While pharmacy benefit manager (PBM) rebates are frequently blamed by drugmakers for the increasing list prices of long-acting insulin medicines which treat type 1 and type 2 diabetes, new insights from Express Scripts, Evernorth’s PBM, has found that the opposite is true.
A recent analysis of Express Scripts data on historical wholesale acquisition costs (or list prices) of long-acting insulin biologic medications also found that the increased competition of insulin medications, including biosimilars, correlated with lower increases in list prices and greater rebate levels, resulting in lower net prices to health plans. In fact, the highest list price increases occurred during a period when rebates were at extremely low levels.
The greatest price increases occurred when rebates were at their lowest
The analysis also reviewed Sanofi’s disclosure of list prices from 2012 to 2021 for the long-acting insulin biologic Lantus. From 2012 to 2014, list prices increased substantially while during this time the ability of Express Scripts to negotiate rebates was extremely limited (due to a lack of clinically viable alternatives). From 2015 to 2021, PBM rebates increased substantially, while the list prices rose only by a modest amount. These pricing patterns are inconsistent with pharmaceutical industry claims that PBM rebates drive higher list prices.
Click here to view a larger version of this graph. Source: The Sanofi 2023 Pricing Principles Report, corroborated by Express Scripts data.