Lilly announces new program to provide insulin at discounted prices directly to patients – December 13, 2016

Early this morning, Lilly announced the upcoming launch of a new program that will offer significant discounts on Lilly insulin, aimed particularly at those with high out of pocket drug expenses, such as patients with high deductible plans or no health insurance. We salute Lilly for going out to have conversations with five to ten patient advocacy groups over the last three months and then taking action stemming from those conversations. Patient leaders from virtually every organization with whom Lilly spoke expressed concern over the patients “left behind” who either did not have insurance at all or had very high costs due to various barriers.

The discounts, provided by Lilly through a partnership with Express Scripts, will be offered through online and mobile app-based platforms hosted by Blink Health beginning January 1, 2017 – we are very impressed that this is starting so quickly as it reflects major focus by the company. As we understand it, users can pay for their insulin online at an up to 40% discounted rate using Blink Health and simply pick up the prescription at their local pharmacy. Blink Health was originally developed as a tool for finding the lowest prices for generic prescription medications; notably, Lilly’s program marks the first time this platform will be used to discount branded medicine. The initial program period is 12 months, with potential for an extension based on the response. We stress that this discount program occurs separate from and outside of existing insurance plans. In a sense, patients are able to “buy direct” through Blink Health at a discount, and it will be up to individual insurance companies whether they will accept Blink Health purchases toward an individual’s deductible. We can certainly imagine a lot of patient pressure to do so. That said, in the event that these insulin purchases do not count toward a patient’s deductible, the patient will have to do the mental calculus on to what degree his or her healthcare costs would have exceeded the deductible in the first place and determine whether this discount program is a good value for them. We certainly hope that the majority of payers will accept these purchases toward the deductible and wonder what role, if any, not only Lilly might be able to play in negotiating this, but also patient advocacy groups themselves.

The program encompasses all Lilly insulin products, including all formulations of Humalog (insulin lispro U100), Humulin U100, and Basaglar (biosimilar insulin glargine), and anyone with a prescription for these insulins is eligible to receive Lilly’s discounts via Blink Health. We’re especially relieved to see insulin analogs and insulin pens included in this program alongside human insulin and vials. These advances are particularly important from a patient safety and quality of life perspective, in terms of hypoglycemia reduction and minimizing dosing errors. That said, Lilly’s announcement did not mention coverage for Humalog U200 and Humulin U500 formulations – these formulations are particularly important for those with high insulin requirements and demand has been growing for these concentrated products. Humulin U500 is searchable on the Blink Heath website, which we hope bodes well for its inclusion in this program. We are also interested in how oral medications will feed into the program eventually since many people with diabetes struggle with the costs for these as well.

Indeed, during a private call with several advocates from the diabetes community, Lilly management elaborated that depending on the program’s success, the discounts may be expanded to Lilly’s wider diabetes portfolio, which includes GLP-1 agonist Trulicity (dulaglutide), SGLT-2 inhibitor Jardiance (empagliflozin), and DPP-4 inhibitor Tradjenta (linagliptin). Lilly VP of Diabetes, Mr. Mike Mason, also acknowledged on the call that it’s unclear how this move will impact formulary negotiations with payers moving forward – we hope that that this would not result in the unintended consequences of pharmacy benefits managers (PBMs) demanding even larger rebates that are often not passed on to patients. We applaud Lilly for their leadership on the important issue of the rising cost of insulin. The launch of this program is positive news for the growing number of patients who struggle to pay their drug costs and sets a valuable example for other manufacturers. Hopefully this initiative will raise awareness of the insulin pricing crisis and drive forward additional change at the wider policy level. 

• This program was inspired by meetings Lilly has held over the past months with leaders in the diabetes community, including advocacy groups and patients themselves, regarding the insulin pricing crisis.  We were pleased to take part in two of these meetings ourselves and find Lilly’s emphasis on collaboration and communication between the various stakeholders in the diabetes community particularly notable. We personally urged investment in better understanding patients’ needs and financial realities (as the meetings were doing), greater transparency on investments in patient access programs (thank you to Lilly leadership for such an excellent response!), and an end to the “blame game” in favor of working toward actionable solutions – we’re glad to see this advice appears to have been taken to heart. Surely a more extensive solution to the rising costs of diabetes medications will require similar cooperation across these various disciplines.
• Notably, Novo Nordisk has already expressed supportive remarks regarding Lilly’s leadership in spearheading this insulin discount program – the speed was very impressive (the article can be found here; though it is unfortunately only available in the original Danish). Last week, Novo Nordisk addressed the high costs of insulin in the US with the release of a compelling position statement calling for collaboration between pharmaceutical companies, payers, PBMs, insurance companies, and policymakers to (i) transform the complex pricing system; (ii) create more pricing predictability; and (iii) reduce the burden of out of pocket costs. Novo Nordisk further committed to limit any potential list price increases for its drugs to no more than single-digit percentages annually, which we would love to see other manufacturers commit to as well (to date, Allergan is the only other one that has). We were pleased to hear this call for leadership, action, and policy-level change and we like the idea of companies sharing creative ideas. Lilly’s initiative to directly providing discounts to the patients who need them sounds like a great one and we’ll be eager to see how this trickles down to patients and how the insurers and PBMs response. We encourage Novo Nordisk (as well as other diabetes-focused companies) to match Lilly’s example and announce ways to help the patients who are in the most need. We also hope they will quantify the scope of the investment in 2018.   

Close Concerns Questions

Q: How much will the average patient pay for insulin after the 40% discount afforded by Lilly’s program? Will discounts increase in future years to match list price increases?

Q: On what timescale will Lilly decide whether to expand the Blink Health program to its other diabetes medications beyond insulin?

Q: Will other insulin companies follow with similar programs?

Q: How feasible is this program as a long-term solution to the insulin pricing crisis?

-- by Abigail Dove, Helen Gao, and Kelly Close