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April 3, 2019

Insulin for $25 per month? How Cigna, Express Scripts plan to cap patients' out-of-pocket costs.

Daily Briefing

    Cigna and its recently acquired pharmacy benefit manager Express Scripts on Wednesday unveiled a new program that will give Express Scripts' some clients the option to cap their enrollees' out-of-pocket costs for a 30-day supply of insulin at $25.

    New report: 5 strategies to lower medical group drug spend

    Background: Rising insulin prices, patient costs face increased scrutiny

    The move comes as insurers and drugmakers face increased scrutiny over rising insulin prices and costs for patients.

    Federal lawmakers have launched their own investigations into rising insulin prices and have called for new measures to expedite FDA approval of new insulin products, as research has shown U.S. insulin prices have increased drastically in recent years, sparking concerns about patients' access to the life-saving drug.

    Cigna, Express Scripts look to cap enrollees' insulin costs

    Cigna's new program, called the Patient Assurance Program, will be available to Express Scripts' non-government clients, including Cigna health plans. Under the program, participating clients will have the option to cap their enrollees' out-of-pocket costs for a 30-day supply of insulin at $25, which includes any deductible, copayment, and coinsurance requirements the enrollee typically would face.

    Cigna estimated the program will save the average patient 40%, or about $15 a month, on a 30-day supply of insulin, while patients enrolled in high-deductible health plans (HDHPs) could see greater savings. Cigna said patients typically pay an average of $41.50 a month for a 30-day supply of insulin, while patients enrolled in HDHPs pay an average of $100 a month for a 30-day insulin supply.

    Express Scripts said it partnered with insulin makers to achieve the lower costs. Glen Stettin, Express Scripts' chief innovation officer, said Eli Lilly, Novo Nordisk, and Sanofi SA have agreed to offset patients' out-of-pocket costs for insulin.

    "We figured out a way to get additional money from the pharmaceutical manufacturers. They're reinvesting money they could've spent elsewhere and helping us make the insulin more affordable to the patients that we serve," Stettin said.

    A Novo Nordisk spokesperson said the company currently is "working closely with [Express Scripts] to finalize [its] participation in this effort."

    A Sanofi spokesperson said the company's collaboration with Cigna and Express Scripts is part of its effort to make treatments more affordable and accessible for patients.

    An Eli Lilly spokesperson said, "Lowering the high out-of-pocket costs some people pay at the pharmacy for insulin is [the company's] priority." The spokesperson said Eli Lilly is "glad Express Scripts is looking for ways to make that happen, and [Eli Lilly] support[s] their efforts."

    An Express Scripts spokesperson said patients can expect to begin participating in the program within the next few months, but it largely depends on whether and when health plan sponsors decide to opt into the program.


    Steve Miller, executive vice president and chief clinical officer of Cigna, said the program is important because, "[f]or people with diabetes, insulin can be as essential as air." He said, "We need to ensure these individuals feel secure in their ability to afford every fill so they don't miss one dose, which can be dangerous for their health."

    But Elizabeth Rowley, founder and director of the diabetes advocacy group T1International, said the new program fails to address increases in insulin list prices, which makes insulin less accessible for diabetes patients. "This is yet another [public relations] move—a stopgap at best—to release the pressure on those responsible for the insulin price crisis," she said. Rowley continued, "Those patients who are lucky enough to be on a 'participating plan' can benefit, but what about those who aren't? This program gives no lifetime 'assurance' that people with Type 1 diabetes can rely on" (Banerjee, Reuters, 4/3; Walker, Wall Street Journal, 4/3; Thomas, New York Times, 4/3; Winfield Cunningham, "PowerPost," Washington Post, 4/3).

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