Cigna and Express Scripts launch program to cap out-of-pocket cost for insulin at $25 per 30-day supply

Cigna and Express Scripts have launched a patient assurance program to  ensure eligible beneficiaries with diabetes pay no more than $25 for a 30-day supply of insulin.

The program reduces out-of-pocket costs for insulin by 40 percent or more for many patients, Cigna said.

The patient assurance program will be available to members in participating non-government funded pharmacy plans managed by Express Scripts, including Cigna and other health plans, with out-of-pocket costs for insulin greater than $25. Out-of-pocket costs for insulin include deductibles, copays or coinsurance.

The patient assurance program is an optional adoption for clients of PBM Express Scripts. Cigna and Express Scripts clients will activate the new program for participating plans by moving covered insulin products to a lower copayment.

In most cases, people who use insulin will see lower out-of-pocket costs without any increased cost to the plan, Cigna said.  The average out-of-pocket cost for insulin in plans managed by Cigna and Express Scripts was $41.50 for a 30-day supply in 2018.

WHY THIS MATTERS

The insurer and its PBM are partnering with insulin manufacturers to lower copayments to $25 at the point of sale.

PBMs and insurers are under pressure from the Department of Health and Human Services, Congress and stakeholders to reduce costs to consumers at the point of sale.

Executives from five of the largest PBMs go before the Senate Finance Committee Tuesday in an ongoing series of hearings being held to lower drug costs.

HHS wants to change the current rebate system, in which pharmacy benefit managers and Part D plans negotiate rebates as a percentage of the list price and pass these savings to insurers to reduce premiums.

Instead, HHS wants the rebate discounts to be passed directly to consumers at the pharmacy counter. Consumer premiums could increase 3-5 percent under the proposed rule, HHS said, but out-of-pocket costs would be dramatically reduced.

Insurers have said premiums would increase by about 25 percent under the plan.

The discounts being offered by Cigna through the assurance program are separate from rebates, Cigna said. Participating drug makers Lilly, Novo and Sanofi, are providing additional discounts, in addition to established rebates, that will pay down the patient's copay to $25, Cigna said.

But America's Health Insurance Plans reacted favorably to Cigna's new program, citing it as a "perfect example of the value pharmacy benefit managers and health insurance providers bring when it comes to driving down costs for patients and consumers."

PBMs play an important role in negotiations with drug companies, and the savings achieved are passed on through lower premiums and lower out-of-pocket costs, AHIP said.

TREND

More than a quarter of the approximately 24 million Americans who are diagnosed with diabetes use insulin – alone or along with other medications – to keep their blood glucose levels in check, according to research from Express Scripts. A recent Yale study said one in four people with diabetes who use insulin admitted to cutting back on the use of insulin because of cost.

ON THE RECORD

"For people with diabetes, insulin can be as essential as air. 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," said Dr. Steve Miller,  executive vice president and chief clinical officer, Cigna. "We are confident that our new program will remove cost as a barrier for people in participating plans who need insulin. 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."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com