Sunday, May 26, 2019 | ePaper
High insulin costs come under fire
For many Americans, the cost of lifesaving insulin is simply too high, leading as many as one in four to ration the drug, experts testifying before the House Committee on Energy and Commerce said this week. The meeting focused primarily on defining the problem and exploring potential solutions, such as lowering the list prices of insulin and increasing transparency so that anyone can see who is paying what in the complicated insulin supply chain.
"The price of insulin has doubled since 2012, after nearly tripling in the previous 10 years," said Rep. Diana DeGette (D-CO), co-chair of the house Diabetes Caucus. "We've been hearing stories and reading disturbing news reports for too long. People are skipping doses, failing to pay rent or buy groceries, and even resorting to an insulin black market to afford their insulin," she noted.
What's behind the stunning rise in insulin prices?
That's not yet clear. The American Diabetes Association (ADA) formed a working group to try to tease out the root causes behind the soaring prices. The ADA's group found there was little transparency in pricing throughout the insulin supply chain. Dr. William Cefalu, chief scientific, medical and mission officer for the ADA, repeatedly called for increased transparency during the meeting.
Right now, no one knows exactly how much each intermediary (wholesalers, pharmacy benefit managers and pharmacies) in the supply chain benefits from the sale of insulin. Information about how much manufacturers end up getting paid for insulin also isn't publicly available. The current system encourages high list prices (and that's the price someone without insurance or who has a high deductible is often stuck paying), according to experts testifying at the meeting.
"There is plenty of blame to go around," testified Dr. Alvin Powers, director of the Vanderbilt Diabetes Center. But the need to address this growing problem is urgent, he said, adding that, "Our insulin supply chain is broken, unfair and dangerous."
He explained that, as a physician, he has no idea what his patients will be asked to pay when he writes a prescription. Even with electronic health records, that information isn't available to him.
PhRMA, a trade industry association for the pharmaceutical companies, has proposed several solutions to make insulin more affordable. One suggestion is to offer insulin with a flat co-pay. Another is to exclude insulin and other medications for chronic disease from the deductible in high-deductible health plans, and begin paying for those medications before a deductible has been met. The group also recommends reforming the current rebate systems, and when rebates are available, they suggest those payments should be passed directly on to patients.
And on Wednesday, pharmacy benefit management giant Express Scripts announced that out-of-pocket costs for insulin could be restricted to $25 a month for people under a new drug benefit plan. The average monthly savings for workers whose employers adopt the company's plan would be about $16 a month, The New York Times reported.