$25 List Price + $35 Copay Caps: Lilly’s New Insulin Cost Reductions
Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can find which cost-saving tools you may qualify for through our tool GetInsulin.org.
On March 1, 2023, Lilly announced insulin list price and out-of-pocket cost reductions in the United States. These measures build upon Lilly’s $35 copay program (initially launched in April 2020) and include the May 1 launch of Insulin Lispro (non-branded Humalog®) at a $25 per vial list price, as well as future list price reductions for Humalog and Humulin® insulins.
What to know now
Starting now for people with commercial insurance, Lilly will automatically cap out-of-pocket insulin costs at $35 per month per type of insulin at participating retail pharmacies. Approximately 85% of U.S. retail pharmacies are participating. There is no limit to the number of vials or pens that can be covered each month as long as they are prescribed, but there is a $16,000 annual coverage limit. This process removes the step of downloading Lilly’s existing $35 copay card for those with commercial insurance.
Available since April 2020, people with no health insurance coverage can use the Lilly Insulin Value Program savings card to cap out-of-pocket costs at $35 per month per type of insulin. This savings card will also work for those with commercial insurance who use retail pharmacies not participating in the automatic out-of-pocket cap. You can go to InsulinAffordability.com to immediately download the pharmacy card.
People covered under Medicare can sign up for specific coverage plans that cap out-of-pocket insulin costs at $35. Learn more about the program here and about Medicare coverage for diabetes here.
What else is coming
Starting April 1, the list price of a five-pack of RezvoglarTM KwikPens® will be $92. Rezvoglar is basal insulin glargine-aglr, which is biosimilar to and interchangeable with Lantus®, basal insulin glargine. This list price is a 78% discount compared to Lantus.
Starting May 1, the list price of one vial of Insulin Lispro Injection 100 units/mL will be $25. Insulin Lispro is non-branded Humalog, Lilly’s brand of rapid-acting insulin. It is not a biosimilar but is the same exact medication without the Humalog branding. Insulin pricing advocates have called for significant list price reductions as a primary measure needed to address the U.S. insulin pricing crisis.
The list price of Humalog—rapid-acting insulin lispro, the most commonly prescribed Lilly insulin—will be cut by 70% beginning in Q4 2023. Vials will be between $82-$86 while a five-pack of pens is expected to cost $92.
Actual out-of-pocket costs will be based on insurance coverage and participation in the $35 copay cap at participating pharmacies or through the Lilly Insulin Value Program savings card. This price reduction most significantly helps those facing the full list price of Humalog—those who don’t have or are unable to get health insurance.
The list price of Humulin—a short-acting human regular insulin—will be cut by 70% beginning in Q4 2023. Vials will be between $82-$86 while a five-pack of pens is expected to cost $92.
Actual out-of-pocket costs will be based on insurance coverage and participation in the $35 copay cap at participating pharmacies or through the Lilly Insulin Value Program savings card. This price reduction most significantly helps those facing the full list price of Humulin—those who don’t have or are unable to get health insurance.
Important to note: Humulin is a type of analog insulin. This means it absorbs and works at a different rate than modern insulins like Humalog or other brands of insulin lispro options. Analog insulins are typically less expensive, but switching between modern and analog insulins should be done with great care and attention to blood sugar levels, ideally with the help of your diabetes care team. For those who use or prefer analog insulins, several cost-saving options are already available. For those with insurance, a copay card may bring your cost down to $25 per month. Walmart also offers regular human insulin under the ReliOn brand for $25 per vial regardless of insurance coverage. Read about one person’s experience switching between modern and analog here.
The bottom line
Insurance coverage is confusing and often has gaps and rapidly changing coverage policies. Pharmacies don’t always know which programs people qualify for or how a prescription should be run through the system for the most savings. But if you use Lilly insulins, with these expanded cost-saving programs, you should not be paying more than $35 out of pocket per insulin type for your monthly insulin needs. If your insurance or pharmacy tells you otherwise after presenting your Lilly Insulin Value Program savings card, reach out to Lilly’s Diabetes Solution Center for assistance at 1-833-808-1234.
If you use other brands of insulin, like Sanofi or Novo Nordisk, there are cost-saving programs available that typically cap costs at no more than $100 per month, with or without health insurance. Go to our tool GetInsulin.org to create an action plan based on your specific circumstances. Your action plan will provide a list of which cost-saving programs you may qualify for.
With new insulin companies like Civica Rx soon to enter the market, Beyond Type 1 is eager to see the impact of market competition on cutting the list price and out-of-pocket costs for everyone who relies on insulin, regardless of diabetes type, insurance coverage and socioeconomic status. Learn more about the U.S. insulin pricing crisis here.