Programs to lower patient out-of-pocket costs work – but only if manufacturers remain at the table


For people living with diabetes, affordable access to medication is essential, whether it’s insulin or non-insulin diabetes treatment. Since 2020, Express Scripts has been proud to cap patient out-of-pocket costs for these drugs at $25 for up to a 34-day supply (or $75 for a 90-day supply) for the over 11 million members enrolled in our Patient Assurance Program. By bringing manufacturers to the table around the common goal of an affordable, predictable patient experience, the Patient Assurance Program has delivered more than $225 million in patient savings for insulin and other diabetes medications since its launch.

“The success of the Patient Assurance Program demonstrates how seamless and affordable medications can be when manufacturers come to the table and work with us with a shared goal,” said Harold Carter, Pharm. D., senior vice president of trade relations at Express Scripts. “We’re committed to constantly innovating to offer solutions that help the pharmacy benefit work as it should.”

Over time, Express Scripts has expanded the Patient Assurance Program from insulin to include non-insulin diabetes treatments and cardiovascular therapies including GLP-1s, and has continued to encourage manufacturer participation year-over-year. However, the drugmaker Novo Nordisk recently and unilaterally decided to exit the program for 2024, leaving many patients without the same predictable, affordable experience at the pharmacy counter that they’ve come to know.

This decision comes at a time when nearly 75% of patients with insurance coverage are concerned about affording their prescription drugs, and a large portion of plan sponsors are looking at ways to reduce costs for members. Meanwhile, analysts project that Novo Nordisk has the potential for $33 billion in sales for their GLP-1s like Ozempic®, one of the drugs Novo Nordisk is removing from the program, by 2030.

“We’re disappointed in Novo Nordisk’s decision to abandon support for patients through our Patient Assurance Program and understand their decision will create confusion over out-of-pocket costs of certain drugs at the pharmacy counter,” continued Carter. “We hope that Novo Nordisk will put patients over profits and rejoin the Patient Assurance Program in the future.”

The good news is, other manufacturers and products remain in the Patient Assurance Program and will continue to provide predictability and affordability to eligible patients. And, beyond this program, Express Scripts continues to hold manufacturers accountable for lowering the prices of their drugs. We expect that two-thirds of Express Scripts members will continue to pay $35 per month or less for diabetes medications.