Eli Lilly actually doesn’t negotiate for higher prices. I’ve had somewhat more insight than the average person into how the dynamics of the insulin pricing work, and it’s a total abomination, largely born out of a lack of a universal public insurance option in the US.

Despite the skyrocketing costs of insulin over the decades, Eli Lilly’s profits per unit are mostly in line with inflation. This is because in the US system, there is a pervasive system of rebates that exists between pharmaceutical companies and insurers. Insurers often may only pay 10% of what the sticker price is for insulin. But the way these rebates get negotiated through third party firms known as PBMs create a system that incentivizes insulin that is marked up an incredible amount and then discounted to X, than simply pricing it at X in the first place. But this obviously screws over anyone without access to the rebate, i.e. those without insurance. And this system largely exists because the privatized nature of insurance in the US. If there was some kind of universal medicare in the US, undermines those incentives and the market would normalize immediately.