Update 9/10/20:Lilly announced that the $35 copay card has been added to their suite of insulin affordability solutions, and will remain accessible indefinitely.
People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can build custom plans based on your personal circumstances through our tool, GetInsulin.org.
The Trump administration says most people with Medicare will have access to prescription plans next year that limit copays for insulin to a maximum of $35 a month. The Part D Senior Savings Model – which was announced on March 11, 2020 – is a voluntary model that tests the impact on insulin access and care by participating Part D enhanced alternative plans offering lower out-of-pocket costs, at a maximum $35 copay for a month’s supply, for a broad range of insulins. Insulin costs between $2.28 and $3.42 for drug makers to manufacture, yet many people with diabetes pay hundreds of dollars for the lifesaving drug.
Cost Of Insulin On Medicare
On April 7, 2020, Eli Lilly announced the introduction of the Lilly Insulin Value Program, allowing people without health insurance and people with commercial health insurance in the United States to fill their monthly prescription of Lilly insulin for $35 per month through a new copay card.
“Too many people in the U.S. have lost their jobs because of the COVID-19 crisis, and we want to make sure no one goes without their Lilly insulin,” said Mike Mason, president, Lilly Diabetes. “We’ve been providing affordability solutions for a long time, but more is needed to help people during this unprecedented period. People with commercial insurance, as well as those without insurance at all, are eligible, and the process is quick and simple. We want people who need help to call us.”
Included in the press release was a quote from CEOs Aaron Kowalski and Thom Scher on behalf of the JDRF – Beyond Type 1 Alliance stating, “It’s critical that people with diabetes can reliably access insulin at a low, consistent out-of-pocket cost. Enabling a $35 per month insulin copay regardless of employment status will help many Americans in this difficult time.”
Andy Vicari, US Insulin Brand Leader for Lilly Diabetes, spoke to Beyond Type 1 and answered some of the most pressing questions about this new program, including the process for obtaining the savings card, how the program will work with insurance, how long it will last, and why it was introduced at this time.
Who is eligible for this program?
This program is available to patients in the US with commercial insurance, including those with high deductible plans. Notably, this program is also available to US patients without commercial insurance, a subset who have been excluded from using copayment cards in the past.
The Lilly Insulin Value Program is NOT available to patients with any government insurance including Medicaid or Medicare. Patients who are not eligible are still encouraged to call the Lilly Diabetes Solutions Center for advice on other cost-saving measures. However, last month the Centers for Medicare & Medicaid Services (CMS) launched a new plan for some Medicare Part D participants to pay a maximum $35 copay for their monthly supply of insulin.
A note from Beyond Type 1:if you do not qualify or do not take Lilly Insulin, explore options here.
How does it work?
Patients with an active prescription for a Lilly insulin should call the Lilly Diabetes Solution Center at 833-808-1234. From there, patients can choose whether to receive the savings card via email (expected within 24 hours of placing a call) or in the mail. If you are filling prescriptions for more than one Lilly insulin, (for example Humalog and Basaglar) you will have a separate $35 monthly copay for each product. If you have an active copay card with Lilly, it will automatically be updated to the new $35 price point. The card will be good for the remainder of the year until January 2021, when it will need to be renewed.
Which insulins are covered and how much can you get?
Most Lilly insulins, including Humalog formulations and Basaglar, in either vials or pens, are covered by this new program. Note: Cartridges are not covered.
When asked how much insulin a patient could fill in a month, Vicari told Beyond Type 1 that although they monitor quantities in the background to prevent abuse of the system, “There’s effectively no cap… Patients will be able to get their Lilly insulin for $35 a month, regardless of the dosage.”
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Update 4/9: After reports of a $7,500 limit, we reached out for clarification.
Wade Neucks, Director of the Patient Affordability Solutions Team at Lilly Diabetes told Beyond Type 1 “The $7,500 is an annual limit, not lifetime. The limit is based on the amount Lilly covers at the pharmacy and not the list price. In the very rare event that someone meets that limit, they should call the Lilly Diabetes Solution Center back and ask for help. The Solution Center can work with your pharmacy to see if an adjustment to your solution is necessary.”
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Vicari also said that those with deductibles, including people with high deductible health plans (HDHPs), should see these $35 copays count towards their deductible.
“If they are covered by Lilly insulin today on their insurance plan, and they use this card, it will count towards their deductible… barring some strange benefit designs… In general, we have seen all insurance [companies] are warm to leveraging these [programs] for their individual customers.”
How long will the program last?
Although the press release cites the new $35 copay program as a direct response to the COVID-19 crises in America, it may be here to stay, and will at least last until the end of 2020.
Vicari told Beyond Type 1 “We’re always looking at all of our programs just based on the changing landscape in the healthcare system, but we have no plans to stop this program post-Coronavirus, whenever that is. It’s just something we felt was the right decision — prompted certainly by what’s happening today — but we don’t have plans in place to stop the program. We always look at all of our programs on an annual basis to make sure they’re optimized for the breadth that we need to cover: as many people as we can that are touched by Lilly insulins.”
Why now?
When asked about the timing of this new $35 copay program, Vicari framed it as a natural progression of increased affordability options Lilly has offered recently, citing the company’s partnership with Blink Health in 2016, the launch of the Lilly Diabetes Solutions Center in 2018, and the introduction of a 50% generic version of Humalog (insulin lispro) in 2019.
“The short answer, it was prompted by the COVID-19 pandemic and is what we needed to do. At the same time this is not a new behavior for us, in that we’re constantly looking for new things that we can be doing and should be doing to impact the market, certainly people that are taking our insulins… In a time like this you have to pull out all the stops to get whatever you can done.”
Beyond Type 1 is hopeful that this move by Lilly Diabetes puts pressure on other insulin manufacturers to follow suit and drastically expand insulin assistance programs, for all insulins and all patients, especially those who are uninsured or enrolled in high deductible health plans.
Is Insulin 35 Dollars Now
For more resources on what to do if you find yourself suddenly jobless or without health insurance, click here.
On first blush, President Donald Trump’s $35 insulin discount policy may seem like a serious attack on high prescription drug prices. No doubt, it could help some patients. But the new policy is a limited gesture that is no substitute for comprehensive drug pricing reform. The timing suggests Trump’s insulin plan may be a political ploy to curry favor with senior voters, who – according to recent polling – are turning against the president.
On May 26, the Centers for Medicare and Medicaid Services announced that participating enhanced Part D prescription drug plans will allow beneficiaries to access insulin for a maximum copay of $35 for one month’s supply. Notice the words “participating” and “enhanced.” This means that only those patients who elect (and pay for) enhanced coverage will be able to take advantage of the $35 price cap – and only if their drug plans participate. Millions of seniors whose plans do not include this provision will continue to pay an average of over $1,100 in annual out of pocket insulin costs.
Obviously, any policy that lowers seniors’ insulin copays can be helpful, but this is not nearly enough. The president’s order does nothing to reduce the actual price of insulin, one of the most notoriously cost-inflated drugs in recent memory. The price of a one-month supply of insulin has exploded from $21 in 1996 to $275 today. That’s a 1200 percent price increase, wildly exceeding inflation. A 2019 study found that one quarter of type-1 diabetes patients are rationing insulin because of the soaring cost, sometimes with deadly results. In 2017, a young Minnesota man died of diabetic ketoacidosis after rationing insulin because he couldn’t afford the copays.
Of course, insulin is only one of the many drugs for which Big Pharma has jacked-up prices beyond the reach of everyday Americans, including those with insurance. The president’s policy fails to address that larger issue. A Senate Democrats’ report found that the most often-prescribed drugs for Medicare patients had increased 10 times the rate of inflation during a recent five-year period. The popular anti-inflammatory, Humira – which seniors take for everything from arthritis to Crohn’s Disease – now costs up to $72,000 annually after the drugmaker rang in the new year with a 7 percent price increase.
The president’s $35 insulin policy has no impact on this blatant prescription price-gouging, which forces many seniors of modest means to cut pills or to choose between groceries and medicine. The new Medicare provision simply allows the president to claim credit for lowering the out-of-pocket price of insulin for a limited number of beneficiaries – without offending Big Pharma. (By the way, not all diabetics take insulin.) For all of his bluster about taking on the issue of skyrocketing drug prices, Trump has offered only piecemeal solutions like this one. Most of his modest proposals have either stalled or been blocked by the courts.
Meanwhile, the president refuses to back the House-passed Lower Drug Costs Now Act (H.R. 3), which would allow Medicare to negotiate prescription prices directly with drugmakers — just like the Department of Veterans Affairs does. As a result, the VA pays 40 percent less than Medicare for medications on its formulary. The Congressional Budget Office estimated that Medicare would save $456 billion over ten years through price negotiation with drugmakers. Of all the measures under consideration, this is the most powerful, and yet the White House and most Republicans won’t embrace it.
Meanwhile, a bill from Sens. Charles Grassley (R-Iowa) and Ron Wyden (D-Ore.) that would cap drug price hikes languishes in the Senate. So far, Majority Leader Mitch McConnell has not brought the bill to the floor. The president has voiced support for the Grassley-Wyden measure, but has not exerted pressure on senators to move the legislation forward.
Insulin 35 Dollars
After months of silence on prescription drug prices, the administration announced the $35 insulin policy after polls indicated that Trump is underwater with senior voters – a demographic that helped him win the White House. His approval rating with older voters has plummeted 20 points since the onset of the coronavirus pandemic, which has taken a disproportionate toll on seniors. In this light, the president seems to be more interested in wooing a crucial voting bloc than creating effective policy to reduce out-of-control drug costs.
Trump has had more than three years to lead a broad effort to reduce Americans’ prescription drug costs. He has failed. In the face of such drastic need for help, the $35 insulin policy is a nickel solution for a billion-dollar problem. It will not fool senior voters – or relieve the chronic pain that prescription price gouging inflicts.
Is Insulin Now 35 Dollars
Max Richtman is president and CEO of the nonprofit National Committee to Preserve Social Security and Medicare, and formerly served as staff director of the U.S. Senate Special Committee on Aging.
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