Congressional Diabetes Caucus Confronts Insulin Affordability

November 14, 2018

A new white paper from the Congressional Diabetes Caucus reinforces what patients and advocates know all too well — the insulin pricing system is too complicated, the negotiations are too secretive and the cost for patients is too high.  

Authored by Representatives Diana DeGette (D-CO) and Tom Reed (R-NY), the white paper is titled “Insulin: A lifesaving drug too often out of reach.”  It identifies several drivers of insulin unaffordability:

  • “Perverse” payment incentives
  • Insulin’s convoluted path from manufacturer to patient
  • A lack of transparency.

The paper recommends several policy solutions:

  • Increased transparency.  The caucus suggests requiring each party in the pricing system to disclose the value and volume of insulin rebates.
  • More competition.  Updating patent policies could encourage new manufacturers to enter the market, the paper argues, allowing increased competition to drive down prices.  It also suggests streamlining the FDA’s approval process for biosimilar insulins.
  • Value-based contracts.  The white paper recommends that lawmakers direct the Centers for Medicare and Medicaid Services to conduct a pilot study on value-based contracting.  The approach can reward positive patient outcomes and lower prices by basing a medicine’s cost on how much it helps a patient.  

While the report lacks a defined path forward, the Congressional Diabetes Caucus’ attention to insulin affordability is aptly timed.  The average insulin price has nearly doubled since 2012, putting “an enormous financial burden” on patients, as the paper acknowledges.  

One critical factor may be the role of pharmacy benefit managers, whose push for higher rebates can drive up insulin prices, hurting patient access.  Patients can easily spent upward of $600 a month on insulin, depending on insurance.

To learn more about insulin access, read “Protecting Access to Diabetes Care” or listen to Frank Lavernia, MD’s recent interview, “Why Isn’t Insulin Affordable?”, on the AfPA Patient Access Podcast.

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