Insulin manufacturers and PBMS testify before Congress

Originally posted: Beyond Type 1


On Wednesday, April 10, the Oversight and Investigations Subcommittee of the Energy and Commerce Committee of the US House of Representatives held the second of two hearings on insulin pricing. After hearing from patients, doctors, and patient advocates last week, the subcommittee called on representatives from insulin manufacturers as well as Pharmacy Benefit Managers (PBMs) to answer questions about the high and rising price of insulin in the United States.

Subcommittee chairwoman Diana DeGette (D-Co), who is also the co-chair of the Congressional Diabetes Caucus, set the stage in her opening statements, saying “despite the fact that insulin has been around for 100 years, it has become outrageously expensive” and characterizing the insulin market in America as “a system with perverse payment incentives, and a complete lack of transparency in pricing.”

The witnesses representing Eli Lilly, Sanofi, Novo Nordisk, CVS Health, Express Scripts, and OptumRx were sworn in and each given five minutes to present an opening statement. Eli Lilly, Sanofi, and Novo Nordisk are often referred to as the “Big 3” insulin manufacturers. CVS Health, Express Scripts, and OptumRX are all pharmacy benefit managers (PBMs) responsible for negotiating prices, formularies, and more between manufacturers and insurance providers.

Most of the executives testifying pointed to a personal connection to someone with diabetes, and offered steps their companies have taken recently to address the issue of insulin pricing. Lilly pointed to their announcement of a half-priced generic version of Humalog, Novo pointed to their human insulin available at Walmart, and Sanofi touted a program announced the same morning as the hearing to limit monthly insulin costs to $99 for some patients.

PBM reps similarly tried to deflect responsibility and point to recent offerings, like Express Scripts announcement of a monthly $25 cost of insulin for some patients. Legislators were unimpressed with what appeared to some as PR stunts prior to testimony. Indeed, Senator Chuck Grassley (R-Iowa) said that these recent moves “raise a lot of questions” in a written statement. He went on to say it “shouldn’t take months of bad press, persistent public outcry and increasing congressional scrutiny to get a company to charge a fair price.”

The hearing was contentious throughout, with House members grilling both the manufacturers and the PBM representatives about the reasons for high costs. In general, manufacturers pointed to the rebate system as the underlying issue, while PBMs pointed to increasing list prices as the main culprit. This provided for an interesting scene, with neither party willing to take responsibility and both seemingly blaming the other.

At one point Representative Kennedy (D-Mass) voiced his frustration at the finger-pointing going on by literally pointing his fingers in each direction to describe what he was witnessing. Kennedy went on to scoff at the motivations of Lilly’s offering of a half-priced generic insulin, telling Mike Mason of Lilly Diabetes that “it took 15 years and global outcry” to get lower insulin prices.

Committee Chairman Frank Pallone (D -NJ) told the witnesses that his constituents frequently ask his team why the government doesn’t just set the list prices themselves. He also hinted at getting rid of PBMs altogether, though neither are likely to be pursued, as Pallone himself said that he believes in a market-based system.

The bipartisan scrutiny on insulin pricing is not coming just from this committee, but from all levels of government. The Senate Finance Committee held a hearing with PBM reps on April 9, the FDA is looking at ways to increase competition in the insulin market, and the Trump administration recently proposed targeting the PBM rebate system and instead passing rebates on directly to consumers.

It is hard to know what next steps will come out of this hearing, but one thing was made clear by all parties today — the current system is untenable.

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And nowhere do I see mention that Lilly’s newly reduced price of insulin is still triple or even quadruple the cost of insulin in the rest of the world.

They touch on that. They threaten them with price controls. But, the best was the pharmacist who questions them towards the end of the hearing. I wonder where that guy is from. I think hes from Georgia.

Here’s the link to the actual hearing…

I watched the entire hearing this afternoon. In my opinion it was a long winded repeat of the same thing - drug companies and PBM’s blaming eachother and paying lip-service to the idea they are patient-focused organizations. Give me a break!

I was pleased the House brought this out of the shadows, but we didn’t learn much new. A Senate hearing on perscription drug prices earlier this year flagged the same conflicts between drug companies and PBM’s. What a messed up system!

I can only hope all this results in actionable items. Everyone’s had their chance to vent. Now get down to solving the problem! As so many of the Represenatives pointed out, people are dying.

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Need a Type 1 congressman on these hearings

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Or parent or grandparent!

I’m recalling an episode from The West Wing, the Stackhouse Filibuster, where the senator held the floor for several hours in an attempt to (successfully I might add) introduce legislation for an autistic grandchild.

I think that @YogaO said there is one, and that there are lots of patients playing a role. I, too, worried about that.

Yes, there’s a lot of finger-pointing, but it seems to me that it was pretty clearly established that:

  1. The current system isn’t working very well

  2. No one should be paying list price for insulin

  3. Those paying list price (or a very high price) are either in the Medicare Part D doughnut hole, uninsured, or still in the deductible part of a high deductible plan.

  4. There isn’t enough competition in the insulin market, and part of this reason is due to insulin manufacturers manipulating the patent system to their advantage.

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Hmmm … I’m not aware of a T1D in Congress.

I was pointing out that of the 5 people testifying on the Energy and Commerce Oversight Subcommittee hearing on April 2, 3 of them were T1Ds. Gail DeVore, Christel Marchand Aprigliano and Aaron Kowalski are all T1Ds and provided real-life, dramatic testimony.

The price is high because its like popcorn in the movie theater. You can’t just buy your insulin overseas without breaking the law and risk having the state use its “legal” violence against you.

Kidnapping at gunpoint, also known as arrest.


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Snakes in Suits: When Psychopaths Go to Work is a 2006 non-fiction book by industrial psychologist Paul Babiak and criminal psychologist Robert D. Hare.

I read that book, now I get to watch these people at this hearing read their corporate bull act like they care. Eli Lilly is the worst, complete psychos.

This confirms my statement above.

At the 52 minute mark now and the Eli Lilly corporate slick talker is on the spot, this should be good !

The youtube video I posted above from the official Energy and Commerce Committee channel has 9,338 views but only 2 comments.


I guess they couldn’t handle the public comments calling out all the lies and bull cause no way only 2 people in 9,338 people made a comment. No way.

1, 3 and 4 were established at the Senate hearing on prescription drug prices across the board, but not with specific reference to insulin. The House hearing confirmed it - that’s a good thing. 2 was the purpose of the hearing going in.

I was thrilled to see the drug companies and PBM’s in the hot seat. What we need is an action plan. That can’t happen soon enough. Hopefully it will be forthcoming from the House, Senate and White House as a result of these hearings and those yet to come. Thankfully It’s a bipartisan issue.


ahhhh, maybe I am recalling my state House hearing. I, honestly, am having difficulty keeping all of these different groups of people straight.

I’ll need to watch the hearing you mention. I’ll find the link. Thanks for clarifying.

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There should be no “list price” that doesn’t reflect its true market value. That’s the crux of the whole issue. If I have a car that’s for sale for $20,000 dollars, but I agree to pay you back $19,000 after you buy it—- the true price of the car is $1,000 but the list price is $20,000.

It’s the pbm rebate structure that causes this absurdity


I am just learning, right now I a reading this:

Express Scripts . Express Scripts Holding Company is an American Fortune 100 company. As of 2018, the company is the 25th-largest in the United States by total revenue as well as the largest pharmacy benefit management ( PBM ) organization in the United States. Express Scripts had 2016 revenues of $100.752 billion.

WTF , what do these people who suck up $100,000,000,000 every year produce of value to society ? So many parasites in the supply chain. 100 billion dollars and no meaningful contribution to the world at all.

"How many people spend their working lives doing something essentially meaningless? A recent poll in the United Kingdom found that 37 percent of full-time workers were quite sure that their job made no meaningful contribution to the world. The anthropologist David Graeber’s new book, ■■■■■■■■ Jobs , presents a provocative theory of how and why pointless work has proliferated in the modern world, and what we might do to reverse this trend. "


No way these bureaucratic turds from the government or the insurance industry are ever going to fix anything.

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The three largest PBMs controlling about 80% of the market have merged with insurance companies.

Cigna acquired Express Scripts, completing its acquisition in Dec 2018.
CVS (the parent of CareMark) acquired Aetna in Nov 2018
Optum is a wholly-owned subsidiary of United Healthcare, created in 2011.

FWIW - the Einstein quote you have isn’t known to actually be his.