This document discusses insulin costs and affordability challenges for patients with diabetes. It notes that while list prices for insulin have increased, net prices have declined due to rebates and discounts. However, more patients now face high deductibles and coinsurance based on list prices, increasing their out-of-pocket costs. It recommends several policy solutions to improve insulin affordability like requiring insurers to pass on rebates, capping out-of-pocket costs, and expanding access to lower-cost insulin options.
Prescription Medicines - Costs in Context - October 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - October 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context January 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines Costs in Context - June 2019PhRMA
We are in a new era of medicine where breakthrough science is transforming care with innovative treatment approaches and enabling us to more effectively treat chronic disease, the biggest cost driver.
Prescription Medicines - Costs In Context March 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - August 2018PhRMA
Discussions about the cost and affordability of medicines – and health care more broadly – are important. At the same time, it is important to look at costs across the health care system and not just the share going toward life changing medicines.
On June 11, CBO will present preliminary findings of a study of specialty drugs to be released by the agency later this year. The presentation provides information on the prices for specialty drugs, net of rebates and discounts, in Medicare Part D and Medicaid over the 2010–2015 period; the increase in net spending on specialty drugs in each program; and total net spending and out-of-pocket costs for specialty drugs among Medicare Part D enrollees who use such drugs.
Presentation by Anna Anderson-Cook, Jared Maeda, and Lyle Nelson (all of CBO’s Health, Retirement, and Long-Term Analysis Division) at the conference of the American Society of Health Economists.
Third-party administrators (TPAs), employers and employees are increasingly concerned about the growing cost of specialty drugs. Relief, WellDyneRx believes, will come to those employers and TPAs that (1) encourage specific public policy changes and (2) partner with pharmacy benefit managers (PBMs) that own best-of-breed specialty pharmacies.
Prescription Medicines - Insulin Costs in ContextPhRMA
A century ago, patients were treated with animal insulins. Today, biopharmaceutical companies produce insulins that operate at the molecular level, more closely resembling insulin released naturally in the body and more effectively managing the disease. The options available today also help meet a wide range of unmet needs, providing patients with the tools necessary to stay adherent and healthy – saving costs throughout the health care system. However, this innovation isn’t enough if patients can’t afford their insulin and other medicines at the pharmacy.
Prescription Medicines - Costs in Context January 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines Costs in Context - June 2019PhRMA
We are in a new era of medicine where breakthrough science is transforming care with innovative treatment approaches and enabling us to more effectively treat chronic disease, the biggest cost driver.
Prescription Medicines - Costs In Context March 2019PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - September 2018PhRMA
Discussions about costs are important. We recognize that many are struggling to access the medicine they need, and have important questions about their medicine costs. And we want to help find the answers.
Prescription Medicines - Costs in Context - August 2018PhRMA
Discussions about the cost and affordability of medicines – and health care more broadly – are important. At the same time, it is important to look at costs across the health care system and not just the share going toward life changing medicines.
On June 11, CBO will present preliminary findings of a study of specialty drugs to be released by the agency later this year. The presentation provides information on the prices for specialty drugs, net of rebates and discounts, in Medicare Part D and Medicaid over the 2010–2015 period; the increase in net spending on specialty drugs in each program; and total net spending and out-of-pocket costs for specialty drugs among Medicare Part D enrollees who use such drugs.
Presentation by Anna Anderson-Cook, Jared Maeda, and Lyle Nelson (all of CBO’s Health, Retirement, and Long-Term Analysis Division) at the conference of the American Society of Health Economists.
Third-party administrators (TPAs), employers and employees are increasingly concerned about the growing cost of specialty drugs. Relief, WellDyneRx believes, will come to those employers and TPAs that (1) encourage specific public policy changes and (2) partner with pharmacy benefit managers (PBMs) that own best-of-breed specialty pharmacies.
Prescription Medicines - Insulin Costs in ContextPhRMA
A century ago, patients were treated with animal insulins. Today, biopharmaceutical companies produce insulins that operate at the molecular level, more closely resembling insulin released naturally in the body and more effectively managing the disease. The options available today also help meet a wide range of unmet needs, providing patients with the tools necessary to stay adherent and healthy – saving costs throughout the health care system. However, this innovation isn’t enough if patients can’t afford their insulin and other medicines at the pharmacy.
Competitive Landscape of Insulin Market in Indiaijtsrd
Diabetes in India is reaching epidemic proportions. Prevalence of diabetes have heightened because of rapid cultural changes such as increased urbanization, modified diet patterns and sedentary lifestyles among the young generation. In 2013, 30 million people were in the Prediabetes group whereas 61.5 million people suffered from diabetes in India. The medication for the diabetic population such as OHA and Insulins is the need of the hour since the disease is adding significantly to the mortality rate of India. The Indian insulin market has seen a growth of 13.9 CAGR between financial year 2008 and 2013. Indian insulin market is witnessing tremendous development and is yet to mature. With a huge base of diabetic patients, it is estimated that only 25 of this population is receiving the treatment. Unawareness about diabetes backed by low affordability has left the major proportion of the diabetic populace to remain untreated. However, In India the disposable income is increasing which is leading to better accessibility of healthcare services and enhanced diagnostics which will further broaden the patient base, create opportunities for insulin companies operating in the coming years. Human insulin is being solely used in comparison to the analog insulin in the Indian diabetic population due to the fact that it's cheaper. The revenue from human insulin registered a CAGR of 10.5 during Financial year 2008 2013. Although the share of human insulin has been more since financial year 2008, but the market captured by analog insulin has been growing rapidly with a CAGR of 20.4 during financial year 2008 2013. Seeing the growth of Indian diabetic market, it has become a very lucrative market for insulin multinationals. Companies including Novo Nordisk, Eli Lilly and Sanofi dominate the landscape and had a share of more than 85 in the Indian insulin market in financial year 2013. With a superior product portfolios and marketing strategies such as alliances, the 3 companies have gained a monopoly over the market. Domestic enterprises including Biocon, Lupin and Wockhardt therefore face stiff competition from the foreign counterparts. Prabhsimran Singh | Prof. (Dr.) Harvinder Popli ""Competitive Landscape of Insulin Market in India"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd24018.pdf
Paper URL: https://www.ijtsrd.com/pharmacy/other/24018/competitive-landscape-of-insulin-market-in-india/prabhsimran-singh
My 2013 PBMI presentation on my thoughts about using data and consumer engagement to shift the pharamcy industry to a industry focused on value as part of the overall health reform efforts.
This presentation outlines the current state of the consumer health industry as of 2014, including market analysis, company profiles, new product launches, consumers trends, and other analyst insight.
MediMeals Investor Presentation - February 2017Cory Glazier
Clinical trials have proven irrevocably that heart disease and diabetes can be reversed through deliberate nutritional therapy with a shift to consuming a whole food, plant-based diet.
MediMeals is an evolutionary health service that makes it as easy for doctors to prescribe scientifically proven meal regimens as it has been to prescribe pharmaceuticals and surgery in the past.
We get nutritionally precise, delicious meals to our patients nationwide, on doctor's orders.
We have reduced the learning curve and time constraints to upgrading diet. Healing the body with food has never been as accessible.
Autoimmune Type 1 diabetes nonprofit JDRF and nonprofit drug company Civica Rx announced plans to commercialize several insulin biosimilars at prices (including co-pays, cost-sharing, and pre-deductible) which promise to be significantly lower than U.S. insulin prices sell for in 2022. Prices of insulin have been adversely impacted by the PBM rebate ponzi scheme, but this announcement promises to disrupt that.
Millions of people are diagnosed with diabetes, and the effects are more than physical. The cost of treating the disease has risen significantly in recent years, and many people are at risk of being priced out of their health. Find out how much it costs to treat diabetes and how patients can reduce their expenses.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Will only #innovation be enough? A study regarding the global challenges being faced by the #health_insurance industry introduced in the Second Edition of the Healthcare Insurance Innovation Summit held in Vienna by Rafael Senén CEO at COVERONTRIP ® DIGITAL INSURANCE.
“A 10% of the world´s population will live with a #3Dprinted organ or prosthesis in 2019 and 35% of surgical interventions that require organ transplants or prosthetic implants will find an essential ally in this technique. However, the future challenges of the health insurance industry will not only be overcome with technological innovation.” Said Senén.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Global pharmaceutical companies are modeled with a supply chain, which ensures that the right drug reaches the right people at the right time and in the right condition. The supply chain also ensures 100% product availability at optimum cost by carrying huge inventory, which maintains 100% fill rate. Manufacturers are trying to cut down development time to save costs. For example, a drug manufacturer who can trim development time by 19% can save up to USD 100 million. But if a drug is getting delayed to reach the market, the time delay costs the company around USD 1 million a day. So, pharmaceutical companies today are designing the supply chain to be as responsive as possible to reduce entry time to the market thereby increasing profit margins.
Similar to Prescription Medicines: Insulin Costs in Context January 2021 (20)
Prescription Medicines: International Costs in ContextPhRMA
Our new Prescription Medicines: International Costs in Context explains how medicines benefit patients, health care systems, and the global economy. Advances in treatment are tacking some of the world’s greatest public health challenges. These treatments provide critical savings for health care systems by reducing the need for more costly services. What’s more is the profound impact that biopharmaceutical companies have on the global economy, including the creation of high-skill jobs, R&D investment, and medicines that improve worker productivity.
2016 Report: Medicines in Development for Alzheimer's DiseasePhRMA
Today, more than 5 million Americans have Alzheimer’s disease. The disease devastates the minds of patients, creates substantial burdens for families and caregivers, and currently costs the health care system more than $200 billion a year. These sobering statistics are projected to get much worse as the 76 million American baby boomers age.
This report shows that America's Biopharmaceutical Research Companies Are Developing More Than 70 Medicines for Alzheimer’s Disease
2015 Report: Medicines in Development for Heart Disease & StrokePhRMA
According to the American Heart Association, someone in the United States dies from cardiovascular disease every 40 seconds, and more than 85 million Americans have at least one form of the disease. Heart disease has been the leading cause of death in the United States since 1921, but these numbers are declining. Read this report by PhRMA - in partnership with the Association of Black Cardiologists - on the nearly 200 medicines in development for heart disease & stroke.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Medical Innovation Has Transformed the
Lives of Patients with Diabetes
More recent advances have driven much of this transformation.
A century ago, patients were treated with insulins from pigs and cattle. Today, patients have access to insulins that
operate at the molecular level which more closely resemble insulin released naturally in the body.
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
NOTE: Modern insulin treatment protocol often requires long-acting insulin to provide a base level of coverage all day along with meal-time administration of insulin to modulate spikes in blood glucose.
Maintenance of stable and consistent blood sugar levels is better than ever before, helping to
avoid serious complications and reduce weight gain.
Longer-acting insulins provide coverage for over 24 hours and enable greater flexibility in
dosing and reduced risk of dangerous blood sugar drops.
Rapid-acting insulins—including an inhaled form—enable dosing directly before or even after
meals, rather than in anticipation of meals.
Insulin pens offer greater convenience, including some that reduce injections for high doses or
ease of use in children.
2
3. Better Diabetes Management Saves Money and
Improves Health Outcomes
Improving Medication Adherence
Among Patients with Diabetes Could:
Save $8.3 billion for the U.S.
health care system each year
Result in 1 million fewer ER visits
and hospitalizations annually
22
million
Americans live with
uncontrolled diabetes.
SOURCES: American Diabetes Association.; Jha, et al. “Greater Adherence to Diabetes Drugs is Linked to Less Hospital Use and Could Save Nearly $5 Billion Annually.” Health Affairs
3
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
4. Average amount
discounts can lower
the list price of insulin
Amount average net
prices for commonly used
classes of insulins have
decreased since 2014
Net prices for commonly
used insulins are less
expensive now than in 2007
After Discounts and Rebates, Prices for Commonly Used
Insulin Classes are Declining
83% 40%-50%
SOURCE: PhRMA analysis of SSR Health, October 2020.
NOTES: Includes long-acting insulin analogs (50% decline in class average annual net price between 2014 and 2020) and rapid-acting insulin analogs/mixed insulins (40% decline in class average annual net price between 2014 and 2020).
These classes align with classifications reported in analysts reports.
4
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
5. 5
5
Negotiating power is increasingly concentrated among
fewer pharmacy benefit managers (PBMs).
Top 3
Market Share:
74%
21%
33%
20%
36% OptumRx (UnitedHealthGroup)
CVS Health (Caremark)
Express Scripts
All Other
Insurers and PBMs Have Significant Leverage to
Negotiate Discounts
Insurers and PBMs
determine:
FORMULARY
if a medicine is covered
TIER PLACEMENT
patient cost sharing
ACCESSIBILITY
utilization management through
prior authorization or fail first
PROVIDER INCENTIVES
preferred treatment guidelines
and pathways
SOURCE: Drug Channels Institute, March 2020.
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
6. Despite Large Rebates and Discounts, Increasing Use of
Deductibles and Coinsurance Can Expose Patients to Higher
Out-Of-Pocket Costs
1 in 4 patients taking brand diabetes medicines are exposed to
deductibles or coinsurance, which are typically based off of a
medicine’s undiscounted list price.
More than half of patient out-of-pocket spending on brand diabetes
medicines is attributable to deductibles and coinsurance.
40%
31%
29%
60%
Copay
Deductible
Coinsurance
SOURCE: IQVIA. US Market Access Strategy Consulting analysis. 2020.
6
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
7. 7
7
0.6
0.7
0.8
0.9
1
1.1
1.2
1.3
2015 2016 2017 2018 2019
2015
=
1
Average Annual Out-of-
Pocket Cost Exposure for
Patients Taking Brand
Diabetes Medicines
Insurers and Middlemen Expose Patients with Diabetes to
Increasing Out-of-Pocket Costs Despite Decreasing Net Prices
SOURCES: IQVIA U.S. Market Access Strategy and Consulting, July 2020.; IQVIA, “Diabetes Costs and Affordability in the United States.” June 2020.
Average Net Price of
Diabetes Medicines
Patients taking brand
diabetes medicines are
asked to pay an
increasing amount out of
pocket, even though net
prices have gone down.
NOTES: Out-of-pocket exposure measures the amount health plans required patients to pay; manufacturer cost sharing assistance could help patients pay this required
amount. Diabetes net price data includes both brand and generic medicines.
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
8. 8
8
Patients with Coinsurance and Deductibles Pay More on
Average for Diabetes Medicines
Patients who filled prescriptions
for brand diabetes medicines
while in the deductible spent
out of pocket than patients with
no deductible spending.
Patients with coinsurance cost
sharing who filled prescriptions for
brand diabetes medicines spent
out of pocket than patients with
copay cost sharing.
SOURCE: IQVIA. US Market Access Strategy Consulting analysis. 2020.
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
9. A Small Proportion of Patients with Diabetes Face High
Out-of-Pocket Costs
9
$0
34%
$0.01-$29.99
38%
$30-$74.99
18%
$75-$149.99
6%
$150+
4%
Final Out-Of-Pocket Cost Per Insulin Prescription, All Payers, 2019
NOTES: Includes insulins only, all payers
SOURCES: IQVIA, Medicine Spending and Affordability in the United States, August 2020.; IQVIA, Diabetes Costs and Affordability in the United States, June 2020.
90% of patients paid
less than $75 out of pocket
per insulin prescription.
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
10. A Small Share of Insulin Scripts Account for the Majority of Total
Spending – The Opposite of How Insurance Should Work
Total Insulin Prescriptions Total Patient Spending on Insulin
While just 24% of insulin prescriptions cost patients more than $35 out of
pocket, these prescriptions account for 82% of total patient spending on insulin.
Cost Patients
more than $35
(24%)
Cost Patients less
than $35
(76%)
Cost Patients
more than $35
(82%)
Cost Patients
less than $35
(18%)
NOTES: Includes insulins only, all payers
SOURCE: IQVIA, Medicine Spending and Affordability in the United States, August 2020.
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
11. Patients with Diabetes in High-Deductible Health Plans Face
High Out-of-Pocket Costs at the Start of Each Year
11
For patients with diabetes whose insulin is subject to the deductible,
it takes nearly half a year, on average, to meet that deductible.
NOTES: For patients with diabetes who had at least 1 insulin claim in the deductible. In 2018, 88% of patients with diabetes in HDHPs met their deductible.
SOURCE: Xcenda, Impact of First Dollar Coverage for Insulin, October 2020.
Spending for Patients with Diabetes in High-deductible Health Plans Who Met Their Deductible, 2018
Insulin Spending
After Deductible
$213
Insulin Spending
in Deductible
$504
Non-Insulin
Spending in
Deductible
$552
Non-Insulin
Spending After
Deductible
$206
71%
occurred in
the deductible
Patients with diabetes who met
their deductible spent an average
of $1,475 out of pocket in 2018—
$717 on insulin and $758 on non-
insulin medicines.
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
12. The current system can lead health plans and PBMs to favor medicines with high list prices and large rebates.
As a result, payers have been slow to include lower-cost insulin authorized generics on formularies.
Express Scripts, one of
the nation’s largest PBMs,
blocks coverage for a
lower-cost authorized
generic insulin.
Payers Have Been Slow to Include
Lower-Cost Insulins on Formularies
Just 1 in 4 Medicare Part D beneficiaries
and 1 in 5 patients with commercial insurance
have access to lower-price authorized generic
insulin through insurance.
SOURCE: HHS, OIG “Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit
Manager Service Fees.” 83 Fed. Reg. 2340 (Feb. 6, 2019).; Fein, A. “A World Without Rebates: Predictions for How the Channel Will Evolve and Why Drug Prices Will Go Down,” March 20, 2019.; Politico, Oct 2019. Access issues, drug shortages dictate pharmacy fills in Q3.
12
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
13. Cost-Sharing Assistance Programs Have Become a Crucial
Lifeline for Many Patients with Diabetes
Many companies have taken additional steps to expand their patient assistance programs to help ensure
patients are able to access to insulins during the COVID-19 pandemic.
22.8%
24.5%
26.6%
29.0% 28.9%
2015 2016 2017 2018 2019
In 2019, more than
1 in 4 patients
taking brand diabetes
medicines used cost-
sharing assistance to help
them pay for their
medicines.
SOURCE: BioSpace, “Insulin Makers Eli Lilly, Novo Nordisk and Sanofi Provide Low-Cost Options for Patients During COVID-19 Outbreak” April 2020. IQVIA, US Market Access Strategy Consulting analysis. 2020.
Share of Patients Taking Brand Diabetes Medicines Using One or More form of Cost-Sharing Assistance
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Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
14. Patient Spending On Brand Diabetes Medicines Would Have
Been Twice As High Without Cost-Sharing Assistance
$347
$780
Final Out-of-Pocket Spending
After Patient Assistance
Cost Sharing Set by Health Plan
$488
Average Savings from
Cost-Sharing Assistance
Patients just beginning
treatment with brand
medicines are nearly
more likely to abandon their
medicines at the pharmacy
counter if they didn’t use cost-
sharing assistance.
Average Cost Sharing Requirement and Final Annual Out-of-Pocket Spending for
Patients Taking Brand Diabetes Medicines Who Used Cost-Sharing Assistance, 2019
NOTES: Includes out-of-pocket spending for condition-specific brand medicines only. Out-of-pocket cost sharing requirement
measures the amount health plans required patients to pay. Difference between cost sharing requirement and final out-of-pocket
spending represents the savings from use of cost sharing assistance.
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SOURCES: IQVIA, Patient Affordability, Part 2, 2018.; IQVIA U.S. Market Access Strategy and Consulting analysis, July 2020.
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
15. 15
15
For a typical Part D patient with diabetes taking five medicines, including insulin:
Sharing Negotiated Rebates Would
Lower Medicare Part D Patient Costs
Out-of-pocket
spending could
decrease nearly
$900 a year
NOTE: Plan cost includes medical and pharmacy claims
SOURCES: Avalere Analysis, 2019; OACT, Milliman and Wakely Analysis, February 2019.
Premiums could
increase $3 to $6
a month, as little
as a dime a day
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
16. Sharing Negotiated Rebates Could Lower Out-of-Pocket
Costs for Commercially Insured Patients
Example: High-Deductible Health Plan with a Copay Example: High-Deductible Health Plan with Coinsurance
She would save $359 a year
Her premium would increase
less than 1%
Mary has diabetes and spends
$1,000 each year on medical
and pharmacy expenses
SOURCE: Milliman Analysis, October 2017.
He would save about $800 a year
His premium would increase
less than 1%
Kevin has diabetes and several
other health conditions and spends
$5,000 each year on medical and
pharmacy expenses
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Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
17. First Dollar Coverage for Insulin Could Improve Affordability
for Patients with Diabetes in High-Deductible Health Plans
17
Annual out-of-pocket costs could be: And could save certain patients with diabetes:
Exempting insulin from the deductible could
significantly lower patients’ annual out-of-pocket costs.
If all patients taking
insulin in high-deductible
health plans had first
dollar coverage.
Allowing patients to
more evenly spread
out-of-pocket costs
throughout the year.
2.4x
to 3.7x
Less
SOURCE: Xcenda, Impact of First Dollar Coverage for Insulin, October 2020.
$1,500
in annual
out-of-pocket
costs
Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin
18. Policy Solutions to Address Insulin Affordability Challenges
ENSURE PATIENTS WITH STATE-REGULATED INSURANCE ALSO DIRECTLY BENEFIT FROM REBATES
OR FROM CAPS ON CERTAIN OUT-OF-POCKET COSTS
Support legislation at the state level that could help reduce patients’ out-of-pocket costs by requiring insurers to share discounts
and rebates with patients at the pharmacy counter or cap certain out-of-pocket costs.
SUPPORT REBATE PASS THROUGH AND PROVIDING FIRST DOLLAR COVERAGE
Insurers and PBMs should pass through negotiated rebates and discounts and provide first dollar coverage of preventive
services, like insulin, in high deductible health plans to help lower out-of-pocket costs for insulin and allow patients to spread
costs throughout the year.
MODERNIZE PART D COVERAGE
Establish an annual cap on out-of-pocket costs and allow patients to spread costs throughout the year.
SUPPORT FLAT COPAYS FOR INSULIN FOR PATIENTS IN THE COMMERCIAL MARKET OR IN THE
EXCHANGES
Make regulatory changes to ensure plans put at least one of each type of insulin on a copay-only tier.
COUNT COST-SHARING ASSISTANCE AND THIRD-PARTY DISCOUNT PLANS
Support policies that require health plans to count the cost of prescriptions purchased with cost-sharing assistance or through
third-party programs, like Blink Health and GoodRx, towards deductibles and out-of-pocket limits.
ADDRESS INCENTIVES THAT HARM PATIENTS, BENEFIT MIDDLEMEN
Advance reforms that prevent PBMs and other supply chain entities from having their compensation calculated as a percent of the
price of a medicine and instead support policies that require compensation as on a flat fee based on the value their services provide.
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Prescription Medicines: Insulin Costs in Context www.phrma.org/insulin