July 13, 2023

New Report From Warren, Warnock, Blumenthal: Uninsured Patients Face Significant Problems Getting Affordable Insulin

Survey of 300+ Pharmacies Found Patients Often Cannot Access Cheaper Generic Insulin; Eli Lilly’s Generic Insulin Costs Almost Four Times More than $25 Target Price 

Report: Unaffordable Insulin: Uninsured Americans Still Face High Costs at the Pharmacy Counter for Eli Lilly’s Authorized Generic (PDF)

Washington, D.C. – United States Senators Elizabeth Warren (D-Mass.), Reverend Raphael Warnock (D-Ga.), and Richard Blumenthal (D-Conn.) released a new investigative report,: Unaffordable Insulin: Uninsured Americans Still Face High Costs at the Pharmacy Counter for Eli Lilly’s Authorized Generic. The report surveyed more than 300 pharmacies around the country to review the cost and availability at the pharmacy counter of Eli Lilly’s authorized generic Insulin Lispro, which it announced would cost $25 per vial – and found that uninsured Americans still face significant challenges to access affordable, generic insulin. The generic insulin cost almost four times as much as Lilly’s $25 target price - and almost half of pharmacies did not have the lower-priced generic in stock. The senators are also releasing a letter from diabetes advocacy group T1International, highlighting stories from patients across the country who cannot access affordable, life-saving insulin, even after Eli Lilly’s promise of $25 Insulin Lispro. 

“No American should ever be forced to choose between life-saving medication, like insulin, and their ability to pay for food, shelter, and their everyday needs,” said Senator Warren. “My new report confirms that far too many uninsured Americans cannot access or cannot afford to pay astronomical prices for life-saving generic insulin – lawmakers need to step up and take action.”

“Manufacturers and insurers have taken steps to make insulin more affordable, but this is not enough to ensure no one has to sacrifice their rent or their groceries to afford the insulin they need to live,” said Senator Reverend Warnock. “I’m proud to work with my friend, Senator Warren, on this important report which makes clear that Congress must do more–and we can start by capping insulin costs at $35 a month for everyone.”

“No report should be necessary to persuade Congress that insulin must be made more affordable, but this document provides irrefutable proof,” said Senator Blumenthal. “Congress must heed this call to action—enacting price caps for all patients and other reforms. Low cost insulin can be matter of life and death.”

The senators’ new report comes after a 2019 investigative report from Senators Warren and Blumenthal: Inaccessible Insulin: The Broken Promise of Eli Lilly's Authorized Generic. The report found, after a months-long survey of nearly 400 pharmacies nationwide, that Eli Lilly’s generic Insulin Lispro was not available in most pharmacies, and that the company had not taken meaningful steps to increase insulin accessibility and affordability.

In August 2022, President Biden signed the Inflation Reduction Act into law, which capped insulin costs for Medicare beneficiaries at $35 per month – saving patients millions of dollars. But Republican opposition prevented passage of broader legislation that would have applied the same $35 copay cap to Americans with commercial insurance. Even then, uninsured Americans – who must pay the full list price of the drug – would have been left with no help at all.

In response to increasing political pressure, the three largest insulin manufacturers – Eli Lilly, Sanofi, and Novo Nordisk – announced price cuts to their insulin products in March 2023. While most of these reductions will go into effect in the last quarter of 2023 or in January 2024, Eli Lilly announced that it would be lowering the price of its generic insulin product, Lispro, to $25 per vial effective May 1, 2023.

The senators’ investigation comes after Eli Lilly’s announcement. Its key findings include: 

  • Patients still face significant problems obtaining affordable Insulin Lispro. Patients often do not have ready access to Lispro, the cheaper generic insulin. Nearly half – 43% – of surveyed pharmacies reported that they did not stock the inexpensive, generic insulin. In contrast, 79% reported that they stocked the more expensive brand name, Humalog.
  • Many patients are still forced to pay high prices for insulin. The average Lispro price for uninsured patients at surveyed pharmacies was $97.51 – nearly four times as high as the $25 price point that Eli Lilly promised for its authorized generic. Seven pharmacies charged $200 or more, and two sold Lispro for over $300.
  • Patients must unravel a confusing thicket of coupons, competing generic drugs, and misleading information to get their insulin. In many cases, unless patients are explicitly asking about the drug, they may not learn about the availability of lispro, limiting the benefit of announced price cuts. Additionally, Eli Lilly’s own savings program is difficult to navigate and includes several restrictions based on geography or needs, frequently resulting in patients paying much more than $25, even when the drug is available.

Senator Warren has led the fight to lower drug prices and ensure all Americans have access to lifesaving medications: 

  • In June 2023, Senators Warren and Angus King (I-Maine), and Representative Lloyd Doggett (D-Texas) sent a letter to Department of Commerce Secretary Gina Raimondo and Department of Health and Human Services Secretary Xavier Becerra asking for information on the membership, process, timeline, and scope of work of the recently announced Interagency Working Group for Bayh-Dole. They called on the agencies to move swiftly to lower drug prices for Americans. 
  • In April 2023, Senator Warren and Representative Pramila Jayapal (D-Wash.) sent a letter to Kathi Vidal, Director of the United States Patent and Trademark Office (USPTO), calling on USPTO to take immediate action and use its existing administrative authorities to help lower drug prices and hold pharmaceutical companies accountable for anti-competitive business practices. 
  • In February 2023, Senators Warren and Bernie Sanders (I-Vt.) and Representatives Jayapal and Katie Porter (D-Calif.) sent a letter to the USPTO, calling on the agency to give close scrutiny to any of Merck’s requests for new patents for Keytruda, a biological treatment used to treat cancer, citing new reports about Merck’s ongoing abuse of the patent system to protect its monopoly on the drug. 
  • In January 2023, Senators Warren and King and Representative Doggett led their colleagues in sending a follow-up letter to Health and Human Services Secretary Xavier Becerra that urged the Secretary to exercise his authority to lower the price of cancer treatment drug Xtandi. 
  • In December 2022, Senator Warren and Representative Jayapal sent a letter to Director Kathi Vidal following up on their June 2021 letter about USPTO’s efforts to hold pharmaceutical companies accountable for anti-competitive business practices and tackle high drug prices.
  • In June 2022, Senators Warren and King and Representatives Doggett, Joaquin Castro (D-Texas), Sara Jacobs (D-Calif.), and Porter led a group of 100 members from across the ideological spectrum to urge Health and Human Services Secretary Xavier Becerra to swiftly act and use his existing authorities to lower prices on critical prescription drugs.
  • In April 2022, Senator Warren sent a letter to Secretary Becerra, sharing the findings from a letter that over 25 legal and public health experts sent to her outlining three powerful legal tools the Biden administration could use to lower drug prices. 
  • In March 2022, Senator Warren and her colleagues called out drug manufacturers for squeezing American families with rapid and widespread price hikes on prescription drugs.
  • In February 2022, Senators Warren and King and Representative Doggett urged HHS to exercise its march-in rights for the life-saving cancer drug Xtandi to dramatically lower its price for millions of Americans.
  • In June 2021, Senator Warren led a letter questioning PhRMA's lobbying efforts to block policies that would lower drug costs for millions of Americans.
  • In December 2019, Senator Warren and Representative Jan Schakowsky (D-Ill.) reintroduced the Affordable Drug Manufacturing Act, an ambitious proposal to address the skyrocketing price of prescription drugs. The bill would lower prices and increase competition in the generic pharmaceutical market by establishing an Office of Drug Manufacturing within the Department of Health and Human Services tasked with manufacturing select generic drugs and offering them to consumers at a fair price that guarantees affordable patient access.
  • In December 2019, Senators Warren and Blumenthal released a new investigative report: Inaccessible Insulin: The Broken Promise of Eli Lilly's Authorized Generic, which found that Eli Lilly’s lower-priced, authorized generic insulin is widely unavailable in pharmacies across the country, and that the company has not taken meaningful steps to increase insulin accessibility and affordability.