California’s recent proposal, the CalRx Biosimilar Insulin Initiative, may offer a path forward for states look- ing to curb prescription drug prices. CalRx seeks to lower the price of insulin by having the state of California manufacture the drug itself—in a facility owned and managed by the state, with or without a partnership with a pharmaceutical contractor. Because the state is manu- facturing the drug, it can then set its own prices—ideally, far below the current market prices. Several non-profit organizations—notably, Civica Rx—are currently attempting similar programs to manufacture and dis- tribute insulin at set, transparent, and low prices. If successful, CalRx would be a novel and historic attempt to lower prescription drug costs by turning the state into a vehicle for drug supply. This Viewpoint reviews the mechanics of California’s insulin initiative and the challenges it faces and suggests some broader implications if the effort proves successful.
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