This talk presents the central case study of my doctoral dissertation: the institutional analysis of the responses from Canadian life and health insurers to the rise of the new “nichebuster” pharmaceutical business model featuring the arrival of high costs specialty medicines for rare diseases. I first start by briefly presenting the emerging sociology of insurance literature before discussing my theoretical framework. Following economist and historian Karl Polanyi’s institutional analysis, I developed the theory of the institutional constitution of markets – defining markets as politically and legally constructed and maintained institutions – and the concept of insurance risks as fictitious commodities in order to better understand the functioning of the insurance industry. I argue that insurance capitalization itself generates instabilities and hence depends on the fictitious commoditization of substantive uncertainties into insurance risks by virtue of political-legal and non-competitive reduction and control of the underlying uncertainties covered as capital. After a quick discussion of the institutional method and the challenge of working with data from gray literature, I then present the analysis of the political-legal interventions and non-competitive institutional arrangements having recently emerged as responses to the destabilization of the Canadian prescription drug insurance market due to the arrival of high cost specialty drugs. Finally, I conclude by outlining how the study of insurance risks as fictitious commodities can provide a better understanding of the functioning of other insurance markets.