Eli Lilly cuts prices for some insulin products, but some are wary

Eli Lilly, one of the largest makers of insulin, said Wednesday it would make dramatic cuts to the prices of several of its older insulin products in an effort to lower costs for consumers whose insulin is not fully paid for by insurance. It also expanded its program to cap out-of-pocket insulin costs at $35 for people who do have health insurance.

The moves come amid a public and political uproar over the price of insulin. Previous moves by the industry have been largely viewed as insufficient and haven’t dulled the controversy around the issue.

Lilly is lowering the price of Insulin Lispro to $25 a vial, from $82 a vial, effective immediately, the company said. That product is a generic version of Lilly’s Humalog. The decrease, the company said, brings the price back to what it was in 1999. That change is aimed at helping people who are uninsured or who have to pay the list price of insulin while their plans are in a high-deductible phase.

The company will also cut the list price of Humalog, its most commonly prescribed insulin, by 70% in the fourth quarter, a move Lilly said was made in part to allow it time to negotiate with pharmacy benefit managers and health insurance plans.

It will also launch Rezvoglar, a long-acting insulin that pharmacists can interchange with Sanofi’s branded long-acting insulin Lantus without obtaining a new, separate prescription from a physician. Rezvoglar, Lilly said, will cost $92 per five pack of injectable pens, a 78% discount to Lantus effective April 23.

The company also said it would automatically cap out-of-pocket costs at $35 if consumers go to a participating retail pharmacy. The company says that people who do not have insurance can obtain Lilly insulin for $35 a month by going to InsulinAffordability.com.

The moves come after the recently enacted Inflation Reduction Act dictated that plans that are part of the government’s Medicare program also cap out-of-pocket costs for all insulins at $35.

In a tweet, President Biden called the move “huge news” and cheered it.

“Last year, we capped insulin prices for seniors on Medicare, but there was more work to do,” Biden wrote. “I called on Congress – and manufacturers – to lower insulin prices for everyone else. Today, Eli Lilly is heeding my call. Others should follow.”

In an interview, David Ricks, Eli Lilly’s chairman and CEO, presented the moves as the latest bid by the company, which pioneered the development of insulin in the 1920s, to work within a broken system to get the product to patients.

That system, it is now widely acknowledged, allowed insulin prices to become distorted in the 2010s because of a push and pull between drugmakers and insurance companies and an arcane apparatus for price negotiation. Pharmacy benefit managers, middlemen that work with insurers, would negotiate discounts paid as rebates from drugmakers. Drugmakers would in turn raise their prices. But when consumers purchased insulin in a high-deductible portion of their health plan or without insurance, they would be exposed to these new higher prices.

“There are incentives for everybody, manufacturers included, to maintain the status quo, which really does reward higher list prices and competing on net price, which is what we’ve been doing, you know, for a decade or so,” said Ricks. “But at some stage, that system has become so broken for patients, because they’re bearing the cost in their deductible phase and other phases based on list price, that it’s no longer acceptable.”

Experts and advocates welcomed the moves, but worried about how far-reaching they would truly be.

“It is a win that lower cost options will be available to patients using these insulins,” said Elizabeth Pfiester, founder and executive director of T1International, an advocacy group. “Lower insulin list prices can impact everyone, regardless of insurance status. However, we know that Lispro has historically not been available in all pharmacies or on all formularies. As with any move like this from one of the ‘big three,’ we are optimistic yet skeptical.

“If one insulin manufacturer can choose to offer $25 vials of one type of analogue insulin, all companies can and should do the same for all of their insulins in the United States and around the world,” she said.

Joseph Ross, a professor at Yale Medical School, called the announcements “long overdue.”

“For too many years, patients who required insulin therapy have endured countless unwarranted price hikes by manufacturers, placing many at great financial and medical risk,” he said.

Kasia Lipska, an associate professor of medicine at Yale, who has studied insulin pricing, called the changes “a step in the right direction.” For patients who are paying high prices for co-payments or co-insurance or because they have high deductible plans, it will affect costs.

Stacie Dusetzina, a professor at Vanderbilt University School of Medicine, who researches pharmaceutical costs, worried that Lilly might be taking advantage of the huge spread between list prices and the prices insurers pay after Lilly pays them rebates.

“This will be helpful to some consumers,” Dusetzina said. “It’s not clear to me how much of this is real cutting of the amount that Lilly makes on their insulins versus lowering the list price.”

More than 29 million Americans, or 9.3% of the U.S. population, have some form of diabetes, and about 7.4 million use insulin. An analysis released late last year found that approximately 1.3 million people, or 17% of all adults with diabetes in the U.S., rationed their use of the life-saving treatment in the past year, raising the prospect of harmful and increasingly expensive health consequences.

Among all insulin users, the most common rationing tactic was to simply delay purchases, which 15% of people with diabetes said they did due to cost. Roughly 14% of those with type 1 diabetes took less insulin than needed, compared with nearly 10% of those with type 2 diabetes, according to the analysis, which was published in the Annals of Internal Medicine.

The Inflation Reduction Act limits monthly cost-sharing for insulin to no more than $35 for Medicare beneficiaries. But this does not extend to those without health insurance, who must pay the full list price, or people with high-deductible private health insurance plans. Their costs are also tied to the list price. About one-third of Americans have such a plan, according to a GoodRx survey last year.

The financial burden for these people is high — 14% of those who use insulin in the U.S. face what are described as a “catastrophic” level of spending on the medicine. In other words, they spent at least 40% of their income — after paying for food and housing — on insulin, according to a study published last year in Health Affairs.

David Kliff, who writes The Diabetic Investor newsletter, contended that the people who will be helped by the move to lower list prices are a small minority of the patient population. For instance, two-thirds of the 14% of those identified in the Health Affairs study were covered by Medicare and can now access lower-cost insulin under the Inflation Reduction Act, suggesting only a fraction of those in dire financial straits may be helped by Lilly’s changes.

“This argument that, if they lower the list price that it would change what someone pays out of pocket, is only true if a patient pays something based on the list price,” he said. “Yes, for some people, it may be cheaper, although I think they have to sit down at the kitchen table and do the math. But it’s a myth to say that there aren’t other options available.”

Despite cutting list prices, Kliff suggested Lilly may be able to compensate for lower net pricing because the company might be able to sell still more insulin to those people who must pay cash or have a high-deductible health plan. “This won’t have a material impact on their bottom line,” he explained. “This is all about volume, and the more volume, the better, which can keep manufacturing costs lower.”

Ricks, the Lilly CEO, said that he did expect the moves to affect the company’s sales of insulin, although estimates for those sales are already baked into the sales forecasts the company has given this year.

“We do expect a more significant decline in insulin in ’23 than we would have otherwise, for sure,” Ricks said. “And perhaps if our competitors don’t follow us, we’ll gain share at their expense and that would be a driver of insulin growth, for good reason. But we can’t predict the future or their actions.”

But Lilly faces other corporate pressures. Insulin pricing has become a big risk to the company’s reputation, at the same time as it is launching new big and potentially controversial medicines. The active ingredient in the company’s diabetes drug, Mounjaro, is also awaiting approval as a treatment for obesity, and Wall Street analysts eventually hope it could generate annual sales in the tens of billions of dollars. At the same time, Lilly is awaiting data on an experimental Alzheimer’s drug, an area that could be highly lucrative but has been beset with controversy.

At this point, insulin represents about $2 billion of Eli Lilly’s annual sales, and that figure is declining. Ricks emphasized that the price cuts only apply to the company’s older products, and that it will continue to seek premium prices for newer insulins.

Ricks also said that the company’s executives had been frustrated as the patents on its insulins expired but there seemed to be no motivation for generic drugmakers to make cheaper generic versions of the new drugs. He portrayed Eli Lilly’s move as a step toward changing the way this system works.

“Behind closed doors with the insurance industry, our net prices have fallen every year,” said Ricks. “The general population is not benefiting. So I don’t think that’s a sustainable model for our industry — that when things go off patent, they get cheaper for the conglomerated middleman and not for patients. That doesn’t work. So we’re trying to change that today, through these series of announcements.”

It’s unlikely that will get Lilly’s critics to back down. “Insulin manufacturers have shown time and time again that they will put their CEO’s profits over patients’ lives,” said T1International’s Pfiester. She called for the government to “regulate insulin manufacturers to hold them accountable to ensuring the human right to insulin.”