With all of the new crises and challenges that 2020 brought to people with diabetes — including the physical and economic devastation wrought by COVID-19 — it can be easy for some to lose sight of the fact that a year ago, there was already a crisis in insulin affordability affecting the diabetes community. While insulin manufacturers, pharmacy chains and lawmakers in some states have taken steps to address this crisis, insulin is still far more expensive to far more people in the United States than in other developed countries.
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In light of this continuing crisis, the Endocrine Society — the leading organization of endocrinologists in the United States — has issued a statement outlining different policies that, if adopted, could improve access to affordable insulin in the United States.
Insulin access: recommendations for governments and businesses
Published in the Journal of Clinical Endocrinology & Metabolism, the statement outlines the different ways that insulin can be unaffordable to different categories of people — depending on your income and insurance status — and how the federal government, state governments and businesses could address these barriers.
Steps that governments could take to help lower insulin costs include the following:
- Require greater price transparency throughout the insulin supply chain
- Limit increases in the list price of insulin products to the inflation rate
- Allow governments to negotiate prices with manufacturers
- Cap insulin copays at $35 per month
- Require insulin to be exempt from insurance deductibles
- Cap total insulin costs at $100 per month
- Ban rebates from insulin manufacturers paid to pharmacy benefit managers, or requiring these savings to be passed to consumers
- Speed up the approval process for insulin biosimilars (“generic” insulin) to increase competition
- Require up-to-date insurance benefit information to be listed in electronic health records (to help doctors with prescription decisions)
- Limit copays in Medicare Part B (which covers medical services)
Steps that businesses could take to help lower insulin costs include the following:
For insulin manufacturers:
- Improve the accessibility of patients assistance programs (PAPs) by reducing eligibility restrictions
- Eliminate copay savings cards and instead lower costs directly
For pharmacy benefit managers:
- Develop pricing arrangements with manufacturers that don’t result in large annual increases in the list price for insulin
For doctors and hospital administrators:
- Train healthcare providers in how to use and prescribe lower-cost human insulin (such as NPH)
- Provide doctors with patients’ up-to-date insurance benefit information to help make prescription decisions
- Learn about lower-cost insulin options, and discuss them with patients
- Limit copays for insulin in company-provided health insurance plans
- Seek out health insurance plans with people with diabetes in mind, and provide diabetes-specific information on plans when people are enrolling
Navigating a complicated system
Each of these recommendations from the Endocrine Society assumes that the current healthcare system in the United States will stay pretty much the same in its structure, with a mix of employer-provided, independently-bought private, and government insurance plans. Of course, any major changes to that system could also improve access to insulin, such as if government insurance plans were more widespread and could directly negotiate with manufacturers — bypassing pharmacy benefit managers in the process.
Right now, the complicated state of the American healthcare system means that some people have benefited greatly from recent steps already taken to lower insulin costs, while others have not. For example, beneficiaries of Medicare Part D now have the option — announced in May 2020 — to select a plan that caps insulin copays at $35 per prescription within the programs coverage gap (“doughnut hole”). But many people with private health insurance have no such option.
And while insulin manufacturers have various programs that limit out-of-pocket insulin costs, many people don’t know how to access them, or how they work in combination with health insurance. Integrating these programs with health insurance plans would ensure that as many people as possible have access to them.
Ultimately, the statement notes, it’s likely that a combination of strategies will be needed to meaningfully improve access to affordable insulin. Whether pressure from the public will be enough to make this happen, though, is an open question.
Want to learn more about saving money on insulin? Read “Insulin Prices: Four Ways to Pay Less” and “Cheaper Insulin: Older Insulins May Be Answers to High Prices.”