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So I keep hearing that there is cheap, patent unencumbered insulin in the US but nobody wants it because it's not as good as the more recently invented patented variants that are sold for a premium.

Is this open source stuff just the same old patent unencumbered insulin that people apparently just don't want?

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Did they mention in what way it's not as good?

It is significantly harder to use, and this is a situation where if you make a bad enough mistake, you die. Transitioning from one kind to another means you have to figure out how they're different, introducing situations where you can more easily make a mistake. It also means you have to test more, which means using more strips, which means more cost. Ideally you would be doing this with the help of your doctor, which means more visits, which means more cost.

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