Pharmacy Benefit Managers: Innovations Reduce Insulin Costs, Improve Patient Access

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As we reflect upon National Diabetes Month, we all know how threatening diabetes can be for millions of Americans and that staying on a medication regimen is exceptionally important for managing the disease. It’s the reason the work America’s pharmacy benefit managers (PBMs) do to innovate new ways to reduce costs and support patients is so important.

Though insulin itself has humble beginnings, today’s insulin market is a complex one. It started with a trio of inventors who discovered insulin and then sold their patent for a dollar so that insulin would be widely available and affordable. A century later, insulin’s average price per month exceeds $450, and there is little generic or biosimilar competition. On average, the price of insulin has nearly doubled in just five years. Insulin manufacturers say these price increases are just the cost of innovation, arguing these are more effective insulin formulations for patients. Innovation for patients should be encouraged, but there is a question of whether these prices reflect that value.

In the face of consistent price increases on insulin products, PBMs are leading the effort to break through the often overwhelming financial barrier for patients to access these needed medications. In fact, in some instances, PBMs and health plans are outright eliminating patients’ out-of-pocket costs.

For example, a PBM and a health plan introduced an initiative to apply manufacturer patient assistance programs in a novel way, which lowered the monthly out-of-pocket costs for insulin by 40 percent or more. Under the program, out-of-pocket costs are $25 for a 30-month supply of insulin for eligible health plan enrollees.

In addition, another PBM announced it could provide access to diabetes drugs, including insulin, at no out-of-pocket cost to health plan enrollees, and save on medical expenses for the health plan.

During a recent conversation on my podcast The Pharmacy Benefit, Amy Bricker, Senior Vice President of Health Services Supply Chain at Express Scripts, said that her company is saving people with diabetes a significant amount of money on medications through a combination of discounts and clinical programs.

PBMs continue to think beyond affordability by providing people with diabetes support and education that result in better medication adherence and health outcomes. PBM support programs for those living with diabetes include communicating with patients via text messaging or through devices that monitor glucose, improving care and helping patients stay adherent to their insulin regimens. The total care approach also extends to engaging caregivers to provide additional patient support to manage the disease, and improve medication adherence, blood sugar levels, and lifestyle management.

Given the risk of COVID-19 to people living with diabetes, helping them manage the disease and stay healthy is more important than ever. No one wants an avoidable emergency room visit because their blood sugar is too high or too low.

This month and every month, PBMs are focused on finding cost-effective, care-oriented solutions for diabetes patients and others who rely on prescription drugs for their health. PBMs will continue to use every resource available to ensure that people with diabetes have the affordable care they need.

JC Scott, President and CEO, Pharmaceutical Care Management Association

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JC Scott is the President & CEO of the Pharmaceutical Care Management Association (PCMA), the association representing America’s pharmacy benefit managers

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