Uninsured people often have to pay the full list price, forcing many patients to ration or skip doses. The companies also offer savings programs outside of insurance. The price cuts will allow Sanofi, Novo and Lilly, which combined control about 90% of the U.S. insulin market, to avoid paying substantial rebates to the U.S. government Medicaid program in 2024. Under a U.S. law, drug companies are required to rebate the Medicaid program if annual price increases on medicines outpace inflation. The law capped the maximum payments at the price of the drug, but that cap will be removed in January of 2024. "After the price drop, Sanofi will actually make money off Lantus in Medicaid, when at current prices, it would have had to pay Medicaid," said Dr. Inmaculada Hernandez, a drug pricing expert and associate professor at the University of California at San Diego.