Increasing Insulin Affordability

Read or download the full Position Statement in JCEM

Summary of Society's Position and Recommendations on Addressing Insulin Access and Affordability 

Rising costs have made access to affordable insulin far more difficult for people with diabetes, especially low-income individuals, those on high deductible health plans, beneficiaries using Medicare Part B to cover insulin delivered via pump, Medicare beneficiaries in the Part D donut hole, and those who turn 26 and must transition from their parents’ insurance, to manage their diabetes and avoid unnecessary complications and hospitalizations. For many patients with diabetes, insulin is a life-saving medication. Policymakers should immediately address drivers of rising insulin prices and implement solutions that would reduce high out-of-pocket expenditures for patients. 

The Endocrine Society believes the following policy changes could help expand access to lower cost insulin:

• Create greater transparency across the supply chain to understand rising insulin costs
• Limit future list price increases to the rate of inflation
• Allow government negotiation of drug prices
• Limit out-of-pocket costs through 1, or more, of the following policies without increasing premiums or deductibles:
  • Limit cost-sharing to a copay of no more than $35
  • Providing first-dollar coverage
  • Capping costs at no more than $100 per month
• Eliminate rebates, or pass savings from rebates along to consumers without increasing premiums or deductibles
• Expedite the approval of insulin biosimilars to create competition in the marketplace
• Include real-time benefit information in electronic medical records
• Develop a payment model for Medicare Part B beneficiaries in addition to Part D that lowers their out-of-pocket copays.

The Society believes all stakeholders across the supply chain have a role to play in addressing the high price of insulin. In addition, to prevent against inadvertent impact on people with diabetes, new pricing methodologies and policy changes should be tested prior to implementation. Key recommendations for each stakeholder include the following.

Manufacturers

• Improve patient assistance programs (PAPs) to be less restrictive and more accessible.
• Eliminate copay savings cards in favor of providing actual cost savings to the system and price reductions to patients.

Pharmacy Benefit Managers

• Develop pricing arrangements with manufacturers that do not result in large annual increases in the manufacturers’ list prices.

Physicians and hospital administrators

• Train healthcare providers to use lower-cost human insulins (NPH and regular), which should be available at no cost to patients.
• Provide access to real-time benefit information to help prescribe the lowest cost insulin when clinically appropriate.

Pharmacists

• Learn about and share information with patients about lower cost options offered by manufacturers.

Employers

• Limit cost to copay without increasing premiums or deductibles
• Seek plan options that benefit people with diabetes and provide education about these options in open enrollment...