Cigna’s Initiative to Lower the Out-Of-Pocket Cost of Insulin

Cigna’s Initiative to Lower the Out-Of-Pocket Cost of Insulin

Due to public pressure, the health insurance giant, Cigna, has announced they will lower the monthly out of pocket cost of insulin for participating patients from an average of $40 to no more than $25. This plan, the Patient Assurance Program, comes on the heels of Cigna’s recent purchase of Express Scripts.

Provisions of the Affordable Care Act (ACA) combined pharmaceutical and other medical expenses under one deductible, resulting in an increase of patients’ out of pocket costs. This was due to ACA regulations which defined insulin as disease management, not preventative medicine. In response, some financially burdened patients have begun hoarding, attempting to stretch their insulin supply to lower their total out-of-pocket expenses.  This includes many patients who are enrolled in high deductible health insurance plans. These plans often force patients to pay hundreds of dollars before insurance kicks in to subsidize the cost of their insulin. It has been reported that high deductible plan participants are using just 9.4 months’ worth of insulin over the course of a given year.1 As the Senior Vice President and Chief Innovation Officer at Express Scripts, Glenn Stettin, noted, “And seeing people make what seem irrational decisions to try and stretch things, that’s not acceptable to us. And that’s why we’re trying to do something about it”1

Beginning to Fix the Insulin Cost Problem

Before proposing a solution, Cigna and Express Scripts first needed to understand the current situation and the points at which they had the ability to intervene.  Manufacturers of insulin routinely provide rebates; however, these rebates are not always passed through to the patient. Cigna and Express Scripts’ announcement signals a shift to pass rebates through to patients, hopefully, lower out of pocket costs.  Cigna explained that through their partnership with insulin manufacturers and their new program, “Individuals who are eligible for the program will save approximately 40%, as well as gain peace of mind in knowing they will have access to improved affordability.” 2

Implications for the Pharmaceutical Industry

Efforts are underway to change cultures and mind-sets within the pharmaceutical industry to primarily focus on patients’ needs and priorities.3 We have already seen Cigna and some pharmaceutical companies start to pivot. Cigna is adding value to patients by leveraging partnerships and appropriating already allocated resources. On the pharmaceutical side, the three drug makers that sell insulin—Eli Lilly, Novo Nordisk and Sanofi—are picking up the extra costs associated with the rebates to ensure patients are seeing the value of the Cigna initiative to lower out-of-pocket costs Sanofi has instituted a program of direct-to-patient insulin sales across their portfolio for $99 per month per patient. This is another example of how manufactures and providers are shifting to a patient centric approach; and certainly, an example that patient’s voices are being heard.

Contact us at Beth@Herspiegel.com if you would like further insight into the changing diabetes cost and reimbursement landscape.

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