The United States leads the way in medical innovation and developing new treatments and lifesaving medicines; however, some people cannot afford the medicines, such as insulin, they need. There are many factors involved, including a complex healthcare system with a rising number of high-deductible health plans, high rebates that are not passed on to patients, and medicines for chronic conditions, like insulin, not being exempt from commercial insurance deductibles.

While no one-size-fits-all solution exists to address the need for increased affordability and access, bridging the gap starts with longer-term fixes to the healthcare system, short-term solutions from companies in the healthcare industry, like Lilly, and federal policy reform.

The Current U.S. Healthcare Environment

To understand the solutions that can be put into place to help those who may be struggling to afford their insulin, we must understand how the current U.S. healthcare system impacts out-of-pocket costs for people. In 2019, 92 percent of Americans were insured through either private or public insurance. The price they pay for their medicines depends on several different factors, including whether they are in a high-deductible health plan (HDHP)1. HDHPs can cause some to pay the full list price of their insulin and other treatments before their insurance is responsible.

The list price of a medicine is the price manufacturers charge to wholesalers and does not account for rebates, discounts, or insurance coverage. While Lilly, like other manufacturers, sets the list price for medicines, they pay rebates and offer discounts to payers and supply chain entities to bring down the out-of-pocket cost for patients. However, these discounts are not always passed on to the consumers, like those with HDHPs. With more Americans enrolling in HDHPs every year, more consumers than ever before are responsible for the full price of medicines².

Short-term solutions, like co-pay cards that cap the price for a monthly prescription of insulin, can provide immediate relief for anyone who needs insulin, but real change requires substantive, long-term solutions that can address the core issues of insulin access and affordability.

A Responsibility to Provide Relief Now

Pharmaceutical companies have a responsibility to provide short-term solutions to ensure people have access to the medicines they need at an affordable cost. Lilly recognized that some people with diabetes, whether they had health insurance or not, were paying incredibly high prices at the pharmacy counter and introduced a suite of affordability solutions that help people access Lilly insulins at an affordable cost. Today, anyone using Lilly insulin and enrolled in one of its programs – regardless of their insurance status – is eligible to purchase their monthly prescription for $35.

Through the Lilly Diabetes Solution Center, people with diabetes can call 833-808-1234 Monday through Friday to speak with a live representative who can recommend customized solutions for each person’s specific circumstances. These solutions could include:

• The Lilly Insulin Value Program: Allows anyone with commercial insurance, and those without insurance at all, to purchase their monthly prescription of most Lilly insulins for $35 through a co-pay card.
• Free Lilly Insulin at Participating Clinics: Lilly donates insulins to select relief agencies that provide insulin to free clinics, allowing qualifying people in need to access those insulins free of cost. The Solution Center can provide information about which clinics may have access to this insulin.
• Lilly Non-Branded Insulins: Lilly offers three non-branded insulins with a list price 50 percent lower than their brand name alternatives. These can be ordered by any pharmacist and are typically delivered in 1-2 business days.

In 2020, Lilly announced it would participate in the Medicare Part D Senior Savings Model, a program introduced by the Centers for Medicare & Medicaid Services (CMS) that allows seniors enrolled in participating Medicare Part D plans to access insulins for $35 per monthly prescription.

“It is important that we meet people where they are to provide insulin affordability options that work for their specific circumstances,” said Andy Vicari, U.S. insulins brand leader at Lilly. “Through our suite of solutions, any person taking Lilly insulin should be able to access their monthly prescription insulin for $35. We are continuing to educate and provide people with the knowledge and resources they need to access our affordability solutions.”

While these solutions expand access to Lilly insulins, there is still a need for long-term solutions that address insulin affordability and access for every person with diabetes.

Long-Term Solutions

“There is not one single cause for the issues affecting access and affordability, so we cannot use a one-size-fits-all approach,” said Wade Neucks, brand director of insulins and affordability at Lilly. “To institute real change, different solutions need to be brought to the table to address the root causes behind why many Americans struggle to afford the medicines they need.”

There are several policy solutions that can provide substantive relief for people and address the current healthcare system gaps that contribute to the issues of insulin access and affordability, including:

• First Dollar Coverage: Enacting a “first dollar coverage” policy would exempt healthcare services and medicines for chronic conditions, like insulin, from a commercial insurance deductible, which could provide relief for many struggling to meet high deductibles.
• Employer-Led Initiatives: Employers can play a key role in patient access and affordability, such as offering benefits that help reduce their own employees’ medical costs like prescription drug rebates, preventative and chronic disease medication exemptions from deductibles, and contributions to employees Health Savings Accounts.

“Our current healthcare system does not work for everyone, and we are always looking for opportunities, whether short-term or long-term, to address the needs of people with diabetes. Rebate reform and policies to address high-deductible plans are just the first steps we can take to address the gaps in the current U.S. healthcare system,” said Neucks. “Lilly is committed to collaborating with the entire healthcare ecosystem to develop solutions to ensure people with diabetes can access the medicines they need.”

References: 1. U.S. Census Bureau. Health Insurance Coverage in the United States: 2019. Issued September 2020. Available at census.gov. 2. Kaiser Family Foundation. 2019 Employer Health Benefits Survey. Published September 2019. Available at kff.org.