In Ongoing Insulin Pricing Inquiry, Caucus Seeks Information on Formularies and Drug Discount Programs

Jan 12, 2018

Washington, DC – In their continuing inquiry into skyrocketing costs for insulin, Diabetes Caucus co-chairs Rep. Diana DeGette (D-CO) and Rep. Tom Reed (R-NY) today sent five more letters to health care industry stakeholders seeking further information about health plan benefit design and drug discount programs offered by pharmaceutical companies.

“Insulin is a life-saving drug for people with diabetes, but skyrocketing prices are making it unaffordable for millions of Americans,” DeGette said. “Benefit design and drug discount programs are important factors related to cost, and we need more information about them. This step in our inquiry is a critical and necessary one to resolve this public-health crisis.”

“We must continue the effort to uncover why the cost of insulin is going through the roof,” Reed added. “This is a life-saving drug for those impacted by this disease. As the Diabetes Caucus continues to look into this issue, we hope to work with the health care industry to find effective policy solutions to make insulin more affordable.”

DeGette and Reed sent letters to Mark Merritt and Marilyn Tavenner, the respective heads of the Pharmaceutical Care Management Association (PCMA) and America's Health Insurance Plans (AHIP), requesting information about formularies, which are lists of prescription drugs that a health plan covers. Formularies use a tiered structure with varying levels of cost-sharing that may have a large impact on the cost of drugs, including insulin.

In that letter, the members note that while they understand the complex nature of formulary design, they are concerned that exclusions and placement on higher cost-sharing tiers may restrict patient access to affordable insulins. They posed eight questions on this topic, requesting thorough responses to all before March 5, 2018.

In the second series of letters, the co-chairs write to Lars Fruergaard Jørgensen, David A. Ricks and Dr. Olivier Brandicourt, the Chief Executive Officers of drug-makers Novo Nordisk, Eli Lilly and Sanofi, respectively, inquiring into Patient Assistant Programs (PAPs) as well as discount cards and coupons. All are used to help patients afford medication, but PAPs are typically directed towards low-income consumers while discount cards and coupons are available to a broader range of people. Many patients view these programs as lifelines, but other stakeholders claim they are tools used by pharmaceutical companies to maintain high prices or steer patients toward more expensive drugs. DeGette and Reed pose a list of questions to them as well, asking about the existence and efficacy of any PAPs, coupons and discount codes they have used to provide free or reduced-cost insulin products, also requesting a response before March 5, 2018.

DeGette and Reed began their inquiry in June 2017, securing eye-opening information and in-person meetings from a variety of stakeholders representing patients, insurance providers, pharmaceutical companies and government agencies. They will continue their search for answers and solutions to the question of rising insulin prices, with the goal of providing relief for Americans living with diabetes and their families.