December 16, 2019

Senators Warren and Blumenthal Release Investigation Revealing Diabetes Patients' Lack of Access to Lower-Priced Insulin

Despite Promises, Eli Lilly's Less Expensive Authorized Generic "Insulin Lispro" Widely Unavailable in Pharmacies

Report (PDF)

Washington, D.C. - United States Senator Elizabeth Warren (D-Mass.), a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Senator Richard Blumenthal (D-Conn.) today released the findings of a months-long survey of nearly 400 pharmacies nationwide regarding the availability of pharmaceutical company Eli Lilly's authorized generic insulin, "Insulin Lispro." The investigative report, Inaccessible Insulin: The Broken Promise of Eli Lilly's Authorized Generic, concluded 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.

"This report shows that pharmaceutical giant Eli Lilly has not lived up to its promise to provide a lower-priced insulin to patients who need it," said Senator Warren. "With rising prescription drug costs squeezing families in every part of the country, Congress must bring drug prices down for consumers, hold drug companies accountable for needless price hikes, and encourage more competition in the prescription drug market."  

"Our report shows that Eli Lilly has failed to deliver on its promise to put a more-affordable insulin product on the shelves," said Senator Blumenthal. "Instead of giving patients access to its generic alternative, this pharmaceutical behemoth is still charging astronomical prices for a drug people require daily and cannot live without. Congress needs to step up and take action on skyrocketing drug prices."

For many of the more than 30 million Americans living with diabetes, insulin is an essential medicine that helps the body process glucose derived from food. Without glucose (and the insulin necessary to process it), the human body cannot function properly. Three pharmaceutical companies -- Sanofi, Nordisk, and Eli Lilly -- produce over 80% of the global insulin supply and have taken advantage of limited market competition by steadily increasing insulin prices, even though experts estimate drug manufacturers could profitably produce insulin for $7 to $11 per patient per month. Little generic competition exists in the insulin market, further contributing to increased prices.

Patients, caregivers, and advocates have raised alarms about the life-threatening insulin price increases. In response to this public pressure, manufacturers have announced measures that they claim will help reduce patients' out-of-pocket drug costs-including the introduction of so-called "authorized generics." Unlike true generics, which are produced by competing companies, authorized generics are the same drug sold by the original manufacturer at a slightly discounted price.

In March 2019, Eli Lilly announced that it would produce an authorized generic version of Humalog, "Insulin Lispro," and promised that it would "work quickly with supply chain partners to make [the authorized generic] available in pharmacies as quickly as possible." However, in the months after Eli Lilly's announcement, anecdotal reports raised questions about the availability of "Insulin Lispro" in local pharmacies.

To assess the impact of authorized generics, like "Insulin Lispro," on patients' access to insulin, the offices of Senators Warren and Blumenthal conducted a national telephone survey of pharmacies to determine if they had access to, and were providing patients with, the lower-cost authorized generic version of Humalog insulin. The investigation revealed:

  • Eli Lilly's authorized generic insulin, "Insulin Lispro," is not widely available in pharmacies across the country. In 83% of pharmacies surveyed, the less expensive, authorized generic promised by Eli Lilly was not in stock and available for consumers. In 14 states, not one of the up to eight surveyed pharmacies had the generic version of the drug in stock; in 17 states, the drug was only available in one surveyed pharmacy. And in most cases (69%), pharmacies that did not have the generic drug in stock indicated that they could not order the drug, even if the consumer did not need it immediately. 
  • Pharmacies are unaware of, and not adequately informing consumers about, the availability of Eli Lilly's authorized generic insulin. In many cases, consumers cannot get the generic version of a drug if they do not know to ask for it - and they rely on pharmacies to inform them when generics are available. But this survey revealed that, even when pharmacies have the authorized generic version of Humalog, they do not proactively offer it to consumers. Only half of the limited number of pharmacies that had the authorized generic in stock offered it as a first option for consumers. In total, only 15% of pharmacies offered the authorized generic without prompting.
  • Eli Lilly has not taken meaningful steps to increase patient access to insulin. The results of the survey suggest that Eli Lilly's introduction of a lower-cost alternative has not translated to lower-costs for patients, who are not able to access the authorized generic. Eli Lilly has failed to take consequential steps -- such as simply lowering the list price of Humalog, as it has in foreign markets -- to provide lower-cost access to this important diabetes drug.

The senators' report concluded by urging Eli Lilly to lower the list price of its insulin and calling for Congress to take steps to enact systemic change to reduce drug prices nationwide.

A member of the Senate HELP Committee, Senator Warren has been a leading voice in Washington calling for lower prescription drug prices since joining the Senate in 2013.

In December 2018, Senator Warren and Representative Jan Schakowsky (D-Ill.) introduced the Affordable Drug Manufacturing Act, a bill that would allow the federal government to develop generic drugs -- including insulin -- in cases where the market has failed. Senator Warren is a co-sponsor of the Medicare for All Act of 2019, a bill that would ensure that no family goes broke paying for prescription drugs. Senator Warren has also co-sponsored the Medicare Drug Price Negotiation Act, a bill that would permit the Centers for Medicare & Medicaid Services to negotiate the prices of prescription drugs offered through the Medicare program; the Affordable and Safe Prescription Drug Importation Act, a bill that would allow for the safe importation of drugs from countries like Canada; and the Affordable Medications Act, a bill that would-among other provisions-promote the development of generic drugs.