Report: Those Insulin Price Cuts Are Not Really Helping Uninsured Americans

An investigative report co-signed by three senators has found that uninsured Americans are still paying far too much for insulin lispro, despite the maker’s promises that the price would be slashed.

Insulin lispro is essentially a generic version of Lilly’s Humalog, one of the best-selling insulins in the country, a fast-acting or rapid insulin that is typically used before meals or to quickly correct high blood sugar. Insulin lispro is chemically identical to Humalog, and is manufactured by the same company, but it is sold under a different name under a lower price.

In early March, Lilly rocked the diabetes world when it announced that it would reduce insulin prices in the United States. It was widely seen as an unexpected and dramatic victory for the activists that have spent years bringing attention to the insulin affordability crisis. The other two big insulin manufacturers, Novo Nordisk and Sanofi, soon followed suit, announcing price cuts of their own (most due to take effect in 2024).

As part of its broad price cuts, Lilly promised that it would reduce the list price of insulin lispro to only $25 per vial. In theory, anyone without insurance should pay exactly that sticker price. But the new report, which was prepared by the offices of United States Sens. Elizabeth Warren (D-Mass.), Reverend Raphael Warnock (D-Ga.), and Richard Blumenthal (D-Conn.), found that uninsured Americans found far higher prices for insulin lispro.

The investigation (PDF) surveyed over 300 pharmacies and found that vials of insulin lispro were priced at an average of $97.51, nearly quadruple the $25 that Lilly trumpeted in press releases, media engagements, and at Capitol Hill. Certain individual pharmacies had the medicine priced as high as $300 per vial.

Insulin lispro was also simply unavailable in much of the country. While 79 percent of pharmacies surveyed stocked Humalog, only 43 percent had insulin lispro. Unfortunately, the national pharmacies that most frequently had insulin lispro in stock — including Walmart, Walgreens, and Rite Aid — also charged some of the highest prices for the drug, often well over $150 per vial.

The report also describes how patients “must unravel a confusing thicket of coupons, competing generic drugs, and misleading information” to acquire insulin lispro. Many patients are unaware that a less expensive generic alternative exists, and pharmacists don’t typically take the initiative to inform them, or to let patients know about Lilly’s affordability programs, which can be challenging to navigate.

In a letter (PDF) to Sen. Warren, the nonprofit insulin affordability advocacy group T1International detailed similar results from its own investigation. Volunteer patient advocates across the country called pharmacies and found that the average price quoted was $107.31. The organization also found that many pharmacists were unaware that insulin lispro could be substituted for Humalog without a separate prescription, creating an unnecessary extra layer of fuss and red tape.

More than 20 states have now capped insulin copays, but almost none of those legislative efforts have addressed the plight of Americans without insurance, who frequently get stuck paying egregiously high prices for insulin. Some advocates have even suggested that copay caps actually do more harm than good by hiding “the actual price of insulin from privileged patients with private insurance,” thereby diluting support for legislation that could meaningfully help those without insurance.

The senators concluded their report by calling for federal policy changes designed specifically to address the cost that uninsured Americans with diabetes pay for their insulin. Though Americans of all political stripes are inclined to support limits on insulin prices, past efforts at the federal level have tended to fall apart in Washington, DC.

In a press release, Warnock said, “Manufacturers and insurers have taken steps to make insulin more affordable, but this is not enough to ensure no one has to sacrifice their rent or their groceries to afford the insulin they need to live.”

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