Express Scripts, under fire for rising insulin costs, offers option to cap price at $25

Cigna-owned Express Scripts will offer its clients the option to cap patient costs for 30-day insulin prescriptions at $25, the pharmacy benefit manager said on Wednesday, a decision that comes as the industry faces mounting criticism over its role in the increasing cost of the diabetes treatment.

Should employers opt in to the new pharmacy plan from the St, Louis, Missouri-based company, prices for patients could drop as much as $16.50 on average within a few months.

"We are confident that our new program will remove cost as a barrier for people in participating plans who need insulin," said Executive Vice President Steve Miller. "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."

The announcement comes after lawmakers and advocates put the blame for high insulin costs on Express Scripts and other middleman pharmacy benefit managers, who negotiate with pharmaceutical companies to craft drug formularies for clients including employers and labor unions.

“What is not clear is whether those negotiations that take place…are actually benefiting the patient at the point of sale,” William Cefalu, chief scientific officer at the American Diabetes Association, told the House Energy Commerce Committee’s health panel on Tuesday.

PBM rival UnitedHealth Group’s Optum did not immediately respond to FOX Business' inquiries on whether it would offer a similar program to clients.

CVS Health says it offers clients the option to eliminate copays -- or set low out-of-pocket costs -- for drugs for chronic diseases like diabetes.

At the hearing, Rep. Michael Burgess of Texas, the top Republican on the subcommittee, said he would ask the Trump administration why Medicare does not cover the entire cost of insulin, given it would be cheaper than treating the consequences of when diabetes patients do not take the drug.

Such a move, however, could open the floodgates for other disease groups, like asthma patients, to push the federal government to fully cover the cost of treatments.

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The PBMs, including Express Scripts, are slated to testify in front of the Senate Finance Committee next, where the topic of insulin is sure to come up. The panel is in the midst of an investigation into the increasing cost of the drug and previously requested detailed pricing information from suppliers including Eli Lilly & Co. and Novo Nordisk.

Chairman Chuck Grassley, R-Iowa, and Sen. Ron Wyden of Oregon, the committee’s top Democrat, on Tuesday asked Express Scripts, CVS Health and Optum for documents on their relationships with insulin manufacturers and private insurance companies.


“As consumers face rising bills at the pharmacy counter, it is unclear whether PBMs are appropriately leveraging their power for the benefit of taxpayers and patients, especially patients who take multiple or high-cost medications,” the lawmakers wrote.