“We appreciate the Senate Finance Committee’s focus on insulin pricing and share their urgency in addressing affordability and access for insulin-dependent patients. While we are reviewing the committee’s findings, it’s important to understand that PBMs have stepped up efforts to help patients living with diabetes afford their medications and improve health outcomes. For example, some PBMs have introduced new programs to cap, or outright eliminate, out-of-pocket costs on insulin. PBMs also are providing people with diabetes clinical support and education that result in better medication adherence and health outcomes,” said PCMA president and CEO JC Scott.
A recent Visante analysis, “Insulins: Managing Costs with Increasing Manufacturer Prices,” shows that PBMs have held net insulin costs flat. Total net sales of all insulins were the same in 2012 as in 2019, at $13 billion respectively.
The Visante report also highlights how insulin list prices have escalated dramatically over the past decade largely due to limited competition caused by an oligopoly of three drug manufacturers, a lack of alternative generic and biosimilar insulins, and drug manufacturers’ overuse of patent extensions. As a result of rising list prices, total gross sales for insulins increased from $22 billion in 2012 to $54 billion in 2019.
Click here to read the study and learn more on how PBMs are helping patients with diabetes.
Regarding the report’s discussion on formulary exclusions, typically, if there isn’t competition within a specific class, a drug isn’t excluded from the formulary, and for excluded medications, clinically efficacious options are made available to patients.
PBMs develop prescription drug formularies with Pharmacy and Therapeutic (P&T) Committees that are composed of primary care and specialty physicians, pharmacists, and other clinical professionals. P&T Committees evaluate available clinical evidence to select the best drugs for various conditions. This review focuses only on clinical considerations, including medical literature, Food and Drug Administration-approved prescribing information and safety data, and current therapeutic use guidelines — not economic or cost considerations.