Richard H. Hughes, IV, Strategic Advisor with EBG Advisors and Member of the Firm at Epstein Becker Green, and William (Will) Walters, Associate at Epstein Becker Green, co-authored an article in Health Affairs, titled “Insulin as Preventive Care: Why Not Eliminate Patient Cost Sharing?”

Following is an excerpt:

Recent cuts to the price of insulin raise this question: Why should those who rely on insulin for survival pay anything out-of-pocket to acquire it?
In a surprising move at the beginning of March, Eli Lilly, the manufacturer of Humalog, cut insulin prices by 70 percent and capped patient out-of-pocket costs at $35 per month, mirroring an out-of-pocket price cap for Medicare Part D beneficiaries recently implemented as a part of the The Inflation Reduction Act (IRA). Eli Lilly’s price cap, however, extends to all patients, not just those covered by Medicare Part D prescription drug plans.
Eli Lilly’s actions are not just laudable; for type 1 diabetics, they are potentially lifesaving. A steady stream of news stories documenting the lethal effects of ‘insulin rationing’ over the past few years has led to bipartisan efforts in Congress to curb the costs of insulin. Those efforts led to the passage of the IRA in August of 2022, which reduces the maximum cost-sharing amount for insulin dispensed by a Medicare Part D prescription drug plan to $35 per month.
Within just two weeks of Eli Lilly’s announcement, Novo Nordisk, the manufacturer of Novolog, announced it would reduce the prices of its insulin by up to 70 percent. Just two days after Novo Nordisk’s announcement, Sanofi announced that it would also cut the price of its most-prescribed insulin, Lantus, by 78 percent, including a cap on patient out-of-pocket costs at $35 for all patients with commercial insurance. Within a matter of weeks, the top three insulin manufacturers, together controlling about 90 percent of the U.S. insulin market, all cut their insulin prices by 70 percent or more. And California has announced a new contract with nonprofit drugmaker Civica Rx to start producing a new line of affordable CalRx insulins as soon as the Food and Drug Administration grants the necessary approvals.
Novo Nordisk’s announcement does not cap patient out-of-pocket costs, but those living with diabetes appear poised to realize savings on insulin if they are prescribed either Humalog, Novolog, or Lantus. With the exception of manufacturers that offer patient assistance programs, which help patients with their out-of-pocket costs for prescription drugs, generally the patient out-of-pocket cost is controlled by payors who pass on costs to patients in the form of cost sharing. Some payors, such as CVS Health and CVS Caremark, have exemplified diabetic preventive care by eliminating patient out-of-pocket costs for insulin on their own.
While the actions of the three major insulin manufacturers and certain payors are remarkable, avenues exist to eliminate cost sharing entirely for individuals who are insulin-dependent. Specifically, the United States Preventive Services Task Force (USPSTF or Task Force) should recommend insulin as a preventive service for the primary prevention of complications associated with living with diabetes among the limited population of insulin-dependent individuals living with diabetes.
Previous analyses have shown cost-sharing increases the number of patients who forgo all their medications, notwithstanding the health risks involved. For insulin-dependent diabetics, the choice to forgo or ration their insulin hastens the serious and life-threatening complications associated with poorly managed diabetes. The concept of cost sharing as a utilization management tool is meant to assure that patients need the care they receive by giving them “skin in the game.” The cost-sharing concept, however, is inapposite to preventive care.

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