A new report by the nonprofit Health Care Cost Institute (HCCI) confirms what payers already knew: Insulin’s retail prices have been skyrocketing. For the most part, patients have been shielded from these increases, and the payers have been footing the bill.
The organization studied the commercial claims of approximately 15,000 patients with type 1 diabetes. The data came from several large health plans. The researchers found that the per-unit price of insulin almost doubled in 5 years ($0.13 in 2012 to $0.25 in 2016). The average patient with type 1 diabetes who uses 60 units per day spent $5,705 annually in 2016 (vs. $2,864 in 2012).
During this same period, total annual expenditures for each patient rose from $12,467 in 2012 to $18,494 in 2016. The rise in insulin pricing accounted for the greatest portion of the increase.
The study analysis included both basal and fast-acting insulins. The researchers stated that the utilization of one follow-on insulin was included. Basaglar® became available at the end of 2016. Thus, the utilization of this product was likely very low during the 2016 data collection. In 2017, the national spotlight was clearly placed on bloated insulin prices and resulted in major manufacturers like Novo Nordisk, Lilly, and Sanofi promising to restrict further price increases.
Importantly, the report’s analysis did not capture rebating or patient copay coupons, and was based on wholesale acquisition costs alone. This has little bearing on what the patient (or plan) actually paid. Patients receiving their health benefits from commercial plans have relatively low copays for insulin. In fact, the push to value-based insurance designs over the past 20 years has resulted in a call for minimal barriers to insulin products. A review of several large national plans indicates that insulin is a preferred brand copay, which can still be a $50 or $75 copayment. In some plans, further cost differentials exist for pen-based injectors over the traditional vial-and-syringe injection. For those with plans in which drug deductibles apply, copay coupons can drastically lower the patient’s financial exposure.
Uninsured patients and those who are covered by Medicare face a far different scenario. The Web is rife with stories of patients who have tried to ration their insulin or gone without, rather than pay the full price. For Medicare patients, this exposure is a result of the coverage gap; however, even in the coverage gap, the patient does not get exposed to the full cost of the medication.
It is possible that true biosimilar insulins, rather than follow-on products (the status of which will change in 2020), could help drive down the price of insulin glargine and other insulin types. However, with very limited competition from Basaglar, the only currently marketed follow-on product in the US, it is unlikely that prices will level off soon (only perhaps price increases).
Insulin is not difficult to make; perhaps when biosimilar manufacturers turn greater attention to the insulin market (after the transition from follow-on to biosimilar), sufficient competition will exist to finally reduce prices to levels seen closer to 2012. Yet, one follow-on manufacturer (Samsung Bioepis) lost its marketing partner (Merck) for Lusduna™ because of patent litigation and pricing concerns. This product remains unlaunched.
If insulin price hikes are announced this year, this will not affect patients with average health insurance plans. It will certainly add to the pain of those having to pay out of pocket for their necessary medicines. Outside of government regulation in the price of insulin, the wait for adequate biosimilar competition could be too long for many patients.