Cigna Plan Could Cap Insulin Costs at $25 a Month
Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can build custom plans based on your personal circumstances through our tool, GetInsulin.org.
Health insurance company Cigna, and its recently acquired pharmacy benefit manager (PBM) Express Scripts, announced Wednesday a new plan to cap the out-of-pocket cost of insulin for some patients with diabetes. Patients whose employers opt in to the program will see the price they pay at the pharmacy for insulin capped at $25 a month. The program is expected to be available by the end of this year for Express Scripts members and in 2020 for Cigna plan members.
The move comes amid increased scrutiny from lawmakers about the skyrocketing price of insulin in the U.S. Earlier this week, diabetes patient advocates spoke at the first of two subcommittee hearings in the U.S. House of Representatives about the rising cost of insulin. Next week, the heads of major PBMs—Express Scripts, CVS and Optum—are slated to appear before both the House and the Senate to answer questions about the role they play in drug pricing.
This announcement might bring important savings for some people paying high out-of-pocket costs for insulin, but the $25 price point will only extend to individuals on certain insurance plans and it will require their employers to opt in. Notably, this change will not improve the staggering prices paid by uninsured patients. Cigna’s announcement cited $40 as the average out-of-pocket cost to their members. The new program brings that down to $25.
PBMs represent one of a handful of important players involved in determining insulin pricing in the U.S., with a role invisible from the patient perspective. Wedged in the middle of the system, PBMs’ stated goal is to reduce costs of pharmaceuticals for the insurance companies while improving health outcomes for the members of the insurance plans. They participate in a rebate system and take a share of the profits from prescription medications that are sold to members of the insurance plans, but there’s little to no transparency into the transactions PBMs take part in.
There’s mounting pressure for change in this piece of the drug pricing puzzle. Last month, a bill was introduced in the Senate that would prohibit PBMs from receiving rebates and instead pass those savings directly onto the consumer. The $25 cap program from Cigna and Express Scripts might be an answer the PBMs prefer—one that keeps that rebate system in place while also helping some patients save money on insulin.
Insulin manufacturers have been facing similar pressure and scrutiny to lower list prices. Following up on letters from various congressional committees, representatives from the “Big Three” insulin manufacturers—Eli Lilly, Sanofi and Novo Nordisk—will testify in front of the House of Representatives next week.
On April 2, the FDA commissioner announced a public hearing scheduled for May 13 to “receive input from patients, families, healthcare providers and other stakeholders who live with diabetes or care for someone with diabetes” as they prepare attempts to increase competition and bring down prices across the insulin market with changes slated to take effect in 2020.
To Learn more about insulin access issues in the United States, check out Beyond Type 1’s Focus on Access.
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