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Express Scripts Offers Diabetes Patients a $25 Cap for Monthly Insulin

Consumers whose drug benefits are managed by Express Scripts could see their out-of-pocket costs for insulin limited to $25 a month under a plan announced Wednesday.

The move is aimed at addressing rising anger over the cost of the lifesaving product, whose list price has skyrocketed in recent years. Express Scripts said about 700,000 people filed a claim for insulin last year through its Cigna or Express Scripts plans. The average monthly savings for those whose employers opted into the plan would be about $16 a month.

Insurers and drug manufacturers have been under pressure to show that they are doing something about the rising list price of drugs, in particular insulin, which many people with diabetes need to survive.

The average price of insulin, versions of which have been around since the 1920s, roughly doubled to about $450 a month in 2016 from around $234 a month in 2012, according to the Health Care Cost Institute. And the cost has risen even higher since 2016, putting people without insurance and those with high deductibles at risk of rationing their doses and, in some cases, going without treatment.

“For people with diabetes, insulin can be as essential as air,” said Dr. Steve Miller, executive vice president and chief clinical officer of Cigna, which merged last year with Express Scripts.

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Under the new plan, employers who cover their workers through Cigna and Express Scripts can opt into the program. The extra costs will be picked up by the three drugmakers that sell insulin — Eli Lilly, Novo Nordisk and Sanofi.

Cigna and Express Scripts said the average out-of-pocket cost for consumers under their existing plans was $41.50 for a 30-day supply of insulin.

But Elizabeth Rowley, founder and director of T1International, a diabetes advocacy group, said the new plan failed to address the underlying cause of the problem: high list prices.

“This is yet another P.R. move — a stopgap at best — to release the pressure on those responsible for the insulin price crisis,” she said in an email Tuesday. “Those patients who are lucky enough to be on a ‘participating plan’ can benefit, but what about those who aren’t? This program gives no lifetime ‘assurance’ that people with Type 1 diabetes can rely on.”

This article originally appeared in The New York Times.

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