Leading the way by capping insulin at $25 per month. That’s not a middleman. That’s an advocate.

More than 1 in 10 Americans have diabetes, and another 1 in 3 are pre-diabetic. This disease is one of the great challenges facing patients and presents an incredible affordability strain for the entire health system. Many other chronic conditions are also linked to diabetes, which is why good management of the disease and affordable treatments is so essential.

In addition to lifestyle changes, insulin adherence is critical to the health and wellness of people living with diabetes, but the high price of insulin makes medication access an obstacle for too many. The soaring cost has become a major focus of policymakers at the state and federal levels. 

Evernorth and Express Scripts took our own action, launching an industry-first Patient Assurance Program (PAP) that caps member copays at $25 for a 30-day supply of insulin and certain oral medications for diabetes. Enrollment in this program has steadily increased over time, reaching 11 million covered lives in 2023 and producing significant savings: 

• Patients in PAP saved more than $18 million in 2022 alone and more than $45 million in total since 2020 in the program. 
• In 2023, PAP saved plan sponsors $92 million in total, including $87 million for insulin. 
• Overall, PAP has delivered more than $225 million in savings for insulin and other diabetes medications since its launch. 
• PAP enrollees were also 30% more likely to continue insulin treatment compared with non-PAP enrollees – resulting in a significant reduction in total medical cost (15.9%-16.3% change) to the benefit of plan sponsors and patients.

Separately, in 2022, Express Scripts added Semglee, the first interchangeable insulin biosimilar, to our largest formulary as part of our ongoing efforts to drive access to lower-cost biosimilars (clinically equivalent alternatives to high-cost biologic drugs) and improve insulin affordability. As a result, plan sponsors saved an estimated $20 million in 2022 alone. 

Across all lines of business – including plans with and without PAP, our patients spent less than $23 out-of-pocket for insulin per month.  This represents a 43% decrease in out-of-pocket costs since 2020.