Eli Lilly’s Big Insulin Price Cut and Colon Cancer Screening
March 10, 2023
Happy Friday,
Today, I’ll review news that Eli Lilly will cap patient out-of-pocket costs and lower prices for insulins. March is Colorectal Cancer Screening Awareness month, and I’ll also review recommendations and data on this screening.
1. What Lilly insulin price cuts means for employers.
The Inflation Reduction Act limited cost sharing for insulin to $35 a month for Medicare beneficiaries, but legislative attempts to extend this to employer-sponsored health plans did not pass Congress last year. Despite that, there was good news last week: Eli Lilly announced that it will lower the price of Lispro (a generic version of its own insulin Humalog) to $25 a vial immediately, and cut the price of Humalog by 70% in Q4. Next month, it will also launch a new long-acting insulin, Rezvoglar, which can be interchanged with brand name Lantus (Sanofi) but costs 78% less. Finally, Lilly announced that it would cap the out-of-pocket cost of insulin at $35 a month for the uninsured and for those with employer-sponsored health plans. This will be administered through a savings card which patients can download, and assistance will generally not count toward required plan cost sharing
This is a big deal. Insulin prices have risen 600% in the last twenty years, and prices across the three competing manufacturers are usually very similar for similar types of insulin. Pharmaceutical companies are generally very disciplined about maintaining their list prices, and these price cuts are good news for employers and for members of health plans.
These price drops are only for these specific insulin products. Lilly will maintain its current price structure for other insulins, which represent about half of Lilly’s $2.3 billion annual insulin revenue. Some Pharmacy Benefit Manager formularies don’t include Lispro, so members would have to pay outside their health plans to benefit from this price drop. This price change also doesn’t make diabetes care more affordable for the millions of Type 2 diabetics who are on expensive non-insulin medications.
The price drop is not only good press for Lilly, but surprisingly saves them some money, too. Lilly has increased the price of its insulins by substantially more than allowed by the Inflation Reduction Act, and would have owed millions in rebates to Medicaid starting January, 2024.
Implications for Employers:
- This could decrease the number of diabetics who “ration” their insulin, which could prevent hospitalizations and future diabetes complications.
- Expect to see some relief from the financial cost of insulin, especially if these price cuts are matched by the two other insulin manufacturers.
- Review formularies carefully to be sure that members get the savings from these price cuts.
2. March is Colon Cancer Screening Awareness Month, and with more screening we can save more lives
Colon cancer death rates have plummeted in the last two decades, largely because colonoscopy identifies and removes many polyps which would otherwise have turned into colon cancers. About 150,000 new cases of colon or rectal cancer will be diagnosed this year, and there will be about 50,000 deaths. Over half the new cases of colorectal cancer are in those over 65, but a third are in those between 50 and 64, and one in eight new cases are in those under 50.
While overall colorectal cancer incidence is declining, the rate of new diagnoses is increasing in those under 50, and rates of more advanced colorectal cancer in young patients is increasing, too. That’s why the US Preventive Services Task Force (USPSTF) added those from ages 45-49 to the screening guideline in 2021.
Source: Siegel, et al 2023. Cases per 100,000 LINK
The USPSTF now recommends regular colon cancer screening for those ages 45 and over. The Affordable Care Act requires that this screening is covered without out-of-pocket costs by employer sponsored health insurance. Still, some who have colonoscopies find themselves with out-of-pocket expenses for some component of the screening (such as lab tests or anesthesia). Colonoscopies for those with symptoms like bleeding or to follow up a previous polyp are considered “diagnostic,” and members can be responsible for deductible, copay and coinsurance. Surprising patient costs for “diagnostic” colonoscopies are a common complaint to HR teams and insurers.
The USPSTF recommends screening via any one of a number of methods, each of which has advantages and disadvantages. As you can see, many colorectal cancer deaths can be prevented by each of the screening methods. It’s most important that people are screened, whichever screening method they find most acceptable.
Source: USPSTF 2021 LINK Data for screening those ages 45-70
Source: USPSTF, approximate prices from Health Care Blue Book (prices vary by location)
Rates of colon cancer screening have increased over the last decade, but they remain substantially lower than mammography screening rates. In 2021, colon cancer screening rates were 63.8% (commercial HMO) and 61.3% (commercial PPO) for those ages 50-75.
Implications for employers:
- Encouraging colon cancer screening can save lives. Employers should regularly review reporting on colon cancer screening and establish goals to improve screening rates.
- Plan members who have average risk for colon cancer (no previous polyps or cancer) can safely use FIT tests annually if they prefer this to colonoscopy. This requires no colon ‘cleanout’ preparation and saves costs, but positive results require follow up colonoscopy.
- Cologuard can prevent as many colon cancer deaths as colonoscopy if performed annually, but the cost would be substantially higher.
- FIT tests, done at home, pick up somewhat fewer cancers, but could help be sure that more got proper screening.
- Consider asking carriers to waive out-of-pocket costs for colonoscopies that were performed on those with a history of polyps.
Miscellaneous Notes:
I participated in “Act Fast,” a late February Health Action Alliance webinar about employer considerations as the Pandemic Health Emergency ends. The webinar is available here, and a new set of tips from HAA is here.
For employers interested in details of the importance of clean air, not just to prevent COVID-19 transmission, here’s a link to an excellent article in Nature published this week.
Hope all have a great weekend when it comes!
Jeff