Under pressure from patients and the FDA, Cigna (NYSE:CI) and Express Scripts said today that they will lower the price of insulin to $25 per month for some patients.
Three firms — Eli Lilly, Novo Nordisk and Sanofi — control 90% of the global insulin market and produce all the insulin used in the U.S. Insulin list prices regularly increase by double digits annually, according to the FDA, which attributed the price hikes to a lack of competition.
Drug manufacturers use rebates generated by the gap between their rising list and net prices to pay for preferred status on pharmacy benefits manager’s (PBM) formularies, but the PBMs do not pass those savings along to patients, the agency added. Express Scripts, which Cigna bought for $54 billion in December 2018, and CVS are the nation’s largest PBMs.
The Congressional Research Service reported in November 2018 that the list price of one type of insulin had increased by nearly 600% from 2001-2015, from $35 dollars a vial to $234. Researchers at Yale University recently reported that one in four diabetic patients reported skimping on insulin to save money.
A 26-year-old Minnesota man who had aged out of his parents’ insurance coverage last May and could not afford the $1300 refill began rationing his insulin and died a month later from what an autopsy found was “a critical shortage of insulin”, the Star Tribune of Minneapolis reported. Other deaths attributed to insulin-rationing have been reported as well.
Cigna said it is working with insulin manufacturers to lower copayments to $25 at the point of sale.
“We are confident that our new program will remove cost as a barrier for people in participating plans who need insulin,” said Cigna EVP and chief clinical officer Dr. Steve Miller in a prepared statement. “Better care and better outcomes are rooted in greater choice, affordability, and access, and we can bring all of these to people with the greatest needs.”
People who have coinsurance or high-deductible plans will benefit most from Cigna’s new program, the company said. Users of insulin plans managed by Cigna and Express Scripts paid an average of $41.50 for a 30-day supply of insulin in 2018. Eli Lilly announced March 4 that it would produce a half-price generic version of its insulin product Humalog.
Congress authorized the FDA in 2010 to open biologics such as insulin and human growth hormone to competition. The agency, which has always regulated insulin as a drug, will begin regulating in an “abbreviated pathway” it as a biologic in March 2020.
“The transition of insulin from the drug to the biologics pathway will open up these products to biosimilar competition,” FDA commissioner Dr. Scott Gottileb said in a prepared statement. “We’re already seeing robust activity among sponsors seeking to bring forward biosimilar copies of insulin. The framework for demonstrating that these insulin products are interchangeable should also be efficient and achievable.”
The FDA also announced a public hearing May 13 to discuss affordable insulin products and issues related to the development of biosimilars to insulin.