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PBMs Are Keeping Costs Down for People Living With Diabetes


As we reflect upon National Diabetes Month, we all know how threatening diabetes can be for millions of Americans and that staying on a medication regimen is exceptionally important for managing the disease. It’s the reason the work America’s pharmacy benefit managers (PBMs) do to innovate new ways to reduce costs and support patients is so important.

Though insulin itself has humble beginnings, today’s insulin market is a complex one. It started with a trio of inventors who discovered insulin and then sold their patent for a dollar so that insulin would be widely available and affordable. A century later, insulin’s average price per month exceeds $450, and there is little generic or biosimilar competition. On average, the price of insulin has nearly doubled in just five years. Insulin manufacturers say these price increases are just the cost of innovation, arguing these are more effective insulin formulations for patients. Innovation for patients should be encouraged, but there is a question of whether these prices reflect that value.

In the face of consistent price increases on insulin products, PBMs are leading the effort to break through the often overwhelming financial barrier for patients to access these needed medications. In fact, in some instances, PBMs and health plans are outright eliminating patients’ out-of-pocket costs.

For example, a PBM and a health plan introduced an initiative to apply for manufacturer patient assistance programs in a novel way, which lowered the monthly out-of-pocket costs for insulin by 40 percent or more. Under the program, out-of-pocket costs are $25 for a 30-month supply of insulin for eligible health plan enrollees.

In addition, another PBM announced it could provide access to diabetes drugs, including insulin, at no out-of-pocket cost to health plan enrollees, and save on medical expenses for the health plan.

During a recent conversation on my podcast The Pharmacy Benefit, Amy Bricker, Senior Vice President of Health Services Supply Chain at Express Scripts, said that her company is saving people with diabetes a significant amount of money on medications through a combination of discounts and clinical programs.

PBMs work year-round to save patients money on their prescription drug costs, but National Diabetes Month serves as a reminder of how vital it is to keep the cost of insulin low. You can learn more about how PBMs are #OnYourRxSide, working on behalf of those living with diabetes, here.

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Pharmacy benefit managers (PBMs) are your advocates in the health care system, working to lower out-of-control prescription drug costs for patients across the country.

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