Stemming the Rising Tide of Insulin Prices

MHE Publication, MHE September 2021, Volume 31, Issue 9

States are putting caps on prices, and Semglee, the first interchangeable biosimilar in the United States, may exert some downward pressure.

More than 30 million Americans have diabetes, according to the American Diabetes Association, and many rely on insulin.

But insulin prices have been rising in recent years, and that has put many people with diabetes at risk because the price leads to people skipping doses or not taking insulin altogether.

The latest figures from the American Action Forum show that the price of insulin rose 14% a year, on average, between 2012 and 2018, and the past few years have followed this growth trajectory.

Many patients, policy makers and experts blame companies that manufacture insulin for dialing up the price of an established therapy. Sally Pipes, president and CEO of the Pacific Research Institute, a California-based think tank that favors free markets and limited government, says it’s easy to point the finger at pharmaceutical companies, but she finds fault elsewhere: in a dysfunctional market for insulin and many other prescription drugs and in pharmacy benefit managers.

“Pharmacy benefit managers — middlemen hired by insurance companies to manage their prescription drug plans — are driving those list prices up,” she asserts. The Pharmaceutical Care Management Association, the trade group for PBMs, says its member have done quite the opposite with programs that cap out-of-pocket costs or eliminate them. A spokesperson for the group says insulin makers have used patent extensions to avoid competiton.

States take action

In the summer of 2020, then-President Donald Trump signed an executive order aimed at reining in prescription drug costs, requiring federally qualified health centers and hospitals, which purchase insulin through the 340B Drug Pricing Program, to pass along any savings they receive from discounted drug prices to medically underserved patients. The Biden administration halted its implementation. The National Association of Community Health Centers, among others, expressed support for the new administration’s move, saying the Trump rule would not have lowered the cost of insulin (and EpiPens) for most Americans.

Some states are moving to control insulin prices. This summer, Colorado joined Illinois in passing legislation that caps out-of-pocket costs of insulin. Maine, New Mexico, New York, Utah, Washington and West Virginia are considering
similar legislation.

Prices may also come down if interchangeable biosimilars start coming on the market. In July 2021, the FDA designated Semglee (insulin glargine-yfgn) as an interchangeable biosimilar to Lantus (insulin glargine), a long-acting insulin analog. The designation means a pharmacist can switch the brand-name product for the presumably less expensive biosimilar, although state pharmacy laws can put some limits on interchangeability. Even so, the FDA approval should result in some competition between Semglee and Lantus and price decreases for patients and payers 

Keith Loria is a freelance writer in the Washington, D.C., area.