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The affordability of insulin is a major issue in the diabetes community. Getty Images

Americans with diabetes have long been in the midst of an insulin crisis.

Skyrocketing costs driven by the conflicting demands and intricacies of the United States’ private healthcare system have led to the deaths of several people forced to ration the life-saving drug they couldn’t afford.

Now, pharmacy benefit managers (PBMs) and major insulin manufacturers are signaling a willingness to take more radical action to control these drug prices.

Cigna’s Express Scripts, for instance, has announced a new plan to provide insulin at $25 to a pool of more than 700,000 eligible patients.

Insulin manufacturer Sanofi similarly announced an expansion of its “Insulins Valyou Savings Program” to provide 30-day doses of its insulin for $99 per month to private insurance patients.

“It is unacceptable to Sanofi that some people living with diabetes are struggling to pay for their insulin, so we have moved to act creatively and aggressively to help address affordability and access needs,” Michelle Carnahan, head of North America primary care at Sanofi, said in a press release.

“By giving those who… use more than one box of pens or one vial per month access to their insulins for one flat price, we aim to help limit the burden on the individuals who have high out-of-pocket costs at the pharmacy counter,” she wrote.

These moves come as the nation’s top five PBMs have been called before Congress to explain their role in the nation’s rising prescription drug prices, of which insulin has become a high-profile poster child.

PBMs are intermediary companies that negotiate drug prices on behalf of insurers, unions, Medicare, and others. They have been singled out by critics for negotiating rebates from drug manufacturers that they pocket themselves instead of passing on to patients.

The industry, for its part, argues that PBMs are essential negotiators providing pressure on drug companies to lower prices.

The potential to cover nearly 700,000 patients on a low-cost insulin plan is encouraging, but it’s still a small portion of the 30 million Americans — 9.4 percent of the U.S. population — who have diabetes, according to data from the Centers for Disease Control and Prevention (CDC).

That has critics wondering whether it represents a true shift in pricing for life-saving pharmaceuticals or an effort to fend off change.

“From my perspective, Cigna’s decision is a public relations move, not a pricing decision,” Emily Gelber-Maturo, director of Smart Policy Works, a Chicago-based advocacy group that supports “policy solutions that promote health and economic security” told Healthline. “Drug companies have historically offered discounts and run patient programs that offer lower cost drugs.”

“The way they have structured this cost reduction is a way of relieving public and political pressure and is significantly restricted to those who are on a participating plan,” she said.

Harold Carter, PharmD, senior director of product at Express Scripts disagrees.

He pointed out that this is just the latest in many insulin accessibility relief efforts the company has been actively working on.

“[This program] has been in the works for our side and if you look at what we’ve done in the past, I don’t think it’s fair to say we’re doing things in the diabetes space because of political pressure,” he told Healthline. “We believe this is another piece of the component on an already strong list of things we’re doing today.”

Still, he acknowledged that Cigna’s current plan would not cover people on government-funded programs such as Medicare and Medicaid.

The same is true for Sanofi’s expanded affordable insulin program.

Carter says Express Scripts’ program isn’t helping just people with diabetes.

“At the end of the day, it’s not about just helping our patients but helping the marketplace and the healthcare system at-large,” Carter said. “We expect a strong enrollment [in the new program].”

Danielle K. Roberts, co-founder of the Medicare insurance agency Boomer Benefits, agreed, saying that the program could lead to increased competition.

“This move could potentially force other manufacturers and insurance carriers to follow suit, as many beneficiaries may move to Cigna, causing the carriers to become more competitive,” she told Healthline. “This change is said to take place in 2020. Since we are still at the beginning of 2019, we will have to keep a close eye on this announcement to make sure the deal is sealed.”

Still, politics or not, the problem with voluntary programs like those offered by Cigna or the insulin manufacturers themselves is that they’re vulnerable to clawback, Gelber-Maturo told Healthline.

“Lowering the price now makes no promises that insulin will stay at a lower price in the future,” she said. “But it may convince lawmakers to back off policy proposals that could make lower prices more permanent.”