Eli Lilly Caps Insulin Out-of-Pocket Costs at $35 Per Month

Eli Lilly and Company has announced a 70% price reduction for its most commonly prescribed insulins, capping patient out-of-pocket costs at $35 or less per month.¹

This includes cutting the list price of its non-branded insulin, called Insulin Lispro Injection 100 units/mL, to $25 a vial, making it the lowest list-priced mealtime insulin available effective May 1, 2023. Additionally, the company is cutting the list price of Humalog 100 units/mL and Humilin injection 100 units/mL² by 70%, effective in the fourth quarter of 2023.¹

Finally, the company is launching insulin glargine-aglr (Rezvoglar) injection, a biosimilar to Lantus injection, for $92 per 5-pack of KwikPens. This is a 78% discount to Lantus and will be effective April 1, 2023.¹

“While the current health care system provides access to insulin for most people with diabetes, it still does not provide affordable insulin for everyone and that needs to change,” said David A. Ricks, MBA, Lilly’s Chair and CEO, in a press release. “The aggressive price cuts we’re announcing today should make a real difference for Americans with diabetes.”¹

Insulin pricing has been a growing issue in recent years, with ongoing federal efforts to cap out-of-pocket costs at $35. Most recently, in his State of the Union Address, President Joseph Biden discussed the successful push to cap insulin prices at $35 per month for seniors on Medicare and urged Congress to make the same change for all Americans.²

Prices for insulin nearly tripled between 2002 and 2013 and continued to increase by 15% to 17% between 2012 and 2016. Average gross spending per person with type 1 diabetes on insulin increased by $2841 between 2012 and 2016, and the percentage of those patients’ total health care spending for insulin alone rose from 23% to 31% during the same period.³

Experts have noted that these high costs are significantly attributable to pharmacy benefit managers (PBMs) and their negotiations with manufacturers. Manufacturers work with PBMs to place their medications on a lower cost-sharing tier or to avoid utilization constraints on the PBM’s client formulary, and frequently offer discounts on the list price in exchange. These rebates represent nearly 50% of the net cost of insulin.³

These negotiations and discounts are also confidential, leading to a lack of transparency from PBMs and manufacturers, as well as pharmacies. As a result, insulin prices have continued to rise and higher rebates have been paid between stakeholders, benefiting nearly all members of the supply chain except for patients.³

In addition to capping out-of-pocket expenses, interchangeable biosimilars have offered a potential solution. Semglee was the first insulin biosimilar to receive FDA approval, and early projections suggest that it could have major impacts on insulin pricing. In one model, researchers determined that the biosimilar could be sold at a profit for between $5.32 and $7.38 per 10 ml, which would be a 91.4% to 93.8% decrease from the listed price of insulin glargine.³

However, experts also note that this is not guaranteed, as much still depends on negotiations between PBMs, manufacturers, and insurers.³ Nevertheless, Lilly’s move to cut its prices and launch its own biosimilar could signal a major step toward more affordable insulin and could potentially pressure other manufacturers as well as lawmakers to take more drastic action, as well.

“We are driving for change in repricing older insulins, but we know that 7 out of 10 Americans don’t use Lilly insulin,” Ricks said in the press release. “We are calling on policymakers, employers, and others to join us in making insulin more affordable.”¹

In addition to reducing the list prices, Lilly is also expanding its Lilly Insulin Value Program to improve access. Effective immediately, the company will automatically cap out-of-pocket costs at $35 at participating retail pharmacies for individuals with commercial insurance using Lilly insulin. Further, those without insurance can download the Lilly Insulin Value Program savings card to receive Lilly insulins for $35 per month.¹

“For the past century, Lilly has focused on inventing new and improved insulins and other medications that address the impact of diabetes and improve patient outcomes,” Ricks concluded. “Our work to discover new and better treatments is far from over. We won’t stop until all people with diabetes are in control of their disease and can get the insulin they need.”¹

REFERENCES

1. Lilly Cuts Insulin Prices by 70% and Caps Patient Out-of-Pocket Costs at $35 Per Month. News release. Lilly; March 1, 2023. Accessed March 1, 2023. https://investor.lilly.com/news-releases/news-release-details/lilly-cuts-insulin-prices-70-and-caps-patient-insulin-out-pocket
2. Antrim A. State of the Union Address Focuses on Affordable Health Care, Cost of Insulin. Pharmacy Times. February 8, 2023. Accessed March 1, 2023. https://www.pharmacytimes.com/view/state-of-the-union-address-focuses-on-affordable-health-care-cost-of-insulin
3. Kenney S. Biosimilar Semglee Could Spell Massive Changes for Net Cost of Insulin. Pharmacy Times. August 11, 2021. Accessed March 1, 2023. https://www.pharmacytimes.com/view/biosimilar-semglee-could-spell-massive-changes-for-net-cost-of-insulin