To be sold under the names Insulin Lispro Protamine and Insulin Lispro Injectable Suspension Mix75/25 KwikPen (3 milliliters [mL] at 100 units/mL) and Insulin Lispro Injection Junior KwikPen (3 mL at 100 units/mL), the disposable insulin pens will have a list price of $265.20 for a package of five, the company said in a January 14, 2020 news release. This follows the company’s introduction in May 2019 of a half-price generic version of its popular Humalog fast-acting insulin (insulin lispro injection), at a list price of $137.35 per vial and $265.20 for a package of five KwikPens. Since then, about 10 percent of people using Humalog insulin have transitioned to the generic insulin lispro injection, according to Eli Lilly. RELATED: Eli Lilly to Offer a Half-Price Version of Humalog Insulin These moves come amid skyrocketing insulin costs and a crisis of affordability in the United States. An estimated 7.4 million Americans use insulin, according to an article published in June 2018 in Diabetes Care. That includes the 1.25 million with type 1 diabetes who rely on insulin, according to the American Diabetes Association. People who have type 1 diabetes — 6 percent of all people diagnosed with diabetes, according to the U.S. Centers for Disease Control (CDC) — do not make their own insulin and therefore must inject it to survive. So must those who have type 2 diabetes whose bodies do not use insulin well. People who have latent autoimmune diabetes must also inject insulin. Yet the average price per milliliter of insulin more than tripled between 2002 and 2013, according to a study published in April 2016 in the Journal of the American Medical Association. Drug companies serving the U.S. market have been under pressure to lower their list prices. Accordingly, Novo Nordisk also introduced half-price versions of its NovoLog and NovoLog Mix insulin products in January, with the following prices:
Insulin Aspart 10nmL vial (100 units/mL), $144.68Insulin Aspart Penfill (3 mL at 100 units/mL), $268.73 per box of 5Insulin Aspart 5 x 3 mL FlexPen (3 mL at 100 units/mL), $279.41 per box of 5Insulin Aspart 70/30 FOB 110 mL vial (100 units/mL), $150.06Insulin Aspart 70/30 FOB FlexPen (3 mL at 100 units/mL), $279.41 per box of 5
“The cost of insulin at the pharmacy varies dramatically depending on a person’s insurance coverage,” Lilly Diabetes president Mike Mason said in the news release. “These lower-priced insulins may reduce out-of-pocket costs, especially for people in the coverage gap of Medicare Part D, the uninsured, or those with high-deductible insurance plans.” Tamara K. Oser, MD, a family medicine researcher at the University of Colorado Anschutz Medical Campus and a spokesperson for the American Association of Diabetes Educators, called the reduced insulin pricing “a reasonable start to what we hope becomes a more sweeping new trend toward more affordable insulin.” Dr. Oser also hopes the industry will go beyond the so-called “authorized” generics by brand-name insulin makers to allow other companies to enter the market. “The cost savings will be even greater when more generic drug manufacturers are able to produce these insulins. It is when multiple manufacturers compete over the same generic drug that prices tend to drop most precipitously, and we are not there yet, but we look forward to the day when we are.” RELATED: 8 Essentials to Help You Manage Insulin Therapy
Price Reductions May Have Limited Impact for Type 1 Community, Critics Say
Not everyone thinks Eli Lilly’s move will do much to ease the financial burden on the majority of people who face the cost burden of insulin. “The additional products they are adding are not widely used in the type 1 diabetes community — the community that is seeing death after death because of [insulin] rationing,” says Elizabeth Pfiester, the founder and executive director of the type 1 diabetes advocacy group T1International, who is based in Cheltenham, England. Nearly 600,000 prescriptions for Humalog Mix75/25 were filled within the last 12 months, and more than 86,000 prescriptions for Humalog Junior KwikPen were filled between December 2018 and November 2019, according to Eli Lilly. Pfiester says that the first half-price insulin the company rolled out, insulin lispro injection, was difficult for people to access. “Many of our advocates have found that many insurance plans don’t cover it, a high number of pharmacies don’t seem to carry it, and pharmacists don’t seem to know about it.” She points to the findings of a report released in December 2019 by U.S. Senators Elizabeth Warren (D-Massachusetts) and Richard Blumenthal (D-Connecticut). After surveying nearly 400 pharmacies, the senators concluded that Eli Lilly’s half-price insulin lispro injection was “widely unavailable in pharmacies across the country, and that the company has not taken meaningful steps to increase insulin accessibility and affordability.” In 83 percent of pharmacies surveyed, insulin lispro injection was not in stock and available for consumers. In this week’s announcement, Eli Lilly says, “Insulin Lispro Injection is now distributed by all major U.S. wholesalers and can be ordered by any pharmacy. Lilly will begin negotiations immediately with wholesalers and payers to make these additional lower-priced insulins available.” Pfiester says: “This is not about people for Eli Lilly. It is about profit.” She referred to the complex and often opaque process by which drugmakers and pharmacy benefit managers negotiate what is actually paid for a medication, and what the maker receives. “In essence, the authorized generics allow Lilly (and now Novo Nordisk) to offer their branded generic at nearly the same reimbursement price they currently receive after discounts and rebates. If pharmacists substitute the generic, companies will likely bring in the same profits, if not more.” Instead, she says, “They should lower the list price of their insulin so that anyone, whether insured or uninsured, can get insulin at a reasonable cost.” She points to a study published in September 2018 in the journal BMJ Global Health that puts the cost of producing one vial of analog insulin at less than $10 per vial, depending on the type. “There is absolutely no need to charge $300 per vial,” she says. “If they lowered the price to $10 or $25, they would still be making a healthy profit.” Meanwhile, Eli Lilly says that 95 percent of people currently using their Humalog insulins pay less than $100 per month at retail pharmacies because of either insurance coverage or “affordability options,” such as half-price insulin or help through their Lilly Diabetes Solution Center, at 833-808-1234. RELATED: Why Is Insulin So Expensive? (And What to Do if You Can’t Afford It)
How to Find Out if Your Insurance Covers the New Insulins
If you’re unsure whether your insurance covers the half-price insulins offered by Eli Lilly and Novo Nordisk, a great start is to visit the American Diabetes Association’s site InsulinHelp.org. It provides simple instructions for how to contact the company that makes the insulin product you are seeking, offers tips on how to prepare in advance of the phone call, and describes other low-cost options that you may qualify for if your insurance won’t cover them. The page also lists drug discount programs and databases. Or if you’d rather speak to someone, you can call their help line at 800-DIABETES (800-342-2383) and press 5 to speak with an ADA representative. The JDRF, a nonprofit type 1 diabetes research and advocacy organization, has more advice for corresponding with insurance companies. Their detailed primers can help you navigate insurance coverage for insulin, supplies, and devices; learn what to do when coverage is denied; and find out how you can get additional help with costs. Still, don’t take any of these steps without first speaking with your healthcare team. They may be able to provide the advice for your individual case.
