AMA, Endocrine Society call on stakeholders to lower insulin prices
The Endocrine Society and the American Medical Association are putting increased pressure on government agencies and stakeholders to address the rising cost of insulin for people with diabetes, following several years of advocacy efforts but little movement in high list prices for the medication.
In a position statement released Nov. 1, the Endocrine Society said that more information about the factors driving cost increases for insulin is needed to effectively combat the trend of rising prices. The organization cited “complex interactions” among insulin manufacturers, pharmacies, health plans, pharmacy benefit managers (PBMs) and wholesalers, making it a challenge to determine where in the supply chain costs continue to rise.
“Without clear information about expenses incurred by various players in the supply chain, we cannot fully understand what is driving costs up or how to best reduce insulin costs for people with diabetes in the future,” Endocrine Society spokesperson Rita R. Kalyani, MD, associate professor of medicine at Johns Hopkins University School of Medicine, said in a press release. “High costs are forcing some people with diabetes to make the life-threatening decision to ration insulin. This is unacceptable for optimal patient care. Everyone needs to be part of the solution to this problem.”
In an Oct. 26 letter addressed to the Federal Trade Commission, James L. Madara, MD, CEO and executive vice president of the American Medical Association, encouraged the agency to monitor insulin pricing and market competition and recommend enforcement action against manufacturers that engage in anticompetitive actions to the U.S. Department of Justice.
“Over the past several years, physicians have become increasingly concerned that the rapid rise in the price of insulin for patients is unrelated to the actual costs of research, development, commercialization or production,” Madara wrote in the letter. “Instead, physicians are concerned that anticompetitive factors may be present in the market for insulin. The consequences of an anticompetitive market could include worse health outcomes for patients due to artificially high and unaffordable prices of a critical medication that has been and should continue to be widely available and affordable.”
As Endocrine Today previously reported, in the past decade, estimated inflation-adjusted spending for insulin per patient tripled, from $231.48 in 2002 to $736.09 in 2013, according to an analysis of individual and prescription-level data published in the April 2016 issue of JAMA; those data combined both human and analogue insulins. The mean price per milliliter of insulin increased by 197%, whereas the mean price of dipeptidyl peptidase-4 (DPP-4) inhibitors increased by 34% from 2006 to 2013, and the mean price of metformin decreased by 93% from 2002 to 2013. The 2013 insulin cost, the researchers noted, was greater than expenditures on all other antihyperglycemic drugs combined, which was estimated at $502.57 in 2013.
Today, list prices for popular therapies such as insulin lispro (Humalog, Eli Lilly) and insulin aspart (NovoLog, Novo Nordisk) can reach $600 before applying any pharmacy or manufacturer coupons, according to the drug comparison website GoodRx.com.
position statement, the Endocrine Society recommended policy changes to help increase access to affordable insulin:
- Future list price increases should be limited, and reasonable financial incentives should be pursued by all stakeholders.
- Patients’ share of costs should be limited to a co-pay, and human insulins should be available at no cost to the patient.
- Rebates should be passed along to consumers without increasing premiums or deductibles.
- Health care providers should be trained to use lower-cost human insulins and prescribe them as appropriate.
- Patient assistance programs should be less restrictive and have an accessible, common application that can be used for multiple programs.
- Electronic medical records should include up-to-date formulary and price information.
- Physicians should consider prescribing the lowest cost insulin when clinically equivalent options are available.
Felice A. Caldarella, MD, FACP, CDE, FACE, treasurer of the American Association of Clinical Endocrinologists, said the organization supports the AMA’s efforts to address the rising price of insulin.
“In its 2017 position statement on patient access to necessary and appropriate care, the American Association of Clinical Endocrinologists noted that patients with type 1 diabetes need insulin for survival, and frequently insulin is the only drug that can control the diabetes of patients with type 2 diabetes,” Caldarella told Endocrine Today. “In recent years, the cost of insulin has nearly tripled. Patients who cannot maintain their prescribed insulin regimen because they cannot afford insulin are at a greater risk for adverse events, including a number of comorbidities, hospitalization or even death. AACE opposes policies from any party that produces and distributes insulin that may artificially increase its cost and restrict access to this medically necessary medication."
The American Diabetes Association also has a web site — www.makeinsulinaffordable.org — as part of its Stand Up for Affordable Insulin initiative, which launched in November 2016. According to the website, more than 377,000 people to date have signed the petition to support those struggling with insulin affordability.
The three insulin manufacturers are taking steps to address this issue. Insulin manufacturer Sanofi announced last week that it will expand its VALyou Savings Program to include nearly all of its insulins. The program offers the company’s insulins at one set price: $99 for a 10-mL vial or $149 for a box of pens. The company’s combination insulin product is not included in the program. This summer, Eli Lilly launched a patient-focused helpline to help individuals with high out-of-pocket costs reduce their financial burden. Novo Nordisk pledged to limit price hikes in 2016 and has kept annual list price increases in the single digits for the past 2 years, the Endocrine Society noted in a press release.
The Congressional Diabetes Caucus is evaluating legislative action to address rising insulin costs. In a Nov. 1 report summarizing the group’s yearlong investigation into high insulin prices, caucus co-chairs Tom Reed (R-NY) and Diana DeGette (D-CO) listed 11 policy recommendations that include actions to increase the transparency of pricing, foster market competition, modify formulary usage and address patent reform.
Last month, Congress passed legislation that eliminated rules blocking pharmacists from informing patients whether they could purchase their medications for less money. The Trump administration has proposed having Medicare pay for certain medications based on the prices in other industrial nations. – by Regina Schaffer
American Diabetes Association. Stand Up for Affordable Insulin. Available at: www.makeinsulinaffordable.org. Accessed November 5, 2018.
Congressional Caucus on Diabetes. Report on insulin pricing. Available at: diabetescaucus-degette.house.gov/sites/diabetescaucus.house.gov/files/Congressional%20Diabetes%20Caucus%20Insulin%20Inquiry%20Whitepaper%20FINAL%20VERSION.pdf. Accessed November 5, 2018.
Endocrine Society position statement. Available at: www.endocrine.org/advocacy/priorities-and-positions/increasing-insulin-affordability. Accessed November 5, 2018.
Hua X, et al. JAMA. 2016;doi:10.1001/jama.2016.0126.
Disclosures: Caldarella is treasurer of the AACE board of directors.