Insulin pricing in flux as major pharma players take action
18 Apr 2023
Drug Approval
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Source: Pharmaceutical Technology
Credit: Getty images/ Artur Debat
As the three main US pharmaceutical insulin suppliers, Novo Nordisk, Sanofi and Eli Lilly, have announced major price reductions, and the US government is pushing caps on out-of-pocket costs for their blockbuster insulins, experts say the tides may soon be turning for insulin afccess in the US.
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On March 1, Eli Lilly announced a 70% price reduction for its most commonly prescribed insulins a few months after losing $15 billion in market cap after a fake tweet. Novo Nordisk soon followed suit with plans to cut the cost of its pre-filled pens and vials. In the midst of growing public sentiment against price hikes, Sanofi also followed suit by cutting prices for its most popular insulin product Lantus (insulin glargine) by 78%.
This is not the first time that insulin pricing has been in the spotlight. In April 2022, the US House of Representatives passed the Affordable Insulin Act, as part of the Inflation Reduction Act (IRA), which set a price cap for insulin copays of $35 per month. However, this affected insulin prices only for patients above the age of 65 years on Medicare, and several diabetes organisations called for wider action. Still, in August 2022, 43 senators voted against including patients on commercial insurance plans in the group with capped prices. More recently, on March 23, Senators John Kennedy and Raphael Warnock put forward a bipartisan bill to cap insulin costs for all citizens.
Dr. Irl B. Hirsch, the former chair of the Professional Practice Committee for the American Diabetes Association, says, “[Insulin pricing] has become not just a medical issue, but a political issue based on a very complex pricing situation with insulin in the United States.” At the same time, pressure on the big three insulin companies continued to rise, as multiple states like California filed lawsuits alleging that companies and some pharmaceutical benefit managers (PBMs) had leveraged their control of the market to overcharge patients.
Experts attribute the extremely high insulin prices to a dysfunctional rebate system involving PBMs, consistent price gouging, and a flawed healthcare system. Sachiko Ozawa, PhD, a health economist at the University of North Carolina at Chapel Hill, says the extravagant insulin prices seen in recent years have even caused some diabetics to partake in high-risk behaviors such as online purchases from illegitimate websites. “These rogue or illegitimate online pharmacies are really catering to a population that’s looking for cheaper insulin prices,” says Ozawa.
Still, Aaron Turner-Phifer, the director of Health Policy at the nonprofit Juvenile Diabetes Research Foundation (JDRF), says the recent price cuts from the major insulin companies and last year’s IRA-related developments have been encouraging. He says, “Each of these actions mean that people who couldn’t otherwise afford their insulin to live, now can do so. [But] this is not the end of the issue and there are a number of things that need to happen to ensure that everyone regardless of their insurance status has access to affordable insulin.”
The history of insulin pricing
As per the Centers for Disease Control and Prevention, 37.3 million people or 11.3% of the US population have diabetes. In 2017, the American Diabetes AssociationDiabetes Association found that $237 billion was spent in direct medical costs related to diabetes. A high burden of insulin costs factors into this, with the current average price of $636 for 5 units (100IU/ml) for pre-filled insulin pens. This average takes into account the eleven branded preselected insulins in the figure, according to GlobalData’s Price Intelligence database.
Turner-Phifer says there are two issues that moved in parallel to lead the US to the current insulin affordability crisis—high list prices and high out-of-pocket costs. For uninsured US citizens, Turner-Phifer says that the rebate system is the main culprit for high out-of-pocket costs. Critics allege insulin manufacturers increase list prices and give large rebates to PBMs to then prioritise those insulins on their formularies. PBMs in turn argue they negotiate with manufacturers to obtain lower prices and blame the lack of market competition among manufacturers as the culprit. Frank Wharam, a health policy researcher at the Duke Margolis Center for Health Policy, found that even commercially insured US citizens, particularly those with high-deductible health plans, had increased out-of-pocket costs when it came to insulin.
In 2020, Colorado began a trend of states putting their own caps on out-of-pocket costs for insulin. Wharam explains that this was a good short-term solution but did not fix the issue as manufacturers continued to increase their prices. “You’re [the consumer] getting a reduced cost, but someone is paying for it,” he says. Wharam also explains why after 2017, insulin prices began to settle with less-sharp price increases: “In the next few years [2017–20], the situation got a lot of publicity…and politicians became highly aware of it and put it pretty high on their legislative agenda. Private actors in the US system will pay attention to enough political pressure.” Furthermore, Wharam explains that this period is when more players entered the US insulin landscape, developing biosimilars and generics, and states like Colorado began to put caps on prescription insulin. He says, “However it happened, it's a positive development for patients.”
In this analysis, the highest list price of selected insulin pens was taken from January of each year, and then averaged for each company. Each company launched new insulins to the market at different points within this timeline.
A changing insulin market
The recent price changes may indicate the beginning of flux in the insulin market. Eli Lilly said each 100 units/mL vial of Insulin Lispro, a popular short-acting manmade insulin, will cost $25 per vial starting May 1. Humalog and Humulin’s prices will also be reduced by 70% from Q4 2023 onwards. Lilly is also launching Rezvoglar (insulin glargine-aglr), a basal insulin biosimilar that is interchangeable with Lantus, for $92 per five-pack of KwikPens.
In addition, Novo Nordisk is also lowering list prices of its basal long-acting, bolus short-acting, and pre-mix insulins. Specifically, these include Levemir (insulin detemir), Novolin (insulin regular), NovoLog (insulin aspart), and NovoLog Mix 70/30.
Hirsch speculates that negative public sentiment, which has been “severe” for some time, and a changing diabetes therapeutic market may have triggered the recent announcements.
Furthermore, the growing popularity of therapies that target GLP1 like Ozempic (semaglutide), Trulicity (dulaglutide), and Mounjaro (tirzepatide) is causing a shift in the landscape, says Hirsch. The tremendous weight loss that patients see with these drugs makes insulin requirements lower for type 2 diabetes patients, Hirsch explains. “They’ve made their billions of dollars on the insulin, so they can look in the rear-view mirror with insulin as they don’t need it anymore, especially Novo Nordisk and Lilly.” Lilly markets Mounjaro (tirzepatide) and Trulicity (dulaglutide) indicated for type 2 diabetes, and Novo Nordisk markets Ozempic. These drugs are approved as treatment for diabetes but are also being prescribed off-label for obesity, and are popular enough to result in drug shortages. Combination insulins with GLP-1 agonists are already more expensive than standard insulins. For example, Novo Nordisk’s Xultophy (insulin degludec and liraglutide) is $12,057 for a pre-filled pen (with a strength of 100IU/ml) per 5 units.
Additionally, other entities are also shaking up the space. Civica Rx, a non-profit generic drug company, announced a partnership with the state of California to produce cheaper biosimilar insulins for the CalRx Biosimilar Insulin initiative. Hirsch suspects that Civica Rx’s project may be particularly successful due to its method of bypassing PBMs to get insulin to patients.
However, Turner-Phifer is cautious about the recent news from the insulin companies, saying, “Several of these announcements are simply announcements for things to come in the future. And there's no security that two or five years from now, other dynamics might be at play, and prices may be going back up.” He continues, “The system for insulin in the US is broken.”
“The good news is that insulin [pricing] has received so much publicity about the inequities of insulin access that most Americans, independent of their political persuasion, agree that we need to give underserved people and people of color access to insulin…but it’s going to take years to get there,” says Turner-Phifer.
With data analysis support from GlobalData principal research analyst Alex Watt.
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US Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
British Virgin Islands
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Kosovo
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Branded Name Generic Name Company Current Prices ($ USD) per 5 units Average Annual Treatment Cost ($ USD)
BASAGLAR INSULIN GLARGINE Eli Lilly 391.63
HUMALOG INSULIN LISPRO Eli Lilly 636.48 5162.56
LYUMJEV INSULIN LISPRO Eli Lilly 636.48 5162.56
FIASP INSULIN ASPART Novo Nordisk 670.6 3120.79
NOVOLIN N INSULIN (HUMAN) Novo Nordisk 312.3
TRESIBA INSULIN DEGLUDEC Novo Nordisk 610.12 4948.72
XULTOPHY INSULIN DEGLUDEC; LIRAGLUTIDE Novo Nordisk 1486.46 12056.87
ADMELOG INSULIN LISPRO Sanofi 227.22
LANTUS INSULIN GLARGINE Sanofi 525.68 4263.88
SOLIQUA INSULIN GLARGINE; LIXISENATIDE Sanofi 1018.14 8258.25
SEMGLEE INSULIN GLARGINE Viatris 484.85
INSULIN LISPRO INSULIN LISPRO Eli Lilly 190.94
INSULIN ASPART INSULIN ASPART Novo Nordisk 335.29
INSULIN GLARGINE INSULIN GLARGINE Viatris 177.58
INSULIN GLARGINE INSULIN GLARGINE Winthrop/ Sanofi 204.14
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Eli Lilly (Branded) 284.16 325.32 388.74 469.8 549.18 485.31 514.055 514.055 514.055 554.8633333 554.8633333 554.8633333
Novo Nordisk (Branded) 252.17 272.34 363.74 447.31 508.41 720.2133333 699.825 656.566 617.9716667 628.3683333 639.0683333 664.2
Sanofi (Branded) 246.48 273.92 363.74 447.31 447.31 604.655 587.9133333 610.7866667 553.8166667 565.41 555.1633333 569.0833333
Combination therapies of insulin and GLP-1 agonists have a higher average annual treatment cost
Average annual cost of US branded pre-filled pen insulins (with a strength of 100 IU/ml) per 5 units in March 2023.
Branded Name Generic Name Company Average Annual Treatment Cost ($ USD)
HUMALOG INSULIN LISPRO Eli Lilly 5162.56
LYUMJEV INSULIN LISPRO Eli Lilly 5162.56
FIASP INSULIN ASPART Novo Nordisk 3120.79
TRESIBA INSULIN DEGLUDEC Novo Nordisk 4948.72
XULTOPHY INSULIN DEGLUDEC; LIRAGLUTIDE Novo Nordisk 12056.87
APIDRA INSULIN GLULISINE Sanofi 5338.93
LANTUS INSULIN GLARGINE Sanofi 4263.88
SOLIQUA INSULIN GLARGINE; LIXISENATIDE Sanofi 8258.25
TOUJEO INSULIN GLARGINE Sanofi 1471.4
Source:
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