Cigna; Express Scripts Announce Program to Cap Insulin Cost to $25/Month

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By : Suvarna Sheth

Cigna and Express Scripts announced today the launch of a new program which will ensure eligible people with diabetes in participating plans pay no more than $25 for a 30-day supply of insulin.

The increasing cost of insulin has come into recent scrutiny, as diabetes advocates continue to put more pressure on Congress to address what many patients call “deceptive” price hikes on a medication that is a basic necessity to survive.

The move shows consumers the insurers are doing something about the rising cost of insulin.

The list price of Humalog is $274.70 per a vial (as of May 2017). This is a price increase of 1123% since June 1996, according to T1International, a global non-profit supporting those with Type 1 diabetes.

The cost has risen so high, that many without insurance and high deductible plans have resorted to rationing their insulin to make it last longer.

A recent Yale study highlighted the effects of this issue, showing that 1 in 4 people with diabetes who use insulin admitted to cutting back on the use of insulin because of cost.

“For people with diabetes, insulin can be as essential as air,” acknowledged Dr. Steve Miller, executive vice president, and chief clinical officer, Cigna in a statement. “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.”

Miller emphasized that Cigna and Express Scripts are now able to give people who rely on insulin “greater affordability and cost predictability” so they can focus on what matters most: their well-being.

The company’s new program will be available to members in participating non-government funded pharmacy plans managed by Express Scripts, including Cigna and many other health plans, with out-of-pocket costs for insulin greater than $25.

Out of pocket costs for insulin include deductibles, copays or coinsurance.

In most cases, people who use insulin will see lower out-of-pocket costs without any increased cost to the plan.

Cigna and Express Scripts clients will activate this new program for participating plans by moving covered insulin products to a lower copayment.

The insurers state that to ensure people who need insulin get the access and affordability they need, they are partnering with insulin manufacturers to lower copayments to $25 at the point of sale.

“We are confident that our new program will remove cost as a barrier for people in participating plans who need insulin,” said Miller. “Better care and better outcomes are rooted in greater choice, affordability, and access, and we can bring all of these to people with the greatest needs.”

For users of insulin plans managed by Cigna and Express Scripts, the average out-of-pocket cost for insulin was $41.50 for a 30-day supply in 2018.

Through the new program, individuals who are eligible will save approximately 40 percent, as well as gain peace of mind in knowing they will have access to improved affordability.

Individuals with plan designs that involve coinsurance and/or a high deductible, will benefit the most from this new program, according to the companies.

However, diabetes advocates remain skeptical because the new plan fails to address the core of the problem, which is increasing list prices for a medication that has been around for decades.

“This is yet another P.R. move — a stopgap at best — to release the pressure on those responsible for the insulin price crisis,” Elizabeth Rowley, the founder, and director of T1International told the New York Times.

“Those patients who are lucky enough to be on a ‘participating plan’ can benefit, but what about those who aren’t? This program gives no lifetime ‘assurance’ that people with Type 1 diabetes can rely on,” she said.