A frequent complaint about U.S. prescription drug prices is it is difficult to explain WHY the prices here are so high. A frequent pharma answer to the question WHY is this happening is "it's complicated". They aren't kidding. It IS complicated. But today, there are tools on the internet which can help many people navigate the dysfunctional U.S. system without being taken to the cleaners. I recently did a podcast about that which might be worth listening to. But it's helpful to understand how I became the guy the podcasters wanted to interview about the subject.
Back in September 2021, I was invited as a guest to speak with Diabetic Investor David Kliff on his Wacky World of Diabetes podcast where we talked-shop about diabetes stuff and what I was doing. David admitted that he follows me on Twitter and occasionally enjoys some of my short commentary associated with news on the diabetes front. He is also making an effort to interview more diabetes patients in his podcast. I was featured in an episode entitled "A No-Nonsense Perspective on the Business of Insulin with Scott Strumello" (catch the podcast at https://diabeticinvestor.com/its-podcast-day/). Among the topics we talked about was the insulin pricing crisis and how the dual branded/unbranded strategy deployed by Lilly (and to a slightly lesser extent Novo Nordisk) for rapid-acting analogues seemed to be a solution which worked effectively for some people (if the patients actually KNEW the option existed; the companies have invested no resources in marketing those). In recent years, my focus was on runaway out-of-pocket insulin costs because I was directly impacted by the issue. I was covered under an employer-sponsored healthcare insurance plan which had an individual deductible of more than $2,000 which I had to satisfy before I received any pharmacy benefit.
Pharmacy retail prices for cash-payers are artificially-inflated (on all drugs, not just insulin) due to PBM contracts with drugstores (drugstores are forced to contract with PBM's or they would have zero business). I mentioned how in 2019, Lilly and Novo Nordisk each announced plans to introduce unbranded (so-called "authorized generic") versions of Humalog and Novolog (respectively) starting in 2020 (Sanofi did not).
The initial hype around these was the products would retail for half-price, but savvy patients quickly discovered they could buy Lilly Insulin Lispro and Novo Nordisk Insulin Aspart for 75% off the bogus cash retail price using readily-available GoodRx coupons. Lilly subsequently reduced prices on Lilly Insulin Lispro even further (see the company press release HERE) and today, patients can get Lilly Insulin Lispro for about $35/vial with a readily-available Lilly manufacturer coupon (visit https://www.insulinaffordability.com/ and click the relevant button to download one of the discount cards (the manufacturer coupons work on all Lilly insulin varieties, including the company's insulin glargine biosimilar branded as Basaglar). No personal information was required to get the manufacturer coupon. Alternatively, you can simply use a GoodRx coupon and buy Lilly Insulin Lispro for $43.43/vial.
Since being introduced, Lilly's CEO Dave Ricks has told Lilly investors that at least 30% of all Humalog sales in the U.S. are the "unbranded" version called Lilly Insulin Lispro. Also, Lilly investor presentations show that Lilly Insulin Lispro is now generating most of the product's growth in the U.S. market.
Novo Nordisk did not follow Lilly's decision to further reduce prices of Novo Nordisk Insulin Aspart. But that did not stop Novo Nordisk A/S from bragging to investors in its Q4 2021 investor presentation (see the archived presentation at https://seekingalpha.com/article/4483536-novo-nordisk-s-2021-q4-results-earnings-call-presentation and visit slide #135) about how "In 2021, more than 1 million people were reached by Novo Nordisk insulin affordability offerings in the US".
That's a rather curious point of pride for Novo Nordisk to brag about to investors. Instead of interpreting that to mean that the company has a helpless addiction to PBM rebates needed to secure commercial healthcare insurance company drug formulary placement, it should be a point worthy of reflecting about how badly the company's U.S. business is broken and the reason its insulin margins are so low and continue declining. But instead, the Danish company boasted to investors about how comprehensive its U.S. affordability options are.
Anyway, David Kliff manages his Wacky World of Diabetes podcast in a way I rather like: he EDITS his podcasts for organization and clarity (even though they are recorded in a way that flows naturally like a real conversation) so the podcast follows a flow for listeners to follow the discussion, and hopefully walks away more informed about whatever topic was discussed.
Shortly after my visit to David's Wacky World of Diabetes podcast, he informed me of a new website he and a woman named Amber Clour (who's a diabetes podcaster in her own right) were starting called The Diabetes Way https://thediabetesway.com/ which they describe as:
"A unique approach in how we think about diabetes, including answers to questions, a candid podcast and blog, resources and tools, surveys, trivia, rewards ... all delivered with a lighthearted approach".
As noted, David also introduced me to his partner in the venture Amber Clour (a fellow T1D), and we all did a podcast called The Dave and Amber Show for The Diabetes Way on March 14, 2022. You can listen to that podcast below, or by visiting https://thediabetesway.com/podcast/fighting-rising-drug-prices.html. But my topic this time around was about how PBM's are now cannibalizing their own plan-sponsor clients with coupon-generating websites and apps and how patients can take advantage of that cannibalistic behavior for their own financial benefit.
I also helped to co-write a relevant blog post which provides a number of useful links which we discussed in that podcast. To read it and catch the links, visit https://thediabetesway.com/blog/whats-behind-the-diabetes-drug-cost-curtain-1.html for the details.
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