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Diabetes advocates have officially joined the fight against pharmacy benefit managers (PBMs).
In September, advocacy groups the Diabetes Leadership Council (DLC) and the Diabetes Patient Advocacy Coalition issued a joint statement supporting a lawsuit from the Federal Trade Commission (FTC), which claimed in a press release that the three largest PBMs in the US “have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication.”
Insulin access. The biggest issue for advocates is the rising cost of insulin.
“This case underscores the urgent need for greater transparency and accountability within the pharmaceutical supply chain…The current system fails many patients,” the advocacy groups’ statement read.
About 37 million people in the US have diabetes, 8.4 million of whom rely on insulin to live, according to the American Diabetes Association.
While there are cheaper versions of insulin products, PBMs are paid smaller rebates to include them on formularies, which is the list of drugs covered by health plans. The FTC has accused PBMs of directing patients toward more expensive drugs that could yield them higher rebates, artificially inflating prices in a “perverse drug rebate system.”
For example, in 1999, Eli Lilly’s insulin drug Humalog cost $21, but in 2017, it cost $274, the agency shared in its statement.
About 1.3 million people in the US have to ration insulin, according to a 2022 study published in the Annals of Internal Medicine by researchers at Harvard Medical School and the City University of New York’s Hunter College.
Doing so can lead to ketoacidosis, a deadly condition where blood sugar levels spike enough to become acidic. In 2020, researchers in Georgia found that the adult nonadmitted emergency department rate for ketoacidosis doubled between 2009 and 2015 across the US.
Regulatory request. “They’re pitting these insulin companies against each other,” Stewart Perry, chair of the board at the DLC, told Healthcare Brew. “Generics don’t tend to pay rebates. So guess what? Generics don’t tend to be on the formularies.”
The diabetes advocacy groups wrote in the joint statement that they want more transparency and regulatory oversight in the pharmaceutical supply chain.
“We believe that Congress and state legislatures should start shining a light into the darkness of the PBM operation,” Perry said. “A person with diabetes has the tools to manage their disease—those people can live long, happy, productive lives and not cost our healthcare system or our workplaces, just like everybody else. But until we put people before profits, it’s not going to happen.”
The state of California has also sued PBMs over the price of insulin, and New York reached a deal in May 2023 with drugmakers Sanofi and Eli Lilly to cap the price of insulin at $35 for the next five years.