Drug makers and pharmacy benefit managers continued to point fingers over the blame for escalating prices of insulin in the US at a Congressional hearing yesterday – to the fury of lawmakers.
Executives from insulin producers Eli Lilly, Novo Nordisk, Sanofi and Pharmacy Benefit Managers (PBMs) CVS, Cigna’s Express Scripts and United Healthcare’s Optum faced a near three-hour dressing down from the House Committee on Energy and Commerce, and it was clear that patience with the buck-passing is exhausted.
Committee Chairman Frank Pallone (Democrat) said in his opening remarks to the hearing that he is “concerned that the market has simply broken down. It appears that there is limited competition and little incentive to keep prices at a level that patients can afford”.
Rep Diana DeGette, who co-chaired an investigation into insulin pricing last year, said the message from a hearing last week involving expert witnesses and patients was clear: escalating prices mean that many diabetics cannot afford the drug, even though their lives depend on it, and some patients are being forced to ration doses against medical advice.
She said the probe revealed a “system with perverse payment incentives and a complete lack of transparency in pricing”.
After hearing executives argue that while list prices for insulin are high, there are rebates and other workarounds to reduce the cost to patients, she asked each witness to explain exactly why list prices are so high, given that the average price of insulin nearly tripled between 2002 and 2013.
The responses – with manufacturers blaming rebates demanded by PBMs for inclusion in formularies and PBMs insisting this is not the case and that all inclusion decisions are based on net price – incensed the lawmakers, and the frustration over the opacity in the system was tangible.
Expressing his frustration with the situation, Rep Joe Kennedy III (Democrat) told the panel that “you’re hearing bipartisan frustration on this. The status quo is not going to continue – it can’t”.
Rep Jan Schakowsky (Democrat) was even animated, saying: “I don’t know how you people sleep at night.”
She pointed to the “curiously close” pricing between insulins from different companies, which could suggest collusion on pricing, and went on to say: “If you think you can out-talk us without any transparency, without any accountability, I just want you to know your days are numbered.”
Future hearings are being considered and could see the drugmakers and PBMs summoned again, along with insurance companies, distributors and pharmacists, as Congress considers how to take the matter further, and DeGette said she was confident that any measures would enjoy bipartisan support – although it is still not clear what form that could take.
Lilly’s recent move to launch a cut-price version of its Humalog brand, which has come under particularly strong criticism after its price rose from $35 to $234 per vial between 2001 and 2015, was met with near contempt by the lawmakers, with Kennedy asking why “it took 15 years and global outcry to do it”.
Similarly, Sanofi’s announcement just ahead of the hearing that it would cap insulin prices for patients at $99 per month also received short shrift.
Last week, outgoing FDA Commissioner Scott Gottlieb said the regulator would change how insulin is regulated to make it easier for biosimilar insulin products to come to market.
The hearing also heard examples of existing biosimilars that were not finding their way onto formularies because their net prices were actually higher than those of originator drugs; however, preventing that from happening may not be enough to tackle the problem.