In 2005, insulin cost state Medicaid programs $500 million. The diabetes epidemic is causing the government to question one of the big-ticket items on the shopping list - insulin. Insulin was developed over 20 years ago and many of these original forms are now off patent. This is a screaming opportunity for generic drug makers to prosper and government programs to save.

Two of the largest insulin makers, Novo Nordisk and Eli Lily, say they are opposed to any F.D.A. action that would approve generic insulin without clinical studies. Why the concern? The combined sales in the United States for Humulin and Novolin is about $1 billion. No wonder.

A drug maker needs to prove the generic version contains the same active ingredients, purity and quality, and provides equivalent delivery over time as the brand-name version. However the makers of generic drugs agree that the approval process for generic biologics, like insulin, would be more complex than the current shortened process for other generic drugs. Anybody have a guess as to what the hold up is for this much needed and overdue generic insulin explosion?

Wal-Mart Stores planned to offer generic prescription medicines at $ 4 for a 30-day supply, regardless of insurance. This was slated as a test run, in Tampa, FL, before taking the program nationwide, sometime next year. The reduced price represents a 67 percent savings over the normal retail price of the drugs.

By cutting the cost of many generic drugs to $ 4, Wal-Mart hopes to ensure that customers and associates get the medicines they need at a price they can afford. "That's a real solution for our nation's working families," says H. Lee Scott, Wal-Mart president and chief executive officer. Wal-Mart designed this program to dramatically change the way health care is provided in this country. The numbers don't lie: generic medications cost an average of nearly $30 and the average brand-name fix runs about $100. With resounding interest in the concept, Wal-Mart decided to roll out its $4 generic prescription program in Florida beginning Friday, October 6, 2006 -- nearly four months earlier than expected.

Two of my favorite things in symphony: Wal-Mart and Florida. Wal-Mart is my guilty pleasure. I'll spend hours browsing the isles and the faces. I love Florida. Really, I do. No state tax, great highways, warm winters, Disney. And now this! By the way, you know how they say imitation is the highest form of flattery? Well, Target plans to match Wal-Mart's $4 drug program. I guess everybody will have to jump on the generic drug rollback bandwagon.

The production of generic versions of insulin would mean big savings for diabetics who now have no choice but to pay full-price for name brand insulin. Unfortunately, the US Food and Drug Administration (FDA) has put on hold plans to publish guidelines for the production of generic insulin. Back in 2001, the FDA stated it was working on the guidelines, which lay out the steps it would require of manufacturers wanting to produce such a drug. Now, in response to a letter from Senator Orrin Hatch (R-Utah) and Representative Henry Waxman (D-California), the FDA has stated in intends to lump the guidelines for insulin into a broader package of guidelines on all generic versions of protein-based drugs. Rep. Waxman (pictured at right) says the FDA's letter left him "extremely disappointed" and also stated that the FDA's action was "a misguided step that will only result in further delay" of the release of the guidelines and, therefore, of consumer access to lower-cost alternatives to brand name insulin. Rep. Waxman and Sen. Hatch are opposed to further delaying release of the guidelines for insulin and growth hormones, arguing that they are both widely used drugs, each with a long history of safe use, and are of a simple structure.