Between 2002 and 2013, the number of Americans diagnosed with diabetes increased by approximately 65%, from 13.5 million to 22.3 million.1 During that same period, the cost of insulin rose by almost 200%, from $4.34 to $12.92 per milliliter, according to a study published in JAMA.2 This steep increase recently prompted the Board of Directors of the American Diabetes Association (ADA) to issue a call for immediate action with the aim of ensuring that no individual who needs insulin is denied affordable access to it.3
In November 2016, the organization published a resolution calling for increased pricing transparency from all entities involved in the insulin supply chain and requesting congressional action, including hearings with such entities to determine the reasons for the significant price increase.3 Along with the resolution, the ADA launched a public petition that has amassed nearly 200,000 signatures. In January 2017, they announced a new site, which offers patient stories, resources, and more.4
“The increasing price of insulin is particularly concerning for patients with no insurance or high-deductible plans who find themselves paying for this life-saving medication out of pocket,” said Robert Lash, MD, a professor of internal medicine in the division of metabolism, endocrinology, and diabetes at the University of Michigan, and chair of the Endocrine Society’s Clinical Affairs Core Committee. As a result, such patients may ration their insulin supply by undertreating or skipping doses, which can lead to severe complications and hospitalizations that could be avoided with adequate insulin. “Some patients are forced to choose between insulin and other medications, including treatments for hypertension and heart disease,” Dr Lash told Endocrinology Advisor.
The Endocrine Society took a similar position to that of the ADA in statements released in December 2016, in which they pledged to seek solutions and call for greater transparency and action from supply chain entities.5,6 Although the causes of the price hike have yet to be determined, possible reasons “include a general increase in drug pricing across many classes, the lack of ‘generic’ options, and less than robust negotiations between insurers and drug companies,” Dr Lash explained.
“The Endocrine Society has been working across the insulin supply chain — including manufacturers, insurers, and pharmacy benefit managers — to encourage lower prices and continued availability for patients with the greatest financial need.”
A review published in JAMA in 2016 explored thereasons for elevated drug prices, including insulin.7 The investigators, professors at Harvard Medical School, concluded that the “prices are the result of the approach the United States has taken to granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits.”
Three of the main insulin manufacturers — Novo Nordisk, Eli Lilly, and Sanofi SA — were named in January 2017 in a class-action lawsuit by a group of patients alleging price fixing by the companies.8 The suit claims that they “raised their public benchmark price for insulin products while maintaining a lower ‘true’ price they charged large pharmacy benefit managers like Express Scripts, CVS Health, and OptumRX.”8
Two of these companies previously announced their intention to help reduce insulin costs. Novo Nordisk vowed its commitment to collaborating with other stakeholders in order to address the problem and outlined specific ways they would directly contribute to these efforts.9 The company described 3 tenets that they believe are pivotal to increasing insulin affordability: simplifying the pricing system, creating more predictability in pricing, and reducing out-of-pocket costs to patients.
With regard to the second tenet, they stated that they would limit future annual price increase percentages to not exceed single digits. For the third tenet, the company pledged to continue support of co-pay assistance and patient assistance programs, and to ensure that a lower-priced option for human insulin remains available.
Like Novo Nordisk, Eli Lilly and Company echoes the ADA and Endocrine Society’s emphasis on collaboration among various stakeholders. Following meetings with advocacy groups and patients with diabetes, they recently announced the availability of reduced prices on certain purchases beginning January 1, 2017.
In collaboration with Express Scripts, the company is offering discounts of up to 40% to patients who buy insulin using the Blink Health mobile and web platforms.10 The discount is intended for patients who pay full retail prices due to lack of insurance or high deductibles.
Dr Lash describes several approaches to address insulin pricing issues and says stakeholders should work to achieve the following goals.
- Identify patients who are most affected by insulin prices. “This is an important first step,” he said.
- Encourage patient assistance programs for this group and then make sure these patients know about them.
- Work with insurers to design benefit programs that would encourage competition in drug pricing and support patients in selecting appropriate plans.
- Encourage the development of lower-priced generic forms of insulin
“As clinicians, we need to work with our patients to identify cost-effective regimens, including the use of older insulins — such as NPH and regular [insulin] — that are less expensive and can be equally effective,” Dr Lash said.
Dr Lash discloses that he is a consultant for Express Scripts.
- US Centers for Disease Control and Prevention. Diabetes Public Health Resource. Number (in millions) of civilian, non-institutionalized persons with diagnosed diabetes, United States, 1980-2014. www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm Accessed February 20, 2017.
- Hua X, Carvalho N, Tew M, Huang ES, Herman WH, Clarke P. Expenditures and prices of antihyperglycemic medications in the United States: 2002-2013. JAMA. 2016;315(13):1400-1402. doi:10.1001/jama.2016.0126
- American Diabetes Association issues resolution and launches petition calling for access to affordable insulin [news release]. Arlington, VA: American Diabetes Association; November 17, 2016. www.diabetes.org/newsroom/press-releases/2016/american-diabetes-insulin-affordability-petition.html. Accessed February 20, 2017.
- American Diabetes Association launches online hub for insulin affordability advocates [news release]. Arlington, VA: American Diabetes Association; January 25, 2017. www.diabetes.org/newsroom/press-releases/2017/insulin-affordability-microsite.html. Accessed February 21, 2017.
- Endocrine Society calls for solutions regarding insulin price crisis [news release]. Washington DC: The Endocrine Society; December 7, 2016. www.endocrine.org/news-room/press-release-archives/2016/endocrine-society-calls-for-solutions-regarding-insulin-price-crisis. Accessed February 20, 2017.
- Endocrine Society supports improved insulin access [news release]. Washington, DC: The Endocrine Society; December 14, 2016. www.endocrine.org/news-room/press-release-archives/2016/endocrine-society-supports-improved-insulin-access. Accessed on February 20, 2017.
- Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prescription drugs in the United States: origins and prospects for reform. JAMA. 2016;316(8):858-871. doi:10.1001/jama.2016.11237
- Sanofi, Novo Nordisk and Lilly named in patients’ price fixing suit [news release]. New York, NY: Reuters; January 30, 2017. www.reuters.com/article/us-usa-healthcare-lawsuit-idUSKBN15E2I0. Accessed February 20, 2017.
- Our position on pricing and affordability [news release]. Plainsboro, NJ: Novo Nordisk. www.novonordisk-us.com/whoweare/about-novo-nordisk/our-position-on-pricing-and-affordability.html. Accessed February 20, 2017.
- Eli Lilly and Company. Lilly announces program to provide insulin at discounted prices [news release]. Indianapolis, IN: Eli Lilly and Company; December 13, 2016. https://investor.lilly.com/releasedetail.cfm?ReleaseID=1003887 Accessed February 20, 2017.