The Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, introduced by Senators Shaheen (D-NH) and Collins (R-ME) aims to increase access to insulin by lowering the high costs for insured patients.
The INSULIN Act encourages manufacturers to reduce their list prices to 2021 average net Part D prices (after rebates) by requiring commercial and Medicare plans to cover all products with reduced list prices on formulary with no management or prior authorization. This would lock in today’s net prices and would allow for price increases in line with inflation.
CIDSA experts were given the section-by-section summary of this bill to review for the following survey.
The majority of CIDSA experts believed this policy would increase drug spending, but others differed. Five experts believed this policy would increase drug spending, two believed it would have no impact, and the final expert believed it would minimally reduce spending. While the majority of experts agreed that this policy would significantly decrease drug list prices, they also agreed this policy would moderately increase drug net prices. There was overall consensus that this policy would moderately increase drug access for patients with Medicare and commercial insurance, as well as uninsured patients and large patient groups. Rare disease patients and patients with Medicaid would be unaffected by this policy.
The CIDSA experts unanimously agreed that this bill would advance the drug spending policy landscape, with the majority (7) indicating a minimal advancement. The vast majority of the experts agreed that the ability for the policy to be implemented and the size of the affected population should be considered strengths of the policy. However, the experts agreed that the evidence base in support of the policy and the precedent-setting value of the policy are still unknown. Finally, there was no consensus on whether the magnitude of the impact that this policy would have on drug spending would be a weakness or still remains unknown.
*Only 8 experts were able to complete this survey.
Experts highlighted many considerations for policymakers. The primary concerns that the experts brought up were the potential net price reductions that would be foregone by locking in 2021 net prices, before interchangeable biosimilars have a chance to gain any significant traction, and the uncertainty of whether manufacturers will voluntarily participate. Other considerations are the potential increase to Medicare premiums and the subsequent impact on access, the willingness for physicians and patients to switch insulins, and the potential impact on biosimilars. Final minor concerns that the experts had with the policy are its effectiveness in light of the existing Part D Senior Savings Model status, the impact that highly-concentrated insulin formulations would have in net price estimates, and the increased market share that manufacturers could capture from certification.