The War in Iran Is Coming for Insulin Markets

The cost of war seldom stays where the bombs land. Since the United States and Israel launched joint military operations against Iran on February 28, the ongoing conflict has scrambled energy markets and muddled global supply chains far beyond the Persian Gulf.

Most of us have noticed. 

Gas prices have increased 50% since the war began. Food prices have followed. The Consumer Price Index jumped 3.3% this April. Grocery bills jumped  0.7% in April. Such figures have not been seen since the peak of post-pandemic inflation.

While it’s hard to ignore these costs, many Americans are not noticing the warning signs that higher prices and shortages for vital medications they rely on may soon be next, especially insulin.

Supply chain experts at Stanford Health Care have flagged insulin syringes, generic drugs, and petroleum-based medical supplies as products at risk as oil prices rise and shipping costs climb. One logistics firm warned that consumers could see drug costs affected within four to six weeks of sustained disruption—a window that has already opened.

Iran’s blockade of the Strait of Hormuz has sent commercial shipping through the strait 90% below pre-war levels, while air-cargo capacity in the Gulf has fallen by 79%. The Persian Gulf is not just an energy chokepoint—it is a critical transit hub for pharmaceuticals, connecting drug manufacturers in India, Europe, and China to markets in Africa, Asia, and the U.S.

This is to say nothing about the actual production of insulin. The global insulin market is dominated by three companies—Eli Lilly (U.S.), Novo Nordisk (Denmark), and Sanofi (France)—which control 99% of the market. The US is the largest insulin importer in the world and imported nearly $1.1 billion dollars in 2023- much of which was from Denmark, France, and Germany. 

Turmoil in Iran has sent French energy prices up 18 percent, resulting in civil unrest. The government of Denmark began asking citizens to avoid driving in early March to avoid high fuel prices. Germany recently passed new regulations banning gas stations from raising gasoline prices more than once per day. 

Higher energy prices mean two things: higher prices or lower supply of goods that require energy to produce. Industrial insulin production is extremely energy-intensive. 

For now, U.S. consumers are buffered. Large pharmaceutical distributors typically hold 25 to 30 days of stock, and manufacturers maintain an average of 40 days of finished-goods inventory. But inventory buffers are not a supply chain strategy—they’re emergency rations. And they don’t replenish without functioning markets doing the heavy lifting to produce goods people need. 

Barring an unprecedented change of events, those dependent on insulin will have fewer life-saving medical goods available. The truncated supplies will be rationed by insurance providers, pharmacies, and patients. Rationing insulin is a dangerous and painful game of kicking the ketoacidosis can down the road.

The pump. The grocery store. And soon, the pharmacy counter. The costs of war have a way of finding everyone eventually—especially those who can least afford to run out.