Focusing on Out-of-Pocket Costs for Insulin

Earlier this week, Lilly participated in a U.S. House of Representatives Energy & Commerce Oversight and Investigations subcommittee hearing on insulin affordability.

We recognize that insulin affordability is more complex than just the issue of list price and that it’s important to focus on what people actually pay out of pocket for insulin. 

Most people who need insulin have either private or government insurance that requires them to pay a low affordable co-pay.  But some people do not benefit from these low co-pays because their out-of-pocket costs are based on so-called retail or list prices - not negotiated prices or fixed co-pays.  The people most exposed in our current system are those in the deductible phase of high deductible private health plans, those in the Medicare Part D coverage gap phase (also called “the donut hole”), and people without health insurance. 

To address the more immediate needs of people in these coverage gap areas, we created the Lilly Diabetes Solution Center, which connects people to a suite of affordability solutions, including immediate access to savings offers.  We also recently announced the upcoming launch of a half-price version of Humalog called Insulin Lispro.  With these and other meaningful solutions, we’ve tried to build a safety net, preventing anyone from having to pay retail price for Lilly insulin.  

These actions ease the burdens for most people in these coverage gap areas, but we still need long-term solutions. We’re actively working with other key stakeholders to seek policy solutions to address gaps in our current health care system. Some of these include:

  • Rebate pass through: We continue to advocate for insurers to pass through our negotiated rebates directly to consumers at the pharmacy counter.
  • First dollar coverage: We’re supportive of efforts to exempt certain health care services for chronic conditions – including medicines like insulin – from an insurance plan’s deductible.
  • Medicare Part D OOP caps: We’re supportive of legislation to cap out-of-pocket costs for Medicare Part D patients. We believe a cap would provide a critical financial safeguard for patients.

Systemic change in our current health care system will require action by all relevant stakeholders.  We are ready to play our role and are confident that a solution is possible.