Diabetes and Insulin

cost & value of medicines

Diabetes and Insulin

Dramatic improvements in how we treat diabetes have transformed the lives of patients, but many struggle to afford their insulin and other medicines at the pharmacy counter. While discounts and rebates have significantly lowered the price of insulin for health plans and other middlemen, too often these savings are not shared directly with patients at the pharmacy counter.

Helping patients with diabetes means looking at the whole picture. We need to fix this broken system to ensure savings in the health care system go to patients—not middlemen.

PhRMA's Medicine Assistance Tool

Treating Diabetes

A century ago, patients were treated with insulins from pigs and cattle. Today, biopharmaceutical companies produce insulins that operate at the molecular level, which more closely resemble insulin released naturally in the body. These and other advances are helping patients better manage the disease and stay healthy.

For instance, rapid-acting insulins today can be taken directly before meals rather than in anticipation of meals. Inhaled insulins enable dosing immediately before a meal and more rapid-acting injectable insulin can even be dosed after meals.

Long-acting insulins provide stable treatment for 24 hours or longer. A range of pre-filled pens offer greater portability and convenience, including some that reduce injections for those requiring high doses and others designed to ease use in children.

Trends in Insulin Costs

Insurers and middlemen in the biopharmaceutical supply chain known as pharmacy benefit managers (PBMs) leverage competition among a broad range of insulins to negotiate deep discounts from manufacturers.

These rebates, discounts and other payments made by insulin manufacturers lowered the cost of the most commonly used insulins by 84% on average in 2021, and the average net cost of the most commonly used insulins is 20% lower today than in 2007.

Additionally, recent regulatory changes helped lead to approval of the first biosimilar insulin. These and the range of available follow-on insulins and authorized generics are driving fierce competition, helping to lower how much health plans and middlemen pay for insulins. Unfortunately, this doesn’t always lead to lower costs for patients at the pharmacy.

What's Driving Costs for People with Diabetes

Insurance company practices are shifting more of the cost of life-saving care, including insulins, to vulnerable patients. Often patients with deductibles or other out-of-pocket requirements are required to pay the full price of insulin, while their health plan receives substantial rebates.

This shift in cost exposes some patients to significant out-of-pocket expenses – even though their health plan is paying far less for the medicine. A small share of patients with deductibles and coinsurance are responsible for the vast majority of total patient out-of-pocket spending on insulin.

No patient should pay more for a life-saving treatment than their health plan pays. Punishing the sickest patients by making them responsible for the highest costs is not how insurance should work.

Improving Patient Affordability

When patients struggle to afford their insulin, the companies making this life-saving medicine step in and help patients cover their out-of-pocket expenses. Every biopharmaceutical company that produces insulin offers patient assistance programs to help with the costs of insulin.

In 2021, out-of-pocket spending for patients taking diabetes medicines was more than twice as high without manufacturer-provided cost-sharing assistance. Patients just beginning treatment are nearly three times as likely to abandon medicines at the pharmacy counter without this assistance.

While cost-sharing assistance provides a vital lifeline to struggling patients, we need lawmakers to pass commonsense changes that improve insurance coverage for vulnerable patients. Patient-centered solutions include:

Making sure the savings health plans receive are shared directly with patients at the pharmacy counter;
Basing patient cost-sharing for insulins on the price the patients’ health plan receives; and
Making sure the assistance patients receive from insulin manufacturers count toward their deductible and other out-of-pocket expenses.

No patient should go without life-saving medicines because of what they are forced to pay at the pharmacy. We believe changes are needed that address incentives that benefit insurers and PBMs and improve insulin affordability for patients.

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