April 10, 2019
(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) applauds the Energy and Commerce Subcommittee on Oversight and Investigations for holding today’s hearing on the important issue of rising insulin prices.
“Drugmakers are solely responsible for setting and raising prescription drug prices. On average, the price for insulin has nearly doubled in just five years,” said PCMA President and CEO JC Scott. “The most important barrier to lower cost insulin products is the lack of biosimilar and generic competition. PBMs can only negotiate lower prescription drug costs on behalf of health plan sponsors and patients when there is sufficient competition among brand-name drugs, generic and biosimilar competitors, giving manufacturers an incentive to provide discounts.”
Insulins are unique in that brand insulins have almost no generic or biosimilar competition. Insulin manufacturers shield their products from significant competition by patenting the insulin delivery devices, enabling them to continue to raise prices. Importantly, there is no correlation between the growing prices set by drugmakers and the rebates negotiated with PBMs.
In the face of persistently high-priced insulins, PBMs are innovating clinical care coordination programs that are helping diabetes patients afford their medications and improve health outcomes. For example, some have introduced new programs to cap out-of-pocket costs on insulin. To ensure patients can get the lowest-cost option, PBMs also offer real-time prescription drug coverage information to doctors and consumers.
PCMA supports a number of legislative and regulatory policies to increase competition and reduce and build on market-based tools in public programs and private health insurance, including eliminating patent settlements, or “pay-for-delay” agreements that allow drug patent holders to pay off potential competitors who would otherwise produce a competing generic or biosimilar drug, and revising innovator biologic exclusivity to seven years.”