Sanders calls insulin company, PBM executives to testify

The leaders of the three main insulin manufacturers will testify at a Senate Health Committee hearing on insulin pricing next month, Chairman Bernie Sanders (I-Vt.) announced Friday.

The CEOs from Eli Lilly and Company, Novo Nordisk and Sanofi will testify as Sanders uses his bully pulpit to continue pressuring the companies about the high cost of insulin, even though all three said they plan to lower the prices of older insulin products. 

Those three companies control about 90 percent of the insulin market.

Aside from insulin, the hearing will also feature executives from the major pharmacy benefit managers (PBMs) CVS Health, Express Scripts and OptumRX.

PBMs are the intermediaries in the prescription drug supply chain who negotiate discounts with drug companies on behalf of insurance plans. They are facing bipartisan scrutiny from House and Senate lawmakers and are also a frequent target of Pharmaceutical Research and Manufacturers of America, which blames PBMs for high prescription drug costs.  

Sanders has long been a critic of pharmaceutical companies, but the inclusion of the PBM industry leaders signals a new front in his drug pricing fight.

In a statement, Sanders acknowledged that all three of the insulin companies said they will cap out-of-pocket costs at $35 and cut the list price of their most commonly-prescribed product.  

“That’s an important step forward. We must make certain, however, that those price reductions go into effect in a way that results in every American getting the insulin they need at an affordable price,” Sanders said. 

“But that’s not all. We have got to substantially lower the price of all prescription drugs. The United States cannot continue to pay, by far, the highest prices in the world for prescription drugs while drug companies and PBMs make billions in profits,” Sanders added. 

The Inflation Reduction Act, which became law last year, capped the price of insulin at $35 a month for seniors on Medicare. 

Democrats at the time of the bill’s passage tried to impose an out-of-pocket cap for all insurance, but Republicans successfully argued the provision was contrary to Senate rules and blocked it.

Senate efforts

There are dueling Senate proposals aimed at lowering the cost of insulin. 

Sanders and Rep. Cori Bush (D-Mo.) introduced legislation that would cap the list price of insulin at no more than $20 per vial.

Sens. Raphael Warnock (D-Ga.) and John Kennedy (R-La.) have a bill that would cap all insulin products at $35 per month for people with private insurance and would also extend that discount to the uninsured. 

On Friday, Sens. Susan Collins (R-Maine) and Jeanne Shaheen (D-N.H.) introduced their own bill. 

It would cap privately insured patients’ insulin costs at $35 or 25 percent of list price per month for at least one insulin of each type and dosage form. It doesn’t address the uninsured. 

Their legislation would require PBMs to pass 100 percent of the rebates and discounts they negotiate on the manufacturer’s insulin list price to the health insurers, which could help lower premiums.

It would also create a new expedited Food and Drug Administration (FDA) approval pathway for biosimilar products without adequate competition, so that there can be alternatives on the market more quickly. 

The FDA has only approved two biosimilar insulin products that are interchangeable with brand-name products.