Alerts & News

NE AACE Chapter Letter in Support of MA Senate Bill 712

posted: April 8, 2019

Honorable Cindy F. Friedman
Chair — Joint Committee on Health Care Financing
24 Beacon Street, Room 413-D
Boston, MA 02133

Honorable Jennifer E. Benson
Chair — Joint Committee on Health Care Financing
24 Beacon Street, Room 236
Boston, MA 02133

Dear Senator Friedman and Representative Benson,

We are writing on behalf of the New England Chapter of the American Association of Clinical Endocrinologists (AACE) to support S712 — An act to promote transparency and prevent price gouging of pharmaceutical drug prices. The membership of our Chapter includes over four hundred clinical endocrinologists in New England. Although S712 pertains to pharmaceutical drug prices in general, we would like to specifically comment on insulin costs. Insulin is an essential medication to the over 120,000 residents of Massachusetts who take it one or more times a day for the purpose of controlling their blood sugar levels. The approximately 30,000 Massachusetts residents who have type 1 diabetes depend on multiple daily doses of insulin for their survival. According to a recent review by the American Diabetes Association (ADA), list prices of insulin have risen precipitously in recent years. Between 2002 — 2013, the average price of insulin has nearly tripled. Pricing of drugs in general, and for insulin specifically, is very complex. According to an ADA working group, it is unclear how the dollars flow and how much each intermediary profits in the insulin supply chain. There is general consensus that this lack of transparency is a significant barrier to cost containment.

Unfortunately, individuals with diabetes are often forced to choose between purchasing their insulin supply or paying for other necessities of life. As endocrinologists, we are all aware of insulin treated patients who have rationed their insulin supply with significant health consequences. We all agree that access to affordable insulin is essential for our insulin-treated patients with diabetes.

In addition to supporting transparency of the insulin supply chain, our organization also supports the creation of a state-wide organization to purchase insulin-analogues for the entire population of the Commonwealth. There are multiple manufacturers for the two general categories of analog insulin (long-acting and rapid-acting), and we believe the Commonwealth would be able to obtain a deep discount for one product in each of the two categories if it used the buying power of the more than six million residents of Massachusetts. We believe insulin manufacturers would give a deep discount to the Commonwealth in exchange for the ability to capture most of the market for their product within one of the two categories of insulin. Much of the price to purchase analog insulins is going to the pharmacy benefit managers (PBMs) who act as middlemen and purchase the insulin directly from manufacturers. Since people frequently change their health insurance as they change jobs or their employer changes their insurance options, individuals with diabetes often need to change the type of insulin they are taking. Furthermore, insurance companies frequently change the insulins on their formulary. All of these activities lead to the need for individuals with diabetes to change the insulin they are taking, which is disruptive to the care of these patients and for those health care professionals who prescribe insulin products. If the Commonwealth were to create a state-wide purchaser of insulin (essentially a PBM for Massachusetts), it could negotiate for a deeply discounted price for one of the long-acting insulin analogs currently available (brand names include Tresiba, Lantus, and Basaglar) and one of the rapid-acting insulin analogues (brand names include Humalog, NovoLog, Apidra, Admelog and Fiasp ).

On behalf of the New England Chapter of the American Association of Clinical Endocrinologists, we would like to thank the committee for their commitment to ensuring patients in Massachusetts have access to lower cost medications. We agree that prescription drug costs need to be transparent as possible. In conjunction with Massachusetts Chapter of the American College of Physicians, we support S712 as a means to allow our patients to afford insulin and other life saving medications.

Sincerely yours,

Barry Z. Izenstein M.D. MACP, FACE
President, New England AACE

New England AACE Legislative Committee: Miguel A. Ariza, MD, ECNU, Richard Haas, MD, FACE William Sullivan, MD, FACP, FACE.