Express Scripts Launches Program to Cap Insulin Prices at $25 Per Month

Insulin prices in the U.S. are often double, triple, or more compared to the cost of the same product in other countries, such as Canada and Mexico. They’re also 10 times higher than U.S. prices were just 20 years ago. The prohibitive prices of this life-saving drug in the states have led some people to ration their insulin, which is very dangerous, or go elsewhere to get it, which can also be dangerous, depending on the location. Still others are using less costly but older and less effective versions of the same medication, which come with higher rates of complications.

Now one company is finally looking to change the insulin price game for the better. Express Scripts, the largest pharmacy benefit management company in the U.S., which is owned by health insurer Cigna, will be slashing their prices and capping out-of-pocket insulin prices at $25 or less per patient per month.

“We have people with diabetes who take insulin who are having trouble affording their insulin,” said Dr. Glen Stettin, Express Scripts’ chief innovation officer. “And we see an opportunity to do something about that.”

Photo: Adobe Stock/Tom Mc Nemar

The Patient Assurance Progam has apparently been in the works for a while now, but its timing couldn’t be more impeccable. The reduced prices will come at a time when many Americans are barely scraping by and wondering whether they’ll be able to afford next month’s medication.

“What we’re hoping is that we’re going to see more diabetics taking more insulin, [fewer] complications for those patients, and hopefully lower health care costs,” said Steve Miller, Cigna’s chief clinical officer.

Pharmacy benefit management companies have previously come under fire as the middlemen just looking to make an extra dollar between the supplier and the customer, but that doesn’t appear to be the case with Express Scripts at the moment. They have been negotiating with companies like Eli Lilly, Novo Nordisk and Sanofi to get reduced prices on insulin to be able to make the medication more affordable to the consumer.

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Express Scripts customers currently pay an average of $41.50 for their monthly insulin prescriptions, but this cost can vary widely from month to month, depending on the health plan. And for those on high-deductible health plans, the price can be much higher, often upwards of $750 per month.

Express Scripts’s new insulin prices, however, will not be available to everyone. Some of the people not able to get this type of insulin include those currently covered under Medicare and Medicaid insurance plans. This is because Express Scripts can only offer the medication discount to non-government companies that contract with them and are willing to negotiate drug prices down.

Luckily, most employers will be eligible for the program at no extra cost to them, although they will need to opt into it. All told, somewhere around 700,000 people could benefit from the new program, particularly those with high-deductible health plans. The program will begin capping prices at the end of the year.

Photo: Adobe Stock/Allen

The U.S. Food and Drug Administration also intends to do its part to help lower insulin costs. The announcement from Express Scripts comes on the heels of a statement from the FDA saying it will be changing the way it regulates insulin to allow biosimilar products to enter the market, increasing competition and lowering prices. “Once an interchangeable insulin product is approved and available on the market, it can then be substituted for the reference product at the pharmacy, potentially leading to increased access and lower costs for patients,” says FDA commissioner Dr. Scott Gottlieb.

With all the media attention insulin prices have been getting these days, it seems likely that substantial changes are coming soon, much to the benefit of those who live with insulin-dependent type one and type two diabetes. All those who have spoken up about this issue and made strides toward changing it should be proud of their efforts. Hopefully we will not have much longer to wait for lower prescription drug prices.

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