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Lilly joins new Medicare scheme to reduce insulin prices

New model will cover seniors enrolled in Medicare Part D

Eli Lilly

Eli Lilly, one of the largest manufacturers of insulin in the US, has announced it will join a new Medicare scheme designed to lower insulin costs for senior citizens.

The drugmaker will partake in the new ‘Senior Savings Model’, which aims to improve the affordability of insulin for seniors enrolled in Medicare Part D.

The scheme will come into effect on 1 January 2021, through the Centers for Medicare & Medicaid Services (CMS) Innovation Center, and is set to include all formulations of the company’s insulins.

According to Lilly, of the proportion of people paying over $100 per prescription for Lilly insulin, most are enrolled in Medicare Part D plans.

As current laws prohibit manufactures from providing co-pay assistance to these individuals, the new model will allow out-of-pocket costs to be reduced to no more than $35 per 30-day supply during their deductible phase – during initial coverage and while in the coverage gap.

"Lilly is committed to finding solutions for people who need help affording their insulin, and we continue to look for ways to help fill gaps in the system. This is a great example of collaboration between the government and private companies to address a problem faced by many seniors taking insulin," said David Ricks, CEO and chairman of Lilly.

Lilly, along with other insulin manufacturers including Sanofi and Novo Nordisk, have been cutting the price of their products in response to increasing public pressure over the increase in costs for insulin therapies in the US.

Reductions and participation in cost-saving schemes, like the new Medicare model, follow a jump in the average wholesale price of four of the most popular insulins between 2007 and 2017.

Lilly has faced particularly strong criticism, after its widely-used Humalog insulin rose from $34 to $234 per vial between 2001 and 2015.

These rising costs have also caught the attention of the US government, which has proposed a number of solutions – with no real resolution in sight – in a bid to lower out-of-pocket drug costs.

That includes recent draft guidance published by the Trump administration which would allow states in the US to import prescription drugs from Canada to try to reduce cost, although that plan excludes biologics such as insulin as well as intravenous drugs and controlled substances.

Article by
Lucy Parsons

12th March 2020

From: Sales, Marketing

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