A decade ago, insulin — a life-saving medication for people with diabetes — became a central issue in the debate over high drug prices in the United States. The 2017 death of Alec Smith, a young man who died after rationing his insulin due to cost, sparked national outrage. Insulin, which has been around for over 100 years, had seen repeated price increases despite its patent originally being sold for just $1 to a university to ensure it would be used for public good. This led to widespread concern that a critical medication was becoming unaffordable for those who needed it most. In response, lawmakers began taking action. Colorado was the first state to pass a law in 2019 that limited the out-of-pocket cost for insulin. By 2022, 27 states and Washington, D.C., had similar laws in place. Congress also included a provision in the Inflation Reduction Act that capped insulin costs at $35 per month for people on Medicare. Drug manufacturers also made public commitments to lower the cash price for uninsured patients. However, advocates argue that these measures are only temporary fixes for a deeper problem. Despite these efforts, millions of Americans still struggle to afford insulin. A 2024 survey by T1 International found that more people are rationing insulin — meaning they skip doses or use smaller amounts due to cost — than ever before. Shaina Kasper, executive director of T1 International, said that while there has been progress, the system remains broken. She noted that out-of-pocket caps are not enough to solve the underlying issues of high drug prices and limited access. Recent studies confirm that the problem persists. A 2024 study by the Yale Diabetes Center found that the rate of insulin rationing among patients treated there was the same in 2024 as it was in 2017 — about one in four people. When including those affected by insurance delays or supply shortages, the number rises to nearly 38 percent. A T1 International survey found that 34 percent of Americans who use insulin reported rationing it due to cost. Dr. Kasia Lipska, an endocrinologist and researcher, expressed surprise at how common rationing still is. She explained that the issue is complex, with many people still uninsured and forced to pay full cash prices for drugs. While drug companies have pledged to help, the process for accessing discounts can be confusing and time-consuming. A congressional investigation found that some uninsured patients were still paying nearly $100 per vial of insulin, despite promises from Eli Lilly that its generic version would be available for $25. Federal and state laws also have gaps. The $35 cap applies only to Medicare, not private insurance. State laws often cover only small-group and individual plans, leaving large self-funded plans — which many employers use — exempt. In 2025, around 775,000 insulin users in states with caps were protected, but over 1 million others in those states were not, along with 2.1 million people in states without any caps. Even those who benefit from the caps may struggle to afford $35 a month due to other costs or complications in accessing discounts. Advocates continue to push for more comprehensive solutions. Some states are exploring government funding for private companies that promise to make insulin at a low cost, while others are looking into government-run production facilities. These approaches could help increase supply and reduce prices, but they will take years to implement. In the meantime, nonprofit programs and advocacy groups are working to help people access discounts, insurance, and emergency insulin supplies. The fight for affordable insulin continues, but the future of access will depend on whether lawmakers feel the urgency to act.