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The new program helps employees who get their Eli Lilly insulin through employer-sponsored benefits
People with diagnosed diabetes spend about 2.3 times more on medication costs as opposed to those without diabetes, not to mention that insulin prices have nearly doubled in the last five years. While, some recent state and federal regulatory efforts have established caps on patient out-of-pocket prices, this approach has no effect on total insulin cost, and pharmacy benefit managers then shift the balance of insulin prices to employers and health plans, which drives up the total cost of healthcare benefits for plan sponsors.
To help solve these issues, Eli Lilly and Prescryptive Health, a company focused on improving the prescription drug market, announced a partnership on Thursday with the aim of lowering costs for people who pay for their Lilly insulin through their employer-sponsored benefits.
In lieu of a traditional rebate arrangement, the program offers a subscription fee model which Prescryptive Health CEO Chris Blackley says will insulate employers financially from both increases in insulin list price, as well as increases in insulin utilization.
In addition, the program also introduces a risk-sharing element with the employer based on health outcomes.
"With affordable and predictable insulin spend, in addition to overall health and productivity benefits from optimal insulin usage, employers are incentivized to further remove insulin access barriers for diabetic employees," he told VatorNews.
"The goal of robust and affordable insulin access is to reduce disease severity and lower total healthcare costs related to uncontrolled diabetes. As such, if medical (non-drug) expenses for these insulin-dependent patients with diabetes increase over time, Lilly will refund a portion of the insulin expenses paid."
The program is meant to accomplish three things, he explained: first, to provides a predictable, fixed net price in the market for employers free of any additional margin or rebates artificially driving up the cost. Second, it's focused on the patient’s health and total cost of healthcare. Finally, it makes insulin affordable enough that employers can offer it at low or no cost to their employees to remove the barrier to better health outcomes.
The idea is that affordable access to insulin can promote proper utilization of insulin, resulting in better glucose control, and that better diabetes management could mean reduction in avoidable medical events, leading to total cost reduction for both the employee and the employer.
So far, the company has seen a three-fold ROI in this value-based agreement with Lilly: eliminating PBM margins, rebates, and unpredictable costs to deliver savings; establishing insulin subscription pricing that is tied to value and aligned with delivering measurable health outcomes to bring predictability to employers; and making insulin more affordable over time for the people who need it.
Founded in 2017, Prescryptive deploys mobile-first products that connect consumers, pharmacists, and employers, so that people have the information they need to make informed decisions about their health.
The company's platform cuts out the middleman and provides transparency by allowing consumers to shop for medications so they can find the best, most affordable options. It engages benefit plan members at the point of care to ensure they have access to the most affordable and effective options, allowing members to find what their benefit plan covers and what their out-of-pocket expenses will be in real-time.
"Consumers are struggling to afford their medications, and the increasing financial burden for employers providing health benefits is becoming unsustainable: 450 million prescriptions are abandoned each year due to unexpected costs," Blackley said.
"Independent pharmacies are also struggling to sustain their businesses and offer affordable medications and healthcare services in their local communities because of the unfair practices of pharmacy benefit managers (PBMs). We’re creating solutions to fix this broken system."
Prescriptive's solutions include myRX.io, which provides information about prescription drug costs and allows patients to schedule services at their local pharmacy; myRX Pro, which allows pharmacies to grow their business through clinical services and a patient engagement experience; and myRX Benefits, its pharmacy benefits solution for employers that reduces drug costs by eliminating profit taken by the existing system’s middlemen.
The new partnership with Eli Lilly adds to this employer solution for one of their most costly challenges, which is the total cost of diabetes care, Blackley explained.
"Through a flat subscription fee, we are eliminating the rebates and margin added to the price of insulin so that employers can offer insulin to their employees with more predictable and affordable costs. The model ensures Lilly's insulin products are providing value to the patient and the payer and provides the benefits plan sponsor to create an affordable insulin benefit since they no longer have to guess about what insulin will cost," he said.
Ultimately, Blackley sees this partnership with Eli Lilly as validating what his company has accomplished so far.
"This is certainly a validation of our vision and progress in rewriting the script for the U.S. prescription drug market in partnership with others share this vision – to eliminate the artificial barriers to accessing affordable medication, to realign financial incentives to deliver better patient outcomes and to break down the structural constraints of this legacy system," he said.
(Image source: medicalxpress.com)
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