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Congress and other policymakers continue to seek opportunities to lower costs for patients and the federal government. Pharmacy benefit managers (PBMs) are a key stakeholder in the drug supply chain, functioning as intermediaries between insurance providers and pharmaceutical manufacturers.
market, in March 2023 announced that they will cap the cost of insulin for people with private insurance plans. That includes those on employer-sponsored group health plans and plans purchased on a government-run exchange. Three drugmakers, which account for roughly 90% of the insulin in the U.S. for a single vial and $139.71
Reducing out-of-pocketcost-sharing for insulin does mean payers and insurers may be covering a greater share of the costs. However, some of those costs may be offset by increased medication adherence and reduced hospitalization rates, which would end up saving payers money in the long run.
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