AmeriHealth Market Edge Article
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February 2022
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Market Edge
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News for All Segments | All brands
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Our position on preferred long‑acting insulin
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You may be aware that there are now biosimilar medications on the market for long‑acting insulins used to manage diabetes. The U.S. Food and Drug Administration (FDA) has approved Semglee® and its authorized generic (insulin glargine‑yfgn) as interchangeable biosimilars to Lantus® (insulin glargine).
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We have continued to designate Lantus® as one of our preferred long‑acting insulin drugs. This is because its corresponding biosimilars are not lower in cost when considering all discounts that are passed along to members or their employer groups.
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Due to manufacturer pricing of these medications, some members may raise questions about what they pay out of pocket at the pharmacy. This depends upon the member's plan and its funding status. These considerations are outlined below.
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Fully insured prescription drug plans
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Members in these plans should have few questions. Since we apply manufacturer rebates at point-of-sale, fully insured members will consistently see that the price of Lantus is more favorable than its biosimilars.
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Self‑funded prescription drug plans
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Members in the deductible phase of high deductible health plans (HDHPs) and, to a lesser degree, members in coinsurance plans may question why we are preferring what appears to be a higher‑priced medication. There are three options available for self‑funded groups to address this concern:
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- Do not make any changes. Explain that when considering all of the discounts available for these medications, Lantus is the lowest cost medication for the plan sponsor to be covering.
- Consider adding the HDHP preventive drug deductible waiver to your HSA‑qualified HDHP. With this waiver in place, the member cost sharing for Lantus will more consistently be lower than that of its biosimilars. Although at this time we do not charge an administrative fee for this feature, the customer would experience increased claims costs as a result of waiving deductibles on preventive medications.
- Consider adding the point‑of‑sale rebate feature to your HDHP or coinsurance plans. This can now be done exclusively for diabetes products, or it can be done for all medications where rebates are available. The rebate amounts that would be applied to reduce the member's out-of-pocket cost at point-of-sale would be funded by the plan sponsor.
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Ongoing assessment
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We will continue to closely monitor the marketplace with respect to these products and review our position as needed. Member disruption and continued access to cost effective medications will be considered.
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