Insulin Update
The steady rise in insulin prices over the last two decades has raised cost and affordability issues for both health plan sponsors and their members. This challenge is particularly pronounced for the 1.9 million Americans living with type 1 diabetes [1], who depend on insulin as a primary means of managing their condition.
Recently, there has been growing public and government attention on insulin affordability, particularly for the uninsured and underinsured. This heightened focus helped bring about the Inflation Reduction Act provision that caps the monthly cost of insulin at $35 for Medicare beneficiaries. While this legislation addresses affordability within the Medicare population, pharmaceutical manufacturers have been adjusting their pricing strategies in response to these developments.
In the spring of 2023, the following manufacturers announced new pricing on select popular products:
| MANUFACTURER | PRICING STRATEGY | EFFECTIVE DATE |
|---|---|---|
| Eli Lilly | Rezvoglar, the second interchangeable biosimilar to Lantus, launched with a list price of 78% less than Lantus. | April 1, 2023, |
| Unbranded Lispro (Humalog active ingredient) vials cost $25 per vial. | May 1, 2023 | |
| Humalog and Humulin will have a 70% decrease in list price. | 4th quarter of 2023 | |
| For commercially insured patients, a price cap of $35 on all Lilly insulins took effect. Additionally, Eli Lilly allows uninsured patients to obtain insulin for $35 per month using an insulin savings card program. | March 1, 2023 | |
| Novo Nordisk | Price cuts of up to 75% for Levemir, Novolin, NovoLog, and NovoLog Mix 70/30 are expected. | January 1, 2024 |
| Sanofi | A 78% price cut for Lantus and 70% for Apidra are expected. | January 1, 2024 |
What do plan sponsors need to know as they plan coverage strategies in 2024 and beyond?
- Consider manufacturer price cap programs when setting member cost share structure for insulins.
- Lower list prices for insulin products will provide greater cost transparency and simplify passing savings directly to members.
- There may be changes to insulin formulary preferences in 2024, but not all insulin products will experience lower list prices. Lower list prices for insulin products could result in reduced total incentive dollars.
ClearScript continues to monitor developments in the insulin drug class. For more information about ClearScript’s insulin strategy, please contact your ClearScript Account Team.
[1] American Diabetes Association