Well, not so much anymore. It's capped at $35/mo if you're on Medicare or ACA and most other sources.

https://investor.lilly.com/news-releases/news-release-detail...

I'd also mention that most of the insulin these days is not extracted from animals as it once was. One can make arguments for/against this, but for safety reasons almost all of it is now made with biopharmaceutical (bacterial recombinant) processes.

It is my understanding that the expensive insulin is actually more complicated than the insulin that we had a couple of decades ago and that makes it easier to dose correctly so that therapeutic outcomes are improved.

That was due to cartel behavior (and now should be limited by the recent drug capping initiative) - elsewhere in the world insulin is extremely affordable.

Insulin is an interesting case because the insulin you get today is manufactured in a different process than the original batches which has let manufacturers skirt around both generic alternatives and the original patent.

Off patent it's cheap, but the on patent stuff is way better, so it's what everyone wants

I believe it's expensive for the delivery system, not the insulin itself. (Could be wrong).