Express Scripts launches program to cap members' out-of-pocket insulin spending

by Paige Minemyer | Apr 3, 2019 9:00am

Express Scripts is launching a program that will cap insulin costs for eligible diabetes patients at $25 for a 30-day supply. 

The Express Scripts Patient Assurance Program will be open to members of non-government funded pharmacy plans whose out-of-pocket costs exceed $25, Express Scripts and Cigna announced Wednesday morning. For most eligible members, this will lead to lower costs at the pharmacy counter without increasing the cost of the plan itself, Express Scripts said. 

Three drug companies are participating in the program: Eli Lilly, Novo Nordisk and Sanofi.

Members in Express Scripts and Cigna coverage that use insulin averaged $41.50 for a 30-day supply in 2018, so the new program will save them an average of 40%. But the program will be applicable to high-deductible plans as well, members of which are exposed to high cost-sharing before meeting their deductibles. 

Glen Stettin, M.D., chief transformation officer at Express Scripts, told FierceHealthcare that these members pay an average of about $100 at the pharmacy for insulin before meeting their deductibles, so the new program will be a significant boon in this population. 

“We took the combined clout of the company and started thinking about what else we can do,” Stettin said.

He said across Express Scripts’ commercial plans, about 700,000 people use insulin daily, filling an average of 10 prescriptions per year. 

The new program is launching amid increased scrutiny about the price of pharmaceuticals, with insulin a particular focus. Food and Drug Administration Commissioner Scott Gottlieb said in a statement Tuesday that boosting competition to drive down insulin prices is a key goal at the agency. 

He said moving generic insulin products away from the traditional drug approval pathway to the biologics pathway could clear the way for greater biosimilar competition. FDA will hold a public hearing in May on this idea. 

“While the regulatory transition of insulin products nears, we’re cognizant of the fact that it won’t be soon enough for the millions of Americans who struggle to pay for their insulin today,” Gottlieb said. “Americans who rely on insulin to live deserve to have high-quality, affordable options.” 

Also on Wednesday, the Kaiser Family Foundation (KFF) issued a report tracking the growth of Medicare spending on insulin. Medicare paid $13.3 billion for insulin products in 2017, compared to $1.4 billion a decade earlier—an increase of 840%. 

Aggregate out-of-pocket spending in Part D on insulin products quadrupled in that same window, KFF found, growing from $236 million in 2007 to $968 million in 2016. This reflects both higher insulin prices and greater demand for insulin in Part D, according to the study. 

“Rising prices for insulin therapy in recent years and the resulting increases in Medicare Part D and beneficiary out-of-pocket spending illustrate why the cost of prescription drugs is an ongoing concern for patients and public and private payers, and a pressing issue for policymakers,” the researchers said.  

Recent research from the Health Care Cost Institute shows insulin prices nearly doubled in just five years alongside a notable cost increase in overall diabetes care management. 

https://www.fiercehealthcare.com/payer/express-scripts-launches-program-to-cap-members-out-pocket-insulin-spending