Memorandum

Express Scripts announces launch of InsideRx, a cross-industry collaboration to provide direct discounts on diabetes and other drugs to patients – May 8, 2017

Executive Highlights

  • Express Scripts, in collaboration with AZ, Lilly/BI, Novo Nordisk, Sanofi, and others, launches InsideRx direct-to-patient discount program for diabetes and other drugs.
  • Both insulin and non-insulin products (including Jardiance!) are included among the list of discounted branded diabetes drugs, though no GLP-1 agonists are included.

In notable news this morning, Express Scripts announced the launch of InsideRx to provide direct discounts to patients on diabetes and other medications through the GoodRx platform. The program offers average discounts of 34% and is aimed at reducing out-of-pocket drug costs for patients who are uninsured or on health plans with a high level of cost-sharing (high deductible health plans, large coinsurance, etc.) InsideRx is made possible through a cross-industry collaboration including AZ, Lilly/BI, Novo Nordisk, and Sanofi. Eligible patients will need to present the InsideRx discount card (printed off the website or via mobile app) at participating pharmacies nationwide in order to access the discount. According to the announcement, 40,000 pharmacies are participating in the program, including CVS, Walgreens, and the Kroger Family of Pharmacies. This compares to 57,000 pharmacies for Blink Health, the platform through which Lilly previously announced a similar direct discount program for insulin only.

Very notably, unlike Lilly’s Blink Health collaboration, InsideRx includes non-insulin diabetes drugs (including SGLT-2 inhibitor Jardiance, DPP-4 inhibitors Tradjenta and Onglyza, and fixed doze combinations) and non-Lilly insulin products from Novo Nordisk and Sanofi. We’re thrilled to see the inclusion of Jardiance especially – while the discount is on the lower end at 22%, we view any level of expanded access to these agents of substantial benefit (low risk of hypo, weight loss, reduced glycemic variability, and cardiorenal protection) as a huge plus. While Novo Nordisk’s offerings in the program are limited thus far to its human insulins, Sanofi very notably offers its entire range of insulin analogs: Lantus, Apidra, and – very excitingly in our view – next-generation Toujeo (at a 34% discount!). That said, no GLP-1 agonists (or GLP-1/basal combinations) are offered through the program – we find this disappointing given their impressive clinical profile (strong A1c efficacy, weight loss, low risk of hypoglycemia, and potential cardiorenal protection) although presumably they may be offered in the future. Considering that all four participating diabetes companies have a GLP-1 agonist in their portfolio, we hope that that at least one GLP-1 agonist agent will eventually be added to the InsideRx program.

Discounts on diabetes drugs in the program range from 16% (for Lilly/BI’s SGLT-2 inhibitor/DPP-4 inhibitor combination Glyxambi) to nearly 80% (for Novo Nordisk’s human insulins). Notably, Lantus in pen form is offered at a 40% discount, bringing its cost down to $267 ($178 in vial form) – this compares to $218 for Lilly/BI’s biosimilar Basaglar on Blink Health (Basaglar is not offered on InsideRx). Overall, the percent discount appears to be generally higher for insulin products (mostly in the 40%-50% range, with Toujeo on the lower end at 34% and Novolin an outlier at 79%). Oral medications, on the other hand, are generally discounted around 20%-30%. For a complete list of discounted products (including drugs for acid reflux, allergy, asthma, COPD, depression, gastrointestinal, gout, and heart health) and their level of discount, see the InsideRx website.

We’re hopeful about this cross-industry, multi-stakeholder, innovative effort to lower the financial burden of diabetes care for patients. The issue of rising drug prices, particularly insulin, reached a boiling point in 2016 and, rather than continue to point at each other (“It’s Big Pharma! It’s the PBMs!”), we’re glad to see these various organizations work together to help patients. Programs like this and Lilly’s Blink Health program will be increasingly important if attempts to repeal the ACA make it into law. We’re one step closer to the worrisome possibility of up to 24 million Americans losing health coverage with the recent House of Representatives passage of the AHCA and, while programs like these will in no way be able to completely mitigate the fallout, we’re glad to see that it’s possible for this diverse group of industry stakeholders to work together to produce patient-level solutions. As always, the devil will be in the details and we await real-world experience before giving a more detailed perspective on this.

 

-- by Helen Gao and Kelly Close