Today, the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) will examine the cost of insulin and how to make this lifesaving medicine more affordable for patients. The nation’s largest pharmacy benefit managers (PBMs) are expected to testify. These are the middlemen that insurance companies use to determine what’s covered and what patients pay out of pocket at the pharmacy. We expect the hearing will shed light on the misaligned incentives in the system that allow these middlemen and insurance companies to drive affordability and access challenges for patients.
Here is what you should know:
- Insulin costs are down. In 2021, the significant rebates, discounts and other payments that manufacturers paid to PBMs, insurers, the government and others lowered the cost of the most commonly used insulins by 84% on average. The average annual net costs for these insulins have declined by 20% since 2007. In other words, insulins are less expensive today than they were 15 years ago.
- But patients are not the ones benefitting. Health insurers and their PBMs are shifting more costs onto patients through high deductibles and coinsurance. In fact, commercially insured patients taking brand diabetes medicines with deductibles or coinsurance pay an average of 3.6 times more out of pocket than patients with only fixed copays.
- Patients are often denied access to these lower-list priced insulins. All three major PBMs have denied coverage of lower list-priced insulin in favor of higher list priced versions in recent years. Why? As experts have noted, PBMs may benefit from higher list prices and larger rebates – even if it means higher costs for patients.
- The biopharmaceutical industry is taking action to make insulin affordable. When insurers require patients to pay more out-of-pocket than they should, many have turned to manufacturer copay assistance for help. Every biopharmaceutical company that produces insulin has offered patient assistance to uninsured patients and copay assistance programs to commercially insured patients. And in 2023, manufacturers took further steps to limit patient out-of-pocket costs of commonly used insulins to $35 or less per month for those in the commercial market and to help the uninsured through these existing programs.
No patient should pay more for a life-saving treatment than their insurer pays. That’s not how insurance is supposed to work. We need to fix this broken system to ensure every patient – including those who rely on insulin – can afford the medicine they need.
Read our new fact sheet with more key facts on insulin here.