Very, the generics aren’t allowed here. Here’s just one case. Unfortunately the US government doesn’t keep statistics on how many deaths are caused by lack of ability of people to pay for their meds.

It’s not a generic drug there:

[…] Insulin is also unique in its market structure: a persistent oligopoly both nationally and globally, in particular with respect to the prices of analog insulins. Only three companies—Novo Nordisk, Sanofi, and Eli Lilly—provide insulin the United States market, despite the existence of several other manufacturers globally.

https://academic.oup.com/jlb/article/7/1/lsaa061/5918811

Oh, yeah. A lot of us die from lack of insulin because of it. We die a lot from lack of healthcare in general.

I know that if I get some long term disease like cancer, I’m just going to die. I can’t afford treatments. I’ve helped friends glue up stab wounds, and had friends do minor (very minor) surgery on me because I had an infected wound and couldn’t afford the doctor. Had to lance it and clear out the infection. Got really drunk for it. That’s not even the end of it. I’ve got many stories between me and my friends.

Very real. People here have to ration their insulin, if they have any at all, and because of that often go into diabetic coma and die. Insulin in the US costs about $400USD/month on the low end. For a while I was paying for one of my friend’s insulin each month because I was in an okay place economically and she was not, and at the time I was paying about $600/month for her’s. She’s since taken over covering her own insulin since her economic situation improved, but most people don’t experience personal economic growth in the US so most people wouldn’t have that option. Also, had she not gotten in a better place economically the arrangement we had would’ve crashed since my own economic situation took a downturn from 2016 until the last few months with a new job.