How PBMs Reduce Insulin Costs

Host JC Scott speaks with Amy Bricker, Senior Vice President of Health Services Supply Chain at Express Scripts and previous commissioner for MedPac. November is National Diabetes Month, and the discussion this week revolves around how PBMs help keep the costs of insulin down and improve patient care.

Getting Support for Diabetes in America

List prices for insulin have not gone down, leaving some diabetes patients with high costs for the live-saving medicine, either as high insurance co-pays or deductibles or the high cost of insulin itself. While there have been some improvements in delivery technology and formulations, Bricker points out that these innovations don’t justify the high prices pharmaceutical companies continue to charge. To some extent, the lack of competition in the market is causing this, which is why PBMs are so important.

How Express Scripts is Helping

Last year Express Scripts saw a 5% decrease in spending from those enrolled in their clinical solution, thanks in part to discounts but more critically through leveraging formularies, utilization, and diabetes care value program that ensures patients get complete care, communicated in ways that work best for them.

The Effects of Coupon and Discount Programs

Bricker argues that well-intentioned programs like 340B are out of control and no longer helping patients. She believes this and other coupon programs require major reform or even elimination, because they operate in the background and disrupt formularies.

CMS Part D Senior Savings Model

The Centers for Medicare & Medicaid Services established a voluntary Part D plan that limits insulin’s cost share to $35 a month per beneficiary. Approximately a third of Medicare beneficiaries are affected by diabetes and companies such as Express Scripts and Cigna will participate in this program. While Medicare Part D definitely needs reform, steps such as these are a great starting point and crucial to those within the program.

What Does the Future Look Like?

Bricker says we need to encourage manufacturers to lower prices, but that needs to be encouraged by legislation or regulation — while always keeping the patient top of mind. She advocates for Part D reform to establish more programs like the #35/month cost share.

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