Hunter Sego, 26, of Indiana, had been spending about $660 each month on insulin from drug maker Eli Lilly.
When the company announced earlier this month that it would limit the out-of-pocket cost of insulin to $35 a month, she knew it would make her life a lot easier.
“This is going to be absolutely massive,” said Sego, who has type 1 diabetes.
Her mother, Kathy, just wished the change had happened sooner.
Around 2016, Sego began rationing his insulin because he couldn’t afford the high cost of the medication. He eventually developed diabetic ketoacidosis, a life-threatening condition.
“I’m thankful everyone’s come to,” her mother said, referring to the insulin makers. “But I keep thinking, ‘What’s the problem?’”
After years of public protest and political pressure, the three largest insulin makers in the United States — Eli Lilly, Novo Nordisk and Sanofi — said this month they would limit or reduce the cost of many of their insulin products.
Following the passage of the Reducing Inflation Act, which capped the monthly cost of insulin to $35 for seniors on Medicare but left behind millions more who also depend on the drug, President Joe Biden, joined by lawmakers and advocacy groups , called on drug companies to lower the cost of insulin for everyone.
That the insulin makers actually did it, experts say, is a big problem; together, Eli Lilly, Novo Nordisk and Sanofi make up about 90% of the US insulin market. According to the Rand Corp., a group of public policy experts, the cost of the drug in the US is up to 10 times higher than in other Organization for Economic Co-operation and Development countries cheap.
Why did insulin manufacturers cut prices?
On March 1, Eli Lilly announced that it would immediately cap the out-of-pocket cost of insulin to $35 per month and reduce the list price of several of its popular insulin products later this year. Novo Nordisk and Sanofi followed suit later, announcing pocket price caps or list price cuts last week that will take effect on January 1.
Natalie Stanback, 39, a Dallas resident, said the news meant she could afford medication for her 11-year-old daughter Nadia.
Currently, with insurance, you typically pay out-of-pocket between $30 and $50 for a vial of Insulin Humalogby Eli Lilly. Nadia normally uses around 1.5 vials per month.
But that was not the case in 2020, when Stanback lost his job and health insurance due to the pandemic. At the time, she was paying out of pocket between $75 and $100 for a vial of her daughter’s insulin.
“I’m excited,” she said of the insulin price cuts. «As a parent, you’re constantly thinking about worst case scenarios and how to mitigate that.»
It’s not clear why the three insulin makers decided to cut prices now.
Inma Hernandez, an adjunct professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California, San Diego, said that public pressure, as well as the Inflation Reduction Act, certainly played a role.
But, he said, the changes are more likely due to a new Medicaid reimbursement policy that will go into effect next year. The rule will penalize drug manufacturers that increase the price of their drugs faster than the rate of inflation. By lowering the cost of your drugs, insulin manufacturers will owe less money to the government.
For some insulin users, like Kimberly Blincoe, 25, of the Inland Empire, California, the reason doesn’t matter.
“The weight that has been lifted from me, and millions of others, is indescribable,” said Blincoe, who will lose her parents’ health insurance when she turns 26.
Blincoe uses Humalog, from Eli Lilly, as well as Levemir, from Novo Nordisk. Under his parents’ plan, which Blincoe described as “good insurance,” the drugs typically cost her a combined $300 out-of-pocket each month.
However, that out-of-pocket cost was expected to increase to about $1,500 to $2,000 per month once you were disenrolled from your parents’ plan.
Now Humalog will only cost you $35 a month, and next year the price of Levemir will fall 65%at $107.85 per vial.
“This price drop basically makes living past the age of 26 feasible,” he said, adding that the cuts are not only a “money saver” but also a “life saver.”
Could the price cuts have a negative impact?
Not all insulin users saw the price cuts as a positive change.
Chicago resident Anita Brown, 41, said she is concerned that her insurance will no longer cover the cost of her insulin because the list price will be so low that it will force her to pay out of pocket.
That’s what her insurance did when it lowered the price of a medicine she took for sinus inflammation.
Brown takes NovoLog, from Novo Nordisk, which will reduce the cost of the drug by 75% to $72.34 per vial starting next year.
She pays about $70 out-of-pocket for three vials of insulin, about a two-and-a-half-month supply, after insurance coverage. If she is forced to pay the full list price, she will pay more than triple that amount.
“I’m good for another year,” he said, noting that he’ll wait and see what happens at his pharmacy next year, when the change takes effect.
Dr. Adam Gaffney, a critical care physician with Cambridge Health Alliance in Massachusetts, said it’s possible for an insurance company to waive coverage for a drug because of a price change, but added that it usually depends on the formulary or list. from the provider. of covered drugs.
It’s not perfect, but it’s still life changing.
For San Diego mother Annemarie Gibson, 49, the price cuts won’t eliminate all the costs of diabetes, but she was still pleasantly surprised.
His two teenage sons, Owen and Thomas, have type 1 diabetes. Gibson typically pays $200 out-of-pocket each month for four vials of Humalog. With Eli Lilly’s changes, she now only pays $70 a month.
However, other expenses related to Owen and Thomas’ diabetes care will not be reduced. Gibson spends about $1,000 every three months on glucose sensors and another $1,000 every six months on transmitters.
Despite that, the changes provide some comfort.
“Since my children are teenagers, I look to the future,” she said. “This means the cost to them will be much more reasonable” when they have their own insurance.
Even if more needs to be done, price reductions are life-changing, particularly for the uninsured and those with high-deductible plans, Gaffney said.
Kristin Thompson-Lerberg, 43, of Wisconsin, has a high-deductible plan.
He takes Novolog, from Novo Nordisk and occasionally Lantus, from Sanofi to treat his type 1 diabetes.
But your insurance won’t cover the cost of your drugs until you spend $3,000 out of pocket. And even after meeting the deductible, he still has a copay.
Thompson-Lerberg said the price changes will be a «big deal» for her and her husband when the measures take effect next year.
“My husband and I used to joke that we can take at least a little vacation for $3,000 every summer, but instead we buy insulin,” she said.