BioPharma, Payers

Cigna, Express Scripts to cap out-of-pocket costs for insulin at $25 under new program

A company representative said that while a full list of covered products isn’t available, the plan is to include all forms under the program, which could help more than 700,000 people in a Cigna or Express Scripts plan.

The country’s largest pharmacy benefit manager – itself acquired last year by one of the country’s biggest health insurers – is introducing a program to cap out-of-pocket costs for diabetes patients who rely on insulin.

Bloomfield, Connecticut-based Cigna and its PBM division, Express Scripts, said Wednesday they would reduce out-of-pocket costs for insulin by 40 percent or more for many of the diabetes patients they cover. In particular, the program will be available to members in participating non-government funded pharmacy plans that Express Scripts manages, including Cigna and others, and will include patients with out-of-pocket costs for insulin that exceed $25, keeping them from having to pay more than that for a 30-day supply. Such costs include deductibles, copays and coinsurance.

Express Scripts spokeswoman Jennifer Luddy wrote in an email that the program could help more than 700,000 people in a plan managed by Cigna or Express Scripts who use insulin, based on the number of people in a commercially insured plan who had an insulin claim in 2018. A full list of products covered under the program is not yet available, but the plan is to have all forms of insulin – short-acting, basal and intermediate – available, she added.

Cigna acquired Express Scripts last year.

Insulin costs have become a particular flash point in the national discussion around the drug-pricing issue, with widespread reports of patients rationing the drug – a practice that can have deadly consequences. According to a congressional study, insulin prices increased nearly 600 percent between 2001 and 2015. The average out-of-pocket cost for insulin were $41.50 for a 30-day supply, according to the companies.

In December, outgoing Food and Drug Administration Commissioner Scott Gottlieb proposed a biosimilar pathway to tackle those skyrocketing prices.

And last month, Indianapolis-based Eli Lilly said it would lower the cost of Humalog (insulin lispro) from $265.20 for a pack of five injection pens to $137.35. Humalog, whose compound and formulation patents expired in 2013-2014, remains Lilly’s second top-selling drug, with nearly $3 billion in sales last year. In response to the plan, Sen. Dick Durbin, D-Illinois, said the next day that the lower-cost Humalog was still too expensive.

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