U.S. senators press pharma executives on cost of insulin, prescription medications

WASHINGTON — U.S. senators sparred with pharmaceutical companies and pharmacy benefit managers during a Wednesday hearing on the costs of insulin and other prescription medications. 

Louisiana Sen. Bill Cassidy, the top Republican on the panel and a physician, noted that a century ago a diabetes diagnosis was essentially a death sentence for patients before the prevalence of insulin.

When he graduated from medical school, Cassidy said, management of the illness was much more challenging than it is with today’s insulin. 

“It goes without saying in that time period, we’ve had a remarkable increase in the quality of life,” Cassidy said, before questioning whether that matters if patients cannot afford the medicine that allows them to stay alive. 

“The ability to afford the insulin is equally important to the innovation that may have occurred because if you can’t afford the innovation it’s as if the innovation has never occurred,” Cassidy said. 

Democrats’ signature climate change, health care and tax package enacted last year capped the cost of insulin for Medicare at $35 per month. 

Democrats tried to include language in that package, known as the Inflation Reduction Act, that would have capped the cost of insulin for all consumers at that price, but the GOP successfully removed that element from the measure. 

Sen. Bernie Sanders, a Vermont independent and chairman of the Health, Education, Labor and Pensions Committee, said that 1.3 million Americans are rationing their insulin while “all over the world people are paying a fraction of the price, not only for insulin but for other drugs.”

Sanders urged the witnesses to think about the people who die because they can’t afford medicine.

“I, for the life of me, just don’t understand how, when you have something that saves a life and it costs you a few bucks to manufacture … why we can’t make that product available to all at a price that they can afford,” Sanders said. “That is a moral issue, so we’ve got a lot of work to do. But we clearly need revolutionary changes in the way we do prescription drugs in this country.”

Wisconsin Democratic Sen. Tammy Baldwin recalled previously asking officials about the array of prices for insulin and being told that “it’s complicated.”

“One thing I can say when we look at people over profits, is greed is not complicated,” Baldwin said before getting the six witnesses to confirm stock buybacks their companies or patient companies issued during 2022.  

Maine Republican Sen. Susan Collins told a story about a hearing she held in the Senate Aging Committee on why the cost of insulin was so high, including a father who traveled to Canada to purchase affordable insulin for his son. 

“What we found was a system of getting insulin from the manufacture to the customer that was rife with perverse incentives, convoluted and opaque  — so opaque that the witness we had, who had done the study on the system, could not fully explain the chart showing all the links,” Collins said. 

Collins criticized the system that’s in place to manufacture and move pharmaceuticals through pharmacies to consumers, saying it defies logic. 

“I think we have a very strange system here to say the least, because most of us would think that the rebate, the discount that is negotiated by the (pharmacy benefit managers) would largely benefit the consumer at the pharmacy counter,” Collins said. “But, in fact, it goes to the PBMs themselves, and it goes to the plan sponsor.”

David Ricks, chair and chief executive officer at Eli Lilly and Company in Indiana; Lars Fruergaard Jørgensen, president and chief executive officer at Novo Nordisk in Denmark; Paul Hudson chief executive officer at Sanofi in France; David Joyner, executive vice president and president of pharmacy services at CVS Health in Rhode Island; Adam Kautzner, president of Express Scripts in Missouri; and Heather Cianfrocco, chief executive officer at OptumRx in Minnesota, all testified before the committee. 

Ricks, Jørgensen and Hudson all testified that their companies ensure that customers pay less than $35 for all of their insulin products. 

All three later testified that they have programs in place to help people in the United States who don’t have health insurance to access insulin for less than $35.