This is an interesting move, but I have to agree with the T1nternational spokeswoman in the article: this is a PR move rather than an indication of a systematic effort to lower costs.
While this is beneficial for those whose employer provided healthcare plans use Express Scripts, there are a couple of things that are “bugging me” about this:
- the insulin makers are funding this reduction in cost, which again begs the question of why they have list prices so high they can afford to just slash actual costs by more than 30% when pressured by Congress?
- this only applies to those who have insurance from employers who both use express scripts as a PBM and opt into the insulin-price-cap program; the vast majority of insulin-dependent diabetics in the US won’t be affected by this change
- that insulin makers and PBMs are making these changes now, when Congress has started to call them to DC to answer questions, seems awfully suspicious; guilty consciences and all that…
- why on earth do we need PBMs anyways? What value do they bring to the process of healthcare?
Just my initial thoughts. Good for folks on this plan, not nearly enough to make a difference.
Thanks for alerting us! I have Aetna insurance and express scripts is my pharmacy benefit manager. My current co-pay with express scripts is $125 for 3 months so this would make my co-pay $75. I just sent them a message on my online portal asking how to opt-in. If anyone else gets any more information, please share! Hopefully there isn’t a major catch.
There were a few posts recently about savings cards from insulin manufacturers so I called. As we carry insurance through our employer, we were able to obtain a savings card for my Novolog and for my husban’s Lantus. Lantus’ manufacturer has a better program than Novolog’s. Lantus’ monthly out-of-pocket max is $1400 - $0.00 copay. Novolog’s monthly out-of-pocket max is $100 - $25.00 copay.
These are good at pharmacies other than Express Scripts; I know, because we are using them at a local pharmacy.
Am i reading it correctly that this applies only to those plans which are covered by (CIGNA and Express Scripts)? Not just Express Scripts? Or am i residing it incorrectly?
It is for those plans covered by Express Scripts, with the statement that the plan sponsor (aka employers) has to agree and opt in.
Since Express Scripts is now recently a part of Cigna, by next year, the $25 cap will apply to all CIGNA plans.
interesting