Express Scripts' $25 insulin cap led to lower costs, better adherence to diabetes treatment, study finds

Express Scripts' $25 insulin cap program has slashed patient cost-sharing in half and improved diabetes treatment adherence, according to a new study published June 16 by Cigna health services subsidiary Evernorth.

Express Scripts, Cigna's pharmacy benefit manager, launched the Patient Assurance Program  in 2020 to ensure patients with diabetes in participating plans did not pay more than $25 for a 30-day supply of insulin. The program has since been expanded to include certain non-insulin diabetes treatments with copays capped at $25 for up to a 34-day supply.

Four key takeaways:

  1. In 2021, enrolled members improved adherence to their Type 2 diabetes treatments by 2.5 percent. For enrolled members with household incomes less than $50,000, adherence increased 5.7 percent.

  2. In 2021, approximately 220,000 enrolled members received relief totaling $42.7 million. With the addition of cardiovascular therapies in 2022, savings are expected to reach approximately $60 million this year.

  3. Enrolled members' total diabetes-related cost share, including medical and pharmacy costs, decreased 50.5 percent.

  4. Outpatient costs were 18.6 percent lower, inpatient costs were 17.7 percent lower and emergency room costs were 12.1 percent lower.

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