What we are learning

What we are learning

We have known from the beginning that this brouhaha over the “high” out of pocket cost of insulin was an issue that was being somewhat blown out of proportion. To fully appreciate this take a look at the recent decision by Cigna to limit co-pays for insulin to just $25 per month. Per a post on the CNBC web site;

“Health insurer Cigna is lowering the out-of-pocket cost of insulin for some of its members with diabetes, launching a new program next year that caps copays at $25 for a 30-day supply of the drug.

The insurer said the program could lower costs for roughly 700,000 members with diabetes covered under Cigna plans and its pharmacy benefits subsidiary Express Scripts. The average cost for a 30-day supply of insulin was previously $41.50, Cigna said.”

What caught our eye was not the new cost of just $25 for a 30 day supply but what Cigna disclosed that prior to this plan the average cost of a 30 day supply was just $41.50. Now we having nothing against the new lower cost but it does show that this problem over the “high” out of pocket is a problem rather narrow in scope applying mostly to patients who either do not have insurance or have plans that high deductibles.

As we have noted from the beginning it sucks big time for patients who either do not have insurance or have plans with high deductibles. Insulin is a life sustaining drug and no patient no matter what their financial situation should ever have to chose between being able to eat or getting the medication that keeps them alive.However we have also known that the majority of patients do NOT fall into this category.

Even at the “higher” cost of $41.50 for a 30-day supply – that’s about $1.38 per day- this was hardly a huge financial burden. Let’s be honest folks as our guess is these patients spend more on Starbucks then $41.50 per month. Again we are not minimizing the problem here but it is NOT the problem it has been made out to be. The problem however comes in now that everyone is falling all over themselves to lower the cost of insulin what the fallout will be.

The first causality here will be newer and better short-acting insulin’s something everyone wants. Why would any of the major insulin companies spend the money to develop these insulin’s when they will be unable to recoup their investment let alone make a profit. The fact is all insulin’s short and long term are now commodities and in a commodity market all that matters is price. So say goodbye to better short acting insulin’s.

The next issue and this has never been discussed because there is no hard data is will anything change now that insulin is “cheaper”. Will we see better patient outcomes because insulin is now $25 per month rather than $41.50 per month? Our answer is no.

While we applaud what Cigna is doing the fact is it still does NOT solve the real problem here. In fact none of the efforts underway solve the real problem. The real problem being patients without insurance or those with high deductible plans. This is where the high cost of insulin hurts and has a real impact. Yet none of the efforts underway, none of the Congressional hearings, none of the noise being made deals with this very real yet very complex problem.

Patient advocates will claim victory here, our elected officials will get kudos for bringing down big bad pharma but in the end this problem isn’t going away and will not go away until we have serious healthcare reform and no one wants to deal with that. On the left all we hear about is Medicare for all – a single payor system that most likely will come with price controls which will kill new drug innovation. On the right we hear let’s kill the Affordable Care Act which sounds interesting until you consider what happens after you kill it and so far we have heard nothing of substance about what happens after it’s killed.

Given how divided we have become as a country it’s difficult to see any common ground or room for compromise.

What we are learning here is what we have known all along that after all the noise, all the hearings, all the tweets is the people who really need help won’t get it.