned into a machine for extraction.
The original insulin molecule is off-patent. But pharmaceutical companies over the decades developed modified versions called analogs that work somewhat better for some patients. They patented those. Then they made minor formulation changes and patented those. Then they changed the delivery device and patented that. They built what patent lawyers call an evergreening strategy, a web of overlapping patents that extends effective monopoly protection on products that are, at their core, a century-old medical discovery.
The result is a pricing structure that has no logical relationship to manufacturing cost. A vial of insulin costs somewhere between two and ten dollars to manufacture. In the United States, without insurance, the same vial lists for three to four hundred dollars. In Canada, with the same manufacturers, the same vial costs around thirty dollars. This is not because Canada is subsidizing insulin. It's because Canada negotiates drug prices and the United States, by law, largely cannot.
People ration insulin in this country. They die rationing insulin. That fact has been documented repeatedly and has moved virtually nothing in terms of policy, which tells you something important about who the policy serves.