Thursday, June 23, 2022

PBM Trade Group "A Summary of Insulin Coverage in Medicare Part D" Study from Milliman, Inc. Health

The PBM trade group known as the Pharmaceutical Care Management Association (PCMA) recently commissioned Milliman Health to conduct a study of Medicare beneficiaries enrolled in a Part D Plan to determine if they "prefer" brand-name basal insulins over the biosimilar Semglee which is made by Biocon (currently commercialized by Viatris, although Biocon recently announced it was acquiring Viatris half of their joint venture). 

In reality, it is little more than smoke and mirrors from a PBM trade group.

The reason PCMA commissioned the study was to try and generate "evidence" that patients somehow prefer costly, heavily-rebated branded insulins over biosimilars. The study can be seen at

If you visit slide #7 (the one which addresses "Long-Acting Insulin"), that addresses the reality that many Medicare Part D plan members are covered by a plan which now "prefers" Biocon's Semglee over Sanofi's Lantus. Cigna's Express Scripts last year dropped Sanofi Lantus in favor of Semglee (likewise, the PBM known as Prime Therapeutics also preferred Semglee, although Prime relies upon Express Scripts for price negotiations and retail pharmacy coverage). So far, there are a handful of basal glargine biosimilars including Semglee, another unbranded version called Viatris U-100 Insulin Glargine, as well as two made by Lilly including Basaglar and another which will be branded as Rezvoglar which was approved under a new FDA procedure specifically for biosimimilars (Basaglar was approved under the old FDA approval method as a "follow-on" biologic).

But this study was more an exercise in trying to prove the value PBM's say they deliver, rather than compelling, methodologically-sound market research.

I would dare say that the reality is that what Medicare Part D beneficiaries want most is for their Part D plans to share the financial benefit of any savings the plan generates by choosing lower-cost biosimilars, rather than making them pay costs which are comparable to the brand-name innovator product for a biosimilar drug (in this case, Sanofi [soon to be known as Euro API] Lantus).

In the end, the research does not actually prove much of anything. If Part D beneficiaries received Semglee at a price of $60/vial, they might find that "preferable" to Lantus. Instead, Express Scripts is charging patients anywhere from $162.11/vial to $194.82/vial for branded Lantus (although with a ValYOU coupon from Sanofi they can buy it for a price of $99/vial), while Semglee can be purchased for a price ranging from $67.94/vial to $85.75/vial.

The basal insulin market is even more distorted price-wise than the prandial insulin market is if you can believe it. Its therefore unsurprising that Civica (which plans to introduce a biosimilar of glargine first) at a price of just $30/vial or $55 for a box of 5 insulin pens will aim to disrupt the basal insulin market first.

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