Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.
Leading PBMs, such as CVS Health Corp., Express Scripts and Prime Therapeutics, also applied formulary strategies to keep insulin affordable. CVS Health reported a -1.7% trend for antidiabetic drugs in 2018, despite increasing utilization and 5.6% average wholesale price inflation for brand drugs, according to its 2018 drug trend report.
By removing Lantus and Toujeo from the formulary and making Basaglar preferred, CVS reported its clients saw a 21.7% reduction in cost per long-acting insulin prescription, which translated to a lower overall cost of $0.34 per member per month.
At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D “doughnut hole.”
One tactic that the organization’s health plan deploys to ease the burden on members is a policy called “plan pay the difference,” Fried says. If a brand drug becomes cheaper than the generic version after rebates, “we would actually have the member pay the generic copay instead of the brand, and then we would reimburse the pharmacy the brand cost, so that they’re made whole as well,” she says.