Friday, 19 April 2019

KAKE NEWS INVESTIGATES: Prescription pricing…who’s to blame? – KAKE


National headlines tell the story of the state of prescription drug costs. This is especially true for diabetics who face some of the highest drug costs in the nation. Some ration, some trade,  and many don’t take their life saving insulin at all.

“It’s a huge issue in my clinic,” said Doctor Terry Nickle, Medical Director for the Via Christi Clinic.

She gets calls from patients all the time asking to ration insulin as prices keep climbing.

“Patients used to call in November and December. Now they’re calling in September and October asking for samples or help with reduced costs.”

But to get a complete picture of why prices are so out of control, you need to know about the middlemen. They’re called PBMs or Pharmacy Benefit Managers. They not only negotiate drug prices but also determine which drugs are covered by insurance companies. And this happens through a complex system.

“[This] is putting the manufacturer in a bind where they need to raise their prices to continue to sell their products,” said Jesse Bushman, of the Juvenile Diabetes Research Foundation.

This is how it works. The PBM is the broker of a non-stop bidding war between drug companies. Whichever company wins gets their drug covered by insurance companies. The result is the lock step prices increases you pay at the pharmacy counter.

“If you refuse to deal with them you’re giving up an enormous part of the market.”

So how can you help push for change? The American Diabetes Association has collected more than 400,000 signatures with its ‘Make Insulin Affordable’ campaign. This helps them put pressure on policy makers for fairness in drug pricing and has prompted hearings on Capitol Hill.

Also, several insurance companies like Unitedhealth Care and Aetna have made a commitment to start passing rebates on to the consumer which could dramatically dropping prescription costs for several insurance plans.

“I would say it’s an enormous step on the part of the plans,” Bushman said.

And a welcome step in the right direction for Kansas families.

There’s also one more way to push for change.  There is a bill that needs to be reintroduced to Congress called the Chronic Disease Management Act of 2018 (H.R. 4978). It will make medications for chronic illnesses, like diabetes,  not subject to your deductible. In other words, you’ll never pay list price. Call your Congressman and ask them to support the bill today.


KAKE News Investigates reached out to all 3 manufacturers of insulin and these are the responses from 2.

Novo Nordisk Inc. Response

“We hear from more and more people living with diabetes about the challenges they face affording healthcare, including the medicines we make. We take this issue seriously and have been thinking about what we can do to better support patients. For those seeking help, especially in high deductible health plans or without health insurance, we offer human insulin at $25/vial for those needing a lower cost option along with various co-pay assistance programs and other patient support options that are found at

We, and most others in the healthcare system, agree that what we currently have needs to change. We appreciate discussions with the Administration to find long-term ways to reduce the burdens for patients.  We’ve offered policy ideas (H.R.4978 / S.2410) like having high deductible health plans offer chronic disease prevention services before patients satisfy their deductible and get the help they need to afford their diabetes medications.”

Sanifo Response

Sanofi shares concerns regarding people living with diabetes who are having trouble accessing the medicines they need.                                                          

About 85% of people who manage their diabetes with Sanofi insulins pay less than $50 a month for their Sanofi medicine. However, the tragedy of patients skipping or rationing their insulin due to financial hardships is one of the many reasons Sanofi is committed to making our insulins more affordable to all patients. We encourage anyone who is prescribed a Sanofi medicine, and who may be having financial challenges or trouble navigating their insurance, to call Sanofi Patient Connection at (888) 847-4877 where eligible patients can be connected to the medicines and resources they need at no cost.

In 2017, Sanofi announced one of the industry’s most progressive policies in terms of pricing. The policy includes three pillars – 1) a clear rationale for the launch price of a new medicine; 2) limiting price increases in the U.S. to no greater than medical inflation as determined by the U.S. National Health Expenditure growth rate; and 3) greater transparency on the average list price increases and net increases (or decreases) of our portfolio of prescription medicines. The result of these concrete actions is a very modest list price increase of only 1.6% and a net price decrease of 8.4% in 2017 across all of our products.

It is estimated that the biopharmaceutical industry pays over $150 billion in discounts and rebates to PBMs and health insurance companies annually. For example, over the last five years, the net price of Lantus, the most prescribed long-acting insulin, has actually declined due to significant discounts and rebates given to pharmacy benefit manufacturers. Unfortunately, these savings are not consistently passed through to patients in the form of lower co-pays or coinsurance which could be the result of changes to insurance design. In some cases, these discounts and rebates have increased at a higher rate than the list price.

As a company, we take this access and affordability issues seriously and continue to explore innovative ways to find solutions to help eliminate or significantly reduce the out-of-pocket expenses for patients, including those who are uninsured, underinsured or on high deductible insurance plans. For example:

  • The Insulins Valyou Savings Program offers all uninsured and commercially insured patients – regardless of income level – one set price ($99 for a 10 mL vial or $149 for a box of pens) to help lower out-of-pocket costs for Sanofi insulins (Lantus, Toujeo, Admelog, and Apidra). For some patients with diabetes, the program could offer a savings of up to $3,000 per year.
  • We also have co-pay programs which may limit out-of-pocket expenses – sometimes to $0 for commercially insured patients in the U.S., regardless of reimbursement status on an insurance plan. This aims to ensure cost-sharing is not a barrier to medication access.
  • We provide medications at no charge for qualified low-income, uninsured patients through the patient assistance component of the Sanofi Patient Connection program.


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