Cigna's Express Scripts to cap out-of-pocket insulin costs at $25 per month in US

Health insurer Cigna and its pharmacy benefit manager (PBM) arm Express Scripts announced Wednesday the launch of a programme in the US designed to ensure that eligible patients with diabetes in participating plans pay no more than $25 for a 30-day supply of insulin. Cigna, which bought Express Scripts last December, said that under the Patient Assurance Program, the companies are partnering with insulin manufacturers to lower copayments at the point of sale.

Cigna noted that last year, the average out-of-pocket cost for insulin for people on plans managed by Cigna and Express Scripts was $41.50 for a 30-day supply. Steve Miller, chief clinical officer at Cigna, remarked "we are confident that our new programme will remove cost as a barrier for people in participating plans who need insulin," with targeted savings of approximately 40 percent.

Cigna explained that the members in participating non-government funded pharmacy plans managed by Express Scripts with out-of-pocket costs for insulin exceeding $25 will be eligible for the programme. The company indicated that the programme, which is not expected to result in higher plan costs, will be activated by shifting covered products to a lower copayment level.  

The move comes as five PBMs, including Express Scripts, were recently asked to testify at a Senate hearing this month on drug pricing in the US. The hearing will following similar hearings focused on prescription drug costs in January and February, with the second seeing executives from seven drugmakers questioned on the matter.

The news also comes after US Senators Chuck Grassley and Ron Wyden sent letters to PBMs, including Express Scripts, requesting information and documents related to their business relationships with insulin manufacturers, public insurance programmes, private insurance plans and pharmacies. The letters also ask for information regarding how PBMs set the sizes of rebates and select treatments for inclusion on their formularies.  

"While manufacturers set the list price for insulin, [PBMs] play a critical role in the pricing of insulin on which people living with diabetes depend… As the primary negotiators for government payers, commercial insurers and individual employers, PBMs are in a unique position to leverage their size to lower drug prices," the senators remarked. Earlier this year, two US House Democrats asked Eli Lilly, Novo Nordisk and Sanofi for information on why the cost of insulin has skyrocketed in recent years, with its price almost doubling from 2012 to 2016.

More recently, Eli Lilly announced plans to introduce an authorised generic version of Humalog (insulin lispro) in the US at a 50-percent discount to the branded product. For related analysis, see ViewPoints: Pharma gets what it needs from Senate hearing.

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