Endocrine Society Call for Action to Reduce Insulin Costs in US

Miriam E. Tucker

January 13, 2021

The Endocrine Society has issued a new position statement calling on all stakeholders, including clinicians, to play a role in reducing the cost of insulin for patients with diabetes in the United States.

"Addressing Insulin Access and Affordability: An Endocrine Society Position Statement," was published online January 12 in the Journal of Clinical Endocrinology and Metabolism.

"The Society believes all stakeholders across the supply chain have a role to play in addressing the high price of insulin," say the 11 authors, who are all members of the society's Advocacy and Public Outreach Core Committee.  

This is the first such statement from a major professional organization in 2021, which is the 100th anniversary of the discovery of insulin.

And the call for action was issued just a week prior to the inauguration of incoming US President Joe Biden, who has pledged to "build on the Affordable Care Act by giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate."

The cost of insulin has nearly tripled in the past 15 years in the United States, and a lack of transparency in the drug supply chain has made it challenging to identify and address the causes of soaring costs.

The high cost of insulin has made access particularly difficult for people with diabetes with a low income, who have high-deductible health plans, are Medicare beneficiaries using Part B to cover insulin delivered via pump, are in the Medicare Part D "donut hole," as well as young adults once they reach their 26th birthday and can no longer be covered under their parents' insurance.

"Inventors Frederick Banting and Charles Best sold the insulin patent for a mere $1 in the 1920s because they wanted their discovery to save lives and for insulin to be affordable and accessible to everyone who needed it," said Endocrine Society President-Elect Carol Wysham, MD, of the Rockwood/MultiCare Health Systems, Spokane, Washington.

"People with diabetes without full insurance are often paying increasing out-of-pocket costs for insulin resulting in many rationing their medication or skipping life-saving doses altogether," she said.

The society's statement calls for allowing government negotiation of drug prices and greater transparency across the supply chain to elucidate the reasons for rising insulin costs.  

For physicians in particular, they advise training in use of lower-cost human NPH and regular insulin for appropriate patients with type 2 diabetes, and considering patients' individual financial and coverage status when prescribing insulin.

Pharmacists are advised to learn about and share information with patients about lower-cost options offered by manufacturers.

Other policy recommendations for relevant stakeholders include:

  • Limit future insulin list price increases to the rate of inflation.

  • Limit out-of-pocket costs without increasing premiums or deductibles by limiting cost-sharing to copays of no more than $35, providing first-dollar coverage, or capping costs at no more than $100 per month.

  • Eliminate rebates or pass savings from rebates along to consumers without increasing premiums or deductibles.

  • Expedite approval of insulin biosimilars to create market competition.

  • Include real-time benefit information in electronic medical records.

  • Develop a payment model for Medicare Part B beneficiaries as well as Part D to lower out-of-pocket copays.

For manufacturers, the society also recommends improving patient assistance programs to be less restrictive and more accountable. And employers, they say, should limit copays without increasing premiums or deductibles, and seek plan options that benefit people with diabetes and provide education about these options during open enrollment.   

Four of the 11 writing panel members have pharmaceutical industry disclosures.

J Clin Endocrinol Metab. Published online January 12, 2021. Full text

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