- Diabetic patients insured by Cigna, which now owns the pharmacy benefit manager Express Scripts, will pay no more than a $25 copay for a 30-day supply of insulin, the companies said Wednesday. That contrasts the average $42 out-of-pocket paid by the PBM's members last year.
- Glen Stettin, chief innovation officer at Express Scripts, told Healthcare Dive that in most cases there will be no increased cost to the patient's health plan and insulin will not be subject to deductibles. The program should be available by year's end, Stettin said.
- The companies were able to leverage greater discounts from insulin manufacturers Eli Lilly, Novo Nordisk and Sanofi, which will be used to lower copays at the point of sale. There are some caveats, though. Health plans have to opt into the program and government-sponsored plans are not eligible. Not all of Cigna's health plans have transitioned to Express Scripts pharmacy plan management, Stettin said.
Insulin manufacturers and PBMs have faced mounting pressure amid outrage over the rising cost of insulin, a nearly century old lifesaving drug.
Patients and advocates have demanded lower prices from insulin manufacturers as patients struggle to afford the drug they need to survive. The increased cost of insulin has forced some to ration the drug, attempting to make a prescription last longer than intended, sometimes resulting in deadly consequences.
The latest move by Express Scripts and Cigna may pressure other payers and PBMs to follow suit.
Next week, it will be the PBMs turn before the Senate Finance Committee to answer questions about increased drug pricing. In February, the committee launched an investigation into the price of insulin, first calling on drug manufacturers to appear before the committee.
The Trump administration has made lowering drug prices a priority. Last summer, HHS laid out a blueprint of issues it needed to tackle to curb costs, including rising out-of-pocket costs and high list prices.
Even though drug manufacturers set the list prices for drugs, PBMs have come under fire for their role in drug pricing, as they rely on rebates to negotiate discounts on drugs. Almost all of those rebate dollars are passed back to clients, in this case employers or health plans. It's unclear how much (if any) of that rebate gets passed back to the consumer in the form of lower costs.
Patients with high-deductible health plans can be exposed to higher costs for insulin, but this would change under Express Scripts' new arrangement.
Adam Fein, president of Pembroke Consulting, who runs the website Drug Channels, told Healthcare Dive the program is effectively a "copay card program in disguise." Express Scripts will pass along copay support that is being provided by the drug makers -- but it does not come from rebate dollars.
"For too long, patients who need insulin have been forced to pay retail while their insurer gets a rebate check for their prescription. It's long past time for insurers to pass along the full value of insulin discounts to patients."