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Vial: Once the vial is punctured, it is OPEN. Once you stick a needle in the vial, it is OPEN. OPEN vials can be stored in the fridge or at CONTROLLED room temperature. Regardless of where it is stored, OPEN insulin will only last 28 days before it must be thrown in the trash.
A: Your insulin might still be good after the expiration date on the box, or after 28 days at room temperature, but it's not guaranteed to be good. I know some people who don't have health insurance and have to pay out-of-pocket for all of their insulin do continue to use insulin past the recommended times.