NVO Novo Nordisk

By Joseph Walker 

One of the largest managers of prescription-drug benefits will offer clients the option of limiting how much diabetics owe out-of-pocket each month for their insulin, the latest step by a health-care company under pressure to curb drug costs.

Express Scripts, a pharmacy-benefit manager owned by health insurer Cigna Corp., said Wednesday it will immediately begin offering employers, labor unions and other clients the option to cap at $25 a month the copayments and other out-of-pocket costs that diabetics must pay to fill their insulin prescriptions.

The cap, if picked up by employers, would save the average patient about $15 a month, or 40%, and even more for patients covered under a typical high-deductible health plan, according to Express Scripts. Patients could start benefiting from the lower out-of-pocket costs in the next few months, depending on when employers decide to opt-in, a company spokesman said.

The offering will include all insulin types, including those made by Eli Lilly & Co., Novo Nordisk AS and Sanofi SA, three of the biggest makers of diabetes drugs. Express Scripts and Cigna insure about 700,000 patients taking insulin, said Glen Stettin, chief innovation officer at Express Scripts.

"Lowering the high out-of-pocket costs some people pay at the pharmacy for insulin is our priority," a Lilly spokesman said in an email. "We're glad Express Scripts is looking for ways to make that happen, and we support their efforts."

Novo Nordisk is "working closely with [Express Scripts] to finalize our participation in this effort," a Novo spokesman said.

A Sanofi spokeswoman said the collaboration was part of its effort to make its medicines accessible and affordable to patients.

The rising list prices for insulin have figured prominently in mounting criticism of drug costs. Patients, doctors and lawmakers have criticized Lilly, Novo Nordisk and other drugmakers for raising prices, while the pharmaceutical companies have sought to shift blame to the pharmacy-benefit managers.

Amid the scrutiny, Lilly said last month it would introduce a generic version of Humalog, among the most widely used insulins, at half the list price of the brand-name product.

The drug company released data last week saying the sum it was paid for Humalog had dropped $12 to $135 a patient a month last year from 2014, as a result of the rebates and other discounts it paid to PBMs, while the list price increased 52% during that time.

The Trump administration and members of Congress have picked up on the criticism of PBMs, saying the health-care companies have been able to collect ever-larger rebates as a result of the price increases.

The Senate Finance Committee is conducting an investigation into insulin prices and has sent detailed information requests to insulin-makers and PBMs including Express Scripts as part of the probe. Committee Chairman Sen. Chuck Grassley (R., Iowa) on Wednesday questioned the timing of the Express Scripts insulin program.

"Why couldn't this have been done years ago?" Mr. Grassley said in a statement. "It shouldn't take bad press and congressional scrutiny to get health plans, their pharmacy benefit managers and pharmaceutical companies to arrive at a fair price for a drug that's been on the market for nearly a century."

The average out-of-pocket cost for insulin for a typical patient insured by Cigna or Express Scripts last year was $41.50 a month, Express Scripts said. Many patients in high-deductible health plans paid an average of about $100 per monthly prescription.

Health-plan sponsors, such as employers and labor unions, will have to opt-in to an out-of-pocket cap program in order for patients to benefit from it, according to Express Scripts. The PBM isn't making the program available to government-funded health plans, which often have restrictions on pharmaceutical companies helping to pay patients' out-of-pocket costs.

The Express Scripts program will be funded with a new pot of money that some drugmakers agreed to pay to the PBM to offset patient out-of-pocket costs, Dr. Stettin said. That money is separate from the rebates that insulin-makers already pay to PBMs.

"We figured out a way to get additional money from the pharmaceutical manufacturers," Dr. Stettin said in an interview. "They're reinvesting money they could've spent elsewhere and helping us make the insulin more affordable to the patients that we serve."

Write to Joseph Walker at joseph.walker@wsj.com

(END) Dow Jones Newswires

April 03, 2019 18:16 ET (22:16 GMT)

Novo Nordisk (NYSE:NVO)
Historical Stock Chart
From Mar 2024 to Apr 2024

Novo Nordisk (NYSE:NVO)
Historical Stock Chart
From Apr 2023 to Apr 2024