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Prescryptive will offer a subscription-based program for employers that aims to provide a more predictable benefit for companies and their employees.
Prescryptive Health has partnered with Eli Lilly to create a subscription-based insulin program for employers. Through a flat, per-member, per-month subscription fee, employers can offer Lilly insulin to their employees. As part of the program, Lilly will refund a portion of the subscription fee if an employer’s total medical spend increases over time for their employees who live with diabetes.
“Legislators are placing out-of-pocket caps on insulin to help lower the burden on patients, but PBMs just push the cost to the employers while maintaining their profit margins,” Chris Blackley, chief executive officer of Prescryptive told Formulary Watch. “With this program, we are reducing this financial risk for employers and helping them to establish a predictable and lower fixed cost for insulin. They also realize even lower cost if therapy adherence does not deliver lower total healthcare costs - it truly aligns everyone's interests to better employee health. Employees realize the value because they have access to more affordable insulin, which results in better glucose control and an overall better quality of life.”
The fee to employers will remain fixed and free of any additional margin or rebates, but the pricing of the program is not being disclosed, a Prescryptive spokesperson said. The specific insulins that are part of this program have not been disclosed, but the spokesperson said that major insulins will be covered.
The cost share for employees would be determined by the plan sponsor, but it is possible there will be $0 cost-sharing as “statutory limits on patient cost share become more common. This solution helps reduce the financial risk for employers as well, while giving them an affordable option and fixed, predictable monthly subscription,” the spokesperson said.
Patients would access their insulin through their employee-sponsored health plan. Employees also get access to Prescryptive’s mobile experience that helps them access real-time benefit and pricing information, together with products to support patient engagement and adherence for diabetes care.
The price of insulin to patients has been a major focus of drug price reform. The Inflation Reduction Act signed by President Joseph R. Biden in August 2022, for example, caps out-of-pocket costs for insulin at $35 for Medicare beneficiaries, but a $35 cap on insulin for patients outside of Medicare failed in the Senate.
Earlier this year, the Kaiser Family Foundation (KFF) released an updated analysis that found that if insulin copays were capped at $35, Medicare Part D enrollees would save 29% on average. The analysis found that out-of-pocket spending by people with Medicare Part D for insulin products quadrupled between 2007 to 2019.
Health plans, PBMs, and even pharmaceutical companies have begun to offer some insulins at a $35 cost or lower. For example, Sanofi has lowered the out-of-pocket cost of some of its insulins for those without insurance and has teamed up with Optum for a savings card program for those without insurance. United Healthcare beginning in January 2023 will eliminate copays on some drugs, including some insulins, in fully insured group plans.