Cigna, Express Scripts Capping Insulin Co-Pays at $25 for Participating Commercial Members

April 3, 2019

Cigna and its pharmacy benefit manager Express Scripts said they are launching a program for patients with diabetes in its commercial plans so that they pay no more than $25 for a 30-day supply of insulin.

A day after stakeholders told a House of Representatives subcommittee about problems accessing and paying for insulin, Cigna and its pharmacy benefit manager Express Scripts said they are launching a program for patients with diabetes in their commercial plans so that they pay no more than $25 for a 30-day supply of insulin.

In a statement, the companies said Wednesday the average out-of-pocket (OOP) cost for insulin was $41.50 for a 30-day supply last year; under the new program, eligible patients will save approximately 40%.

“We are planning to have all forms of insulin available (short acting, basal, and intermediate). A full list of products is not yet available,” Jennifer l. Luddy, an Express Scripts spokeswoman, told The American Journal of Managed Care®. “In most cases, people who use insulin will see lower out-of-pocket costs without any increased cost to the plan,” the companies said.

The program is not available to people enrolled in government health plans.

On Tuesday, patients and diabetes experts testified before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce about a number of issues related to the rising costs of insulin, including rationing, despite the risk of fatal and near-fatal complications.

Last month, Eli Lilly said it was lowering the cost of Humalog (insulin lispro) by creating an “authorized generic” version. The price of the new generic will be $137.35 per vial, or 50% of the cost of the branded version. Humalog is a fast-acting insulin that people with diabetes use to control blood glucose spikes that occur with meals.

But as happened when Eli Lilly announced its price cut, many on Twitter responded that the co-pay is still difficult for people without health insurance, and that in other countries, insulin is free for some.

Some perspective on Cigna's announcement capping insulin copays at $25.

In the UK, prescription copays are waived in a number of circumstances, including:

People getting treated for cancer

People with diabetes

Pregnant women

Children

People over age 60

Low-income people

— Larry Levitt (@larry_levitt) April 3, 2019

At the hearing on Tuesday, Kasia J. Lipska, MD, of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation at the Yale University School of Medicine, said 1 in 4 patients ration their insulin. In a survey of 199 patients at the Yale Diabetes Center, rationing affected patients across all different prescription coverage plans as well as across most demographic factors, although those with incomes below $100,000 were more likely to ration insulin, she said.

She also pointed out that Eli Lilly’s price cut still places Humalog much higher than its $21 cost in 1996, even though nothing has changed about the drug.