Cigna’s Express Scripts PBM To Cap Insulin Costs Amid Drug Price Scrutiny

Cigna’s Express Scripts PBM To Cap Insulin Costs Amid Drug Price Scrutiny

Pharmacist is Holding a Syringe with Insulin

Pharmacist is Holding a Syringe with Insulin in Hand. Young Female Pharmacist. Insulin is a Medicine for Diabetes. Woman Located in Pharmacy. Closeup View of Syringe in Female Hand.GETTY

Cigna and its Express Scripts pharmacy benefit management unit Wednesday said they are rolling out a new program to cap out-of-pocket costs at $25 per 30-day insulin prescriptions for “non-government funded” drug plans.

The Patient Assurance Program, which is optional for Express Scripts clients to adopt, comes ahead of a high-profile Senate Finance Committee hearing scheduled for next week. At the hearing, executives are scheduled to testify from Cigna, the Caremark PBM unit of CVS Health, UnitedHealth Group’s OptumRx PBM, health insurer Humana, which operates a large PBM, and Prime Therapeutics, a PBM owned by several Blue Cross and Blue Shield plans.

It’s the latest effort by health insurers and pharmacy benefit managers (PBMs) to pass along more prescription drug savings to customers in the face of intense criticism from employers, Congress and the Trump administration. The PBM’s role as a middleman between drug makers and consumers and its share of rebates —  the portion of the drug returned by the seller to the buyer — has turned into a nationwide controversy.

But Cigna and Express Scripts executives say the new program will create more transparency for people with diabetes because the PBM is “partnering with insulin manufacturers to lower copayments to $25 at the point of sale.” Those in Cigna and Express Scripts plans who used insulin in 2018 paid out-of-pocket costs on average of $41.50 for a 30-day supply, the companies said.

“Through the Patient Assurance Program, individuals who are eligible for the program will save approximately 40%, as well as gain peace of mind in knowing they will have access to improved affordability,” the companies announced. “Individuals with plan designs that involve coinsurance and/or a high deductible, will benefit the most from this new program.”

To be sure, insulin costs are rising for Americans and have drawn the particular attention of members of Congress. Drug makers Sanofi, Eli Lilly and Novo Nordisk have largely controlled the insulin market for decades and have faced their own criticism from Congress and reports in recent weeks.

“For people with diabetes, insulin can be as essential as air,” Cigna’s chief clinical officer Dr. Steve Miller said in a statement accompanying the announcement. “We need to ensure these individuals feel secure in their ability to afford every fill so they don’t miss one dose, which can be dangerous for their health.”

[“source=forbes”]