Reducing the financial stress of insulin costs on persons with diabetes has been a long-standing conversation among advocates and policymakers. There has been a patchwork of efforts by stakeholders to ease this burden in the form of copay assistance programs, copay caps, and more recently, the cap on monthly patient costs. Manufacturing cheaper insulin is also on the cards. In this article, we will dive a little deeper into these topics.
Here’s a startling statistic: Medicare Part D enrollees spent more than four-times out of pocket (OOP) on insulin in 2020 compared to 2007—a period during which the user number only doubled. The actual amount spent OOP was $1.03 billion in 2020 compared to $236 million in 2007. The average annual spend on insulin by Medicare Part D enrollees in 2020 was $572 (those without low-income subsidies), but 10% of enrollees spent more than $1,300 and 1% spent more than $2,300.
Pharmaceutical Assistance Programs
*Note that if you have enrolled in the Eli Lilly, Novo Nordisk, or Sanofi assistance programs, you will receive a single-use email voucher that can be redeemed at the pharmacy for free, for an emergency insulin supply.
Their Insulin Value Program makes insulins accessible at $35/month for those on commercial insurance or those who are uninsured.
Copay cards are available here.
Medicaid enrollees are not eligible. Medicare enrollees who have Medicare Part D may be eligible for the $35/month insulin if they are with participating plans.
Their Patient Affordability and Access Support provides the following options:
- $99/month for any combination of insulin products for those on commercial health insurance and the uninsured. The cost does not apply to the insurance deductible.
- Co-pay cards for those on commercial insurance.
- Free insulin (with eligibility restrictions) for Medicare patients and those who are uninsured, via the Patient Assistance Program.
Sanofi has an “Insulins Valyou ” Savings Program. Starting July 1, 2022, uninsured individuals can buy a 30-day supply of one or multiple insulins that Sanofi manufactures for just $35. This matches the cap on the monthly out-of-pocket insulin costs for Medicare patients passed by Congress.
The Semglee Savings Card provides patients on commercial insurance:
- A 30-day supply of insulin for $94 or lower
- The monthly fill is up to 10 vials or 10 packs of pens.
Here are some steps that you can take to reduce what you pay out of pocket for insulin and for other diabetes supplies.
Beyond Type 1 has developed a website, getinsulin.org, where you can:
- Find one-time urgent insulin support, including action plans from manufacturers
- Build an action plan based on:
- Your geographic location
- The insulin you take
- Whether you are insured or not, and the type of insurance you have
What’s Happening With Legislation Around Insulin Prices?
While there were hopes that the Senate’s budget reconciliation bill would cap insulin out-of-pocket costs for all patients with diabetes, it did not. Patients enrolled in commercial insurance plans were left out of the cohort. Medicare patients who have a Part D prescription plan can avail of the $35/month cap.
One bipartisan bill that is aimed to reduce out-of-pocket cost for all patients and encourage manufacturers to reduce list prices of insulin is the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act. This legislation will:
- Lower the price of insulin
- No associated rebates for insurance/PBM
- Insulin products included in this program would have significantly lower list prices that will match the 2021 net price for Medicare Part D or equivalent
- These lower priced insulins will not be subject to medical management requirements such as prior authorization or step therapy and would be eligible for cost-sharing protections
- Reduce patient OOP costs
- Monthly cap of $35 or 25% of the list price for at least one dosage form in each insulin product category
- Limit prior authorization barriers
Are There Any Affordable Insulin Products Being Manufactured?
A company called Civica Rx recently announced plans to manufacture affordable insulin products—an effort that is supported by philanthropic organizations, think tanks, and health insurance companies. The company plans to manufacture three different products that will be available as vials and prefilled pens. Each vial will cost the consumer at the most $30 while a box of five pen cartridges will cost not more than $55.
Depending on FDA approval, products are expected to be available in early 2024.
We would like to acknowledge the insight provided by Erika B. Emerson, Chief Policy Officer, Diabetes Leadership Council, and Andrew Vilcinskas, PharmD, Lead, Diabetes and Cardiovascular, US Public Affairs & Patient Advocacy, Sanofi, in the writing of this article.
Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.