Policymakers Call Out Express Scripts Over Rising Insulin Prices

Two members of the United States Committee on Finance made a final document request to pharmacy benefit manager Express Scripts, owned by Cigna, and warned that failure to comply will result in a subpoena to obtain records on insulin prices, according to an official letter. 

Chairman Charles E. Grassley (R-IA) and Ranking Member Ron Wyden (D-OR) wrote the letter to the Express Scripts president, Timothy Wentworth, as part of the committee’s investigation into rising insulin prices. 

“The finance committee seeks to understand how Cigna’s practices impact the operation of these federal programs, the cost to taxpayers, and the out-of-pocket costs patients face,” the letter said.

The committee warned that failure to comply with the requests will result in a subpoena to require production of the records. The company’s unwillingness to cooperate follows the industry-wide pattern of efforts to shed light on pharmacy benefit management (PBM) practices. 

“Americans are demanding answers from PBMs and pharmaceutical companies, and we expect your company to begin providing them promptly,” Grassley and Wyden wrote. “Cigna has failed to even attempt to answer many of the questions we posed.”

“Your failure to comply with the Committee’s requests has reached an endpoint,” Grassley and Wyden concluded, giving a deadline of March 10.

Individuals and families are continuously struggling to keep up with rising insulin costs and are unaware why prices increase for a therapy that has remained unchanged for decades.

In February 2019, Grassley and Wyden began their investigation into the rising price of insulin in the US by questioning three leading insulin manufacturers. Cigna was one of three companies to receive a letter back in April 2019.

The committee has attempted contact with Cigna for nearly a year to voice concerns and pose questions. But despite these efforts, Cigna has not responded, and Grassley and Wyden are noticeably frustrated with the company. 

Additionally, the committee requested records relating to Cigna’s Value Assessment Committee. But Cigna has failed to produce records or cite any objections that would explain the non-compliance. 

As the affordability of insulin continues to be a challenge, more organizations are stepping up to offer potential solutions for the ongoing issue.

Last week, the FDA published a final rule and additional resources to provide useful information to healthcare providers to expedite a smooth regulatory transition of insulin to a biologic – a move that could potentially lead to reduced drug costs and increased market access. 

The new rule is intended to balance innovation and facilitate the development and approval of biosimilar and interchangeable products, which will ensure the market is competitive and patients can afford treatments. 

Biologic drugs may be useful to treat autoimmune diseases, genetic disorders, and diabetes. But when challenges arose over these drugs, the FDA established a framework for a new pathway for manufacturers to bring biosimilar and interchangeable versions of insulin to the marketplace in its 2018 Biosimilars Action Plan (BAP). 

The plan would improve the efficiency and approval process of the biosimilar and interchangeable drug products and maximize scientific and regulatory changes.

Finally, to ensure a smooth transition, lower costs, and boost overall care, the FDA launched two frequently asked questions documents about the transition, one for patients and one for healthcare providers. The documents touch on topics that may not be covered elsewhere. 

“We will continue to communicate relevant information, including the resources we’ve issued today, to make the transition from our statutory framework to another as seamless as possible,” Hahn concluded.