Disclosures: Wysham is president-elect of the Endocrine Society. Please see the statement for the authors’ relevant financial disclosures.
January 12, 2021
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Endocrine Society outlines policy options to expand insulin access

Disclosures: Wysham is president-elect of the Endocrine Society. Please see the statement for the authors’ relevant financial disclosures.
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The Endocrine Society is advocating for a suite of policy changes to expand access to insulin, including government negotiation of drug prices, limiting price increases and eliminating rebates, according to a new position statement.

The statement, which outlines several steps to rein in the rising cost of insulin for people with diabetes, also calls for an updated payment model for Medicare Part B beneficiaries in addition to Part D that lowers out-of-pocket copays, as well as expedited approval of insulin biosimilars to create competition in the marketplace.

Insulin words 2019
Source: Adobe Stock

Federal law currently prohibits Medicare, which accounts for one-third of all drug spending, from negotiating directly with pharmaceutical companies over drug prices.

Carol Wysham

“Inventors Frederick Banting and Charles Best sold the insulin patent for a mere $1 in the 1920s because they wanted their discovery to save lives and for insulin to be affordable and accessible to everyone who needed it,” Carol Wysham, MD, president-elect of the Endocrine Society, clinical professor of medicine at the University of Washington and an Endocrine Today Editorial Board Member, said in a press release. “People with diabetes without full insurance are often paying increasing out-of-pocket costs for insulin resulting in many rationing their medication or skipping lifesaving doses altogether."

Insulin prices have nearly doubled between 2012 and 2016, according to 2017 data from the Health Care Cost Institute. As Healio previously reported, analogue insulins are the most commonly advertised prescription drugs on the online classified ad website Craigslist, with the drugs being offered at a fraction of their retail price.

The unregulated sale and purchase of prescription medication is prohibited by law and Craigslist policy, yet the review by researchers revealed more than 300 ads for insulin products during a 12-day period in June 2019.

The position statement cites several reasons for the lack of any real movement in insulin prices, including the complexity of the insulin supply chain. Insulin manufacturers set the list prices for insulin and typically sell the medications to wholesalers or pharmacy benefit managers, or PBMs.

“The process to get the medication from the manufacturer to the patient is rather straightforward, but the flow of money and the methodology to establish the price that the patient ultimately pays is much more complex,” the statement authors wrote. “The net price

manufacturers receive is based on the list price minus any fees paid to the wholesaler, discounts paid to the pharmacy, and rebates paid to the PBMs or health plans. Financial agreements between the stakeholders are confidential.”

The authors also called for patient assistance programs to be “more inclusive and accessible,” and stated that any rebate programs should be used by employers to reduce patients’ out-of-pocket costs and health insurance premiums.

  • allowing government negotiation of drug prices;
  • limiting future list price increases to the rate of inflation;
  • eliminating rebates or passing savings from rebates along to consumers without increasing premiums or deductibles;
  • expediting the approval of insulin biosimilars to create competition;
  • including real-time benefit information on medication costs in electronic medical records; and
  • developing a payment model for Medicare Part B beneficiaries in addition to Part D that lowers their out-of-pocket copay.

“One study indicates that improved adherence among people with diabetes could prevent nearly 700,000 emergency department visits [and] 341,00 hospitalizations and save $4.7 billion annually,” the authors of the statement wrote. “Recent increases in drug costs and changes to insurance design are some of the most common reasons for poor medication adherence, particularly for patients on insulin.”

The position statement was published in The Journal of Clinical Endocrinology & Metabolism.