Back in my Usenet days (1990s, still accessible on Google groups)
one of my sock puppets was

Dr. Houston Murphy
Lecturer on Dietetic Materialism
Enver Hoxha Institute of Advanced Studies
marxondrugs@cloud9.edu

Did the good doctor develop a following, unbeknownst to me all of those years?

Several factors at play here, all government actions.

Most of the rest of the world imposes price controls. However, price controls almost always lead to supply reductions (timelines for this vary) to the point where demand exceeds supply.

The US government forced beef and pork insulin off the US market, but they remain available in much of the rest of the world, putting downward competitive pressure on the prices for GM based human insulin products (which are what is running at such high prices in the US.

Not just Insulin, the FDA is deliberately going excessively slow in approving generics for off patent drugs / medical devices (see Epipen). There were only two manufacturers for patented human insulin, the patents expired back in 2000 and the FDA has still only approved two generics, keeping competitive market pressure on prices low.

I do not dispute your point, MattS. It seems as though the pharma companies’ primary objective seems is rent seeking, and they are doing a fabulous job of it.

On the other hand, there is plenty of government interfernece in countries were insulin prices are lower by orders of magnitude, such as Canada (and, yes, I know that the Canadian health care system has been criticized for other things).

To the extent that the market is broken, it was mostly broken by past government interference in the market.

More government interference is more likely to make things worse than it is to make them better.

An easy answer for an easy question. Why is insulin so expensive? Because the market is broken.