Dr Alan Carter on the Steps to Managing Rising Insulin Costs

Legislators and Congress need to be pressured to achieve more price transparency in order to manage the high costs on insulin says Alan Carter, PharmD, principal investigator and senior advisor at MRIGlobal, and adjunct faculty at University of Missouri­—Kansas City School of Pharmacy.

Transcript (slightly modified)

What steps can be taken to manage the rising costs of insulin?

I believe that the best step to take, and it’s just my opinion, is that we need to pressure legislators and Congress, or the Federal Trade Commission if it’s a more appropriate short step, to start regulating the pharmacy benefit manager (PBM) industry as if it were a utility. They are currently in a monopolistic state, they contribute very little to the impact on patients, other than getting in the way, they just simply facilitate payments. Because they maintain that infrastructure, and its very inexpensive to maintain, they make a disproportionate amount of money that does not get returned to the consumer in a significant fashion.

So, there is a lot of hidden things that get in the way and we need more transparency. The only way to get more transparency, I think, is to call them a utility and step in and say here is what you’re going to do. We are going to regulate how much you get to raise your prices because you are performing an essential consumer service that the backbone of the nation’s health is built on.

Do you expect these steps to occur in the coming years?

That will only happen if we take a village approach, where everybody pitches together and we recognize that the manufacturers may have to be more transparent on their pricing scales and the PBMs need to be more transparent. Everyone is going to have to lose a little. The PBMs will probably lose the most, which is not going to make them happy and they are going to put a lot of money into politician’s pockets to stop this from happening. I don’t know how to best do that but I think through the Federal Trade Commission and grassroots efforts, like through the American Diabetes Association and other organizations, the American Medical Association needs to be involved. Everybody needs to be on board of how to get this under control because it doesn’t just affect diabetes patients, it affects any patient on chronic care that’s using any brand-name product.

How will stakeholders need to work together to bring insulin pricing under control?

It will take all of us working together and understanding that we’re going to disagree at times and we are going to agree at times to come to the best compromise possible. We can’t be Congress, we have to make a decision, whether it be the best one or not, make the best one we can at the time, get the most consensus, and move forward to the next step. You can’t eat an elephant in one bite, you have to do it one bite at a time, and we really are tackling an elephant right now in healthcare.