Recent insulin price cuts are a dose of good news.
In March, Eli Lilly lowered the price on its most popular insulins, with Novo Nordisk and Sanofi following suit shortly thereafter, but only after the $35 monthly price cap for people on Medicare that was mandated by the Inflation Reduction Act. Is this the wave of the future or just the first small “step on the journey?”
On March 1, Eli Lilly and Company (Lilly) announced it was cutting the prices for its most commonly prescribed insulin by 70% and expanding its Insulin Value Program, which caps patient out-of-pocket costs at $35 or less per month. (The announcement kicked off a movement in the industry; Novo Nordisk and Sanofi followed suit soon after, as pressure mounts on companies to lower insulin prices. More on that below.)
The move follows the Biden Administration’s Inflation Reduction Act, which capped insulin prices for seniors on Medicare at $35 a month, and Biden himself urging everyone to come together to help ease the financial burden on patients with diabetes who need insulin.
Both the Endocrine Society and the Biden Administration applauded the move from Lilly, with the Society saying that it commends Eli Lilly and Company for taking steps to reduce insulin prices and make insulin affordable for more people with diabetes, and the White House saying in a statement that they were glad to see Lilly answering the call to get this lifesaving drug into the hands of everyone who needs it.
“This action, driven by the momentum from the Inflation Reduction Act, could benefit millions of Americans with diabetes in all fifty states and U.S. territories,” the White House continues. “The President continues to call on Congress to finish the job and cap costs at $35 for all Americans.”
A Catalyst for Positive Change?
The March 1 announcement builds on years of efforts to close the gaps in the healthcare system to ensure everyone with diabetes has access to insulin. In a statement to Endocrine News, Lilly says their priority has always been to ensure that everyone can access Lilly insulin affordably at the pharmacy counter and has worked for years with various stakeholders in the system to find new ways to lower out-of-pocket costs without disrupting patient access.
The changes include:
- Lilly is cutting the list price of its non-branded insulin, Insulin Lispro Injection 100 units/mL, to $25 a vial. Effective May 1, 2023, it will be the lowest list-priced mealtime insulin available.
- Effective in Q4 2023, Lilly will cut the list price of Humalog® (insulin lispro injection) 100 units/mL, Lilly’s most commonly prescribed insulin, and Humulin® (insulin human) injection 100 units/mL by 70%.
- Effective April 1, 2023, Lilly will launch RezvoglarTM (insulin glargine-aglr) injection, a basal insulin that is biosimilar to, and interchangeable with, to Lantus® (insulin glargine) injection, for $92 per five pack of KwikPens, a 78% discount to Lantus.
In addition to cutting prices, Lilly is also making changes that will make it easier for more people with diabetes to access affordable Lilly insulin including:
- Lilly will automatically cap out-of-pockets costs at $35 at participating retail pharmacies for people with commercial insurance using Lilly insulin.
- People who don’t have insurance can continue to go to InsulinAffordability.com and immediately download the Lilly Insulin Value Program savings card to receive Lilly insulins for $35 per month.
“As an endocrinologist and person with diabetes, I know first-hand how vital insulin is to managing this chronic condition,” says Leonard C. Glass, M, FACE, senior vice president of Lilly Diabetes and Obesity and Global Medical Affairs for Eli Lilly and Company. “No one with diabetes should have to make tradeoffs when it comes to their health. Today’s announcement builds on years of efforts to close gaps in the U.S. healthcare system to help ensure everyone who needs insulin for the treatment of diabetes may be able to obtain it affordably. We hope these changes are a catalyst for positive change.”
As reported by Endocrine News in November 2021, a paper had appeared in Mayo Clinic Proceedings the previous year, which detailed the account of a patient with type 1 diabetes in his mid-20s who worked as a restaurant manager in Minnesota. He couldn’t afford the deductible and monthly premiums of his insurance, and he couldn’t afford to pay for his insulin with cash, so he tried to ration his insulin. He was found dead in his apartment from diabetic ketoacidosis.
“Insulin pricing is complex and there are many stakeholders in the supply chain,” Rita Kalyani, MD, associate professor and clinical researcher in the Division of Endocrinology, Diabetes, and Metabolism at Johns Hopkins School of Medicine in Baltimore, said at the time. “It will require all parties involved including manufacturers, pharmacy benefit managers, healthcare providers, pharmacies, administrators, and employers to come together to address this problem.”
“We have definitely moved in the right direction over the past few years and this shift is no doubt encouraging. However, it is important that all persons with diabetes who take insulin can benefit from a reduction in insulin costs, regardless of which type of insulin they take and who manufactures it.” – Rita Kalyani, MD, associate professor and clinical researcher, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, Md.
During a press conference announcing the price cuts, David A. Ricks, Lilly’s Chair and CEO, called on those stakeholders to come together to not only make insulin affordable, but accessible, and to help patients navigate the complex U.S. healthcare system. “The aggressive price cuts we’re announcing today should make a real difference for Americans with diabetes,” Ricks says. “We are driving for change in repricing older insulins, but we know that seven out of 10 Americans don’t use Lilly insulin. We are calling on policymakers, employers, and others to join us in making insulin more affordable.”
“It is exciting news to see the recent developments in insulin pricing, including caps on out-of-pocket insulin costs that are included in the Inflation Reduction Act (IRA) and also offered by Lilly,” Kalyani says. “Hopefully, these reduction in costs will make insulin more affordable to many Americans and facilitate greater accessibility to insulin for those who need it the most.”
Vials Versus Pens
And while this is a major step in the right direction and will go a long way to mitigate some dangerous patient behaviors due to the high cost of insulin – like rationing – which can cause irreversible harm and even death, Robert Vigersky, MD, chief medical officer at Medtronic, director emeritus of Diabetes Institute at Walter Reed National Military Medical Center in Bethesda, Md., and past-president of the Endocrine Society, says there is still work to be done. “This is great, but it’s not a complete solution,” he says. “There are gaps here.”
Vigersky points to the fact that Humalog is only provided in a vial, which is not the preference for most patients. “Prefilled pens make taking insulin easier,” he says. “Dialing a dose is easier, it’s more convenient, it’s a little bit more discreet. And overall, it enhances adherence to the recommended prescription for dosing.”
Up until now, there has been an issue of accessibility. For instance, a patient could go to a Walmart which has been selling inexpensive options of vials of human insulin, which isn’t as good as analog insulin, but it’s better than nothing. “The good news is that now, you have access to Lilly’s Humalog at any pharmacy,” Vigersky says.
“Just a Step on the Journey”
Still, this is welcome news for patients with diabetes who need insulin, as well as the physicians who prescribe it. “We have definitely moved in the right direction over the past few years and this shift is no doubt encouraging,” Kalyani says. “However, it is important that all persons with diabetes who take insulin can benefit from a reduction in insulin costs, regardless of their insurance and what type of insulin they take. It is important for the momentum to continue and that we all work together to ensure this happens.”
At the time of this interview, Vigersky said he thinks other insulin manufacturers will move to match this announcement. “The rest of the industry has to come along, and they will, because ultimately there’s going to be competition among these pharma companies to provide the lowest price for the payers,” he says.
Indeed, right before this story went to print, on March 14, Novo Nordisk announced it is lowering the U.S. list prices of several insulin products by up to 75% for people living with type 1 and type 2 diabetes. Products include both pre-filled pens and vials of basal, bolus, and pre-mix insulins, specifically Levemir®, Novolin®, NovoLog® and NovoLog® Mix 70/30. Novo Nordisk is also reducing the list price of unbranded biologics to match the lowered price of each respective branded insulin. The changes will go into effect on January 1, 2024.
Then, on March 16, Sanofi announced that it will cut the list price of Lantus (insulin glargine injection) 100 Units/mL, its most widely prescribed insulin in the U.S., by 78%. The company will also establish a $35 cap on out-of-pocket costs for Lantus for all patients with commercial insurance.
“[Reduced insulin pricing] has been something the Endocrine Society and all the other professional organizations have been advocating for. It’s a major step forward, but it’s still a step on the journey.” – Robert Vigersky, MD, chief medical officer, Medtronic; director emeritus, Diabetes Institute at Walter Reed National Military Medical Center, Bethesda, Md.
These moves go into effect January 1, 2024, and comes after the June 2022 launch of an unbranded Lantus biologic at -60% versus Lantus list price, and a cap on out-of-pocket costs on insulin to $35 for all people without insurance. “With all those decisions, now Sanofi’s suite of savings programs ensures that no patient will pay more than $35 for a monthly supply of Lantus,” the company said in a statement.
Sanofi will also cut the list price of its short-acting Apidra (insulin glulisine injection) 100 Units/mL by 70%.
“It is exciting that other manufactures have also announced they will cut prices for multiple insulin products beginning in 2024,” Kalyani says. “People with diabetes who use these insulin products will now also benefit from cost reductions in the near future.”
And again, there’s still a road ahead, but it’s getting easier to travel. Lilly, Novo Nordisk, and Sanofi are the three main insulin manufacturers in the U.S., so these changes will impact a wide swath of the 7 million people who depend on insulin. “This has been something the Endocrine Society and all the other professional organizations have been advocating for,” Vigersky says. “It’s a major step forward, but it’s still a step on the journey.”
Bagley is the senior editor of Endocrine News. In the March issue, he wrote about the remarkable life and career of Nobel Laureate Rosalyn Yalow, PhD, the first woman president of the Endocrine Society.