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ProAct's Insulin Price and Formulary Strategy

On March 14, 2023, Novo Nordisk announced price cuts to several prefilled insulin pens and vials, which will be effective starting on January 1, 2024. Outlined below are the 1/1/24 status of these medications on ProAct’s formulary as well as the associated percent decrease in price effective 1/1/24, decreases in price, range from 50-75% off current wholesale acquisition cost (WAC).

ProAct's Insulin Price and Formulary Strategy hero image

Novo Nordisk Product

Vial or FlexPen

Current Price (WAC)

ProAct’s Core Formulary

ProAct’s Advantage Formulary

Preferred Alternative

Price Effective 01/01/2024

Percentage Decrease

NovoLog
(insulin aspart)

Vial

$289.40

Non Preferred

Excluded

Humalog

$72.34

75%

FlexPen

$558.90

Non Preferred

Excluded

Humalog

$139.71

NovoLog Mix
(insulin aspart protamine/insulin aspart) 70/30

Vial

$300.10

Non Preferred

Excluded

Humalog Mix

$72.34

FlexPen

$558.90

Non Preferred

Excluded

Humalog Mix

$139.71

Insulin aspart
(unbranded Novolog)

Vial

$144.70

Non Preferred

Excluded

Humalog

$72.34

50%

FlexPen

$279.45

Non Preferred

Excluded

Humalog

$139.71

Insulin aspart protamine/insulin aspart
70/30 (unbranded NovoLog Mix 70/30)

Vial

$150.10

Non Preferred

Excluded

Humalog Mix

$72.34

52%

FlexPen

$279.45

Non Preferred

Excluded

Humalog Mix

$139.71

50%

Levemir
(insulin detemir)

Vial

$308.10

Non Preferred

Excluded

$107.85

65%

FlexPen

$462.15

Non Preferred

Excluded

$161.77

Novolin

Vial

$137.70

Non Preferred

Excluded

Humulin

$48.20

FlexPen

$260.25

Non Preferred

Excluded

Humulin

$91.09

 

On March 16, 2023, Sanofi announced price cuts to and a cap on out-of-pocket costs for Lantus (insulin glargine) at $35 for all patients with commercial insurance. Both changes will be effective on January 1, 2024. Lantus is preferred on ProAct’s Core formulary and excluded on ProAct’s Advantage formulary. Sanofi also announced it will cut the list price of Apidra (insulin glulisine) by 70%. Apidra is not preferred on ProAct’s Core formulary and excluded on ProAct’s Advantage formulary.

On March 1, 2023, Lilly announced the price of the second interchangeable biosimilar to Lantus, Rezvoglar (insulin glargine). Lilly stated that a five-pack of Rezvoglar KwikPens will be priced at $92, which is a 78% discount to Sanofi’s Lantus (insulin glargine). This price was made effective starting on April 1, 2023.

  • Rezvoglar (insulin glargine) is not preferred on ProAct’s Core formulary and excluded on ProAct’s Advantage formulary.

  • Lilly also announced it will cut the prices of Humalog and Humulin by 70% (effective 4Q 2023) and priced its unbranded Humalog at $25 a vial (effective May 1, 2023). Lilly will cap out-of-pocket costs at $35 per month for individuals with commercial insurance who are obtaining its insulin products from participating retail pharmacies. Humalog products are preferred on both ProAct’s Core and Advantage formulary.

The table below compares the short-acting insulins, Novo’s NovoLog and Lilly’s Humalog, following the announced price reductions of 70% and 75% off of WAC respectively.

Product

Vial or Pen

Current Price (WAC)

Price Effective 4Q 2023

Price Effective 01/01/2024

Percentage Decrease

NovoLog (insulin aspart)

Vial

$289.40

$72.34

75%

FlexPen

$558.90

$139.71

Humalog (insulin lispro)

Vial

$274.70

$82.41

70%

FlexPen

$530.40

$159.12

 

Below are commonly used insulin types and their onsets and durations.

Prandial Insulin

Insulin Type

Approximate Onset of Action

Effective Peak

Approximate Duration of Action*

Lispro, lispro-aabc, aspart, faster aspart, glulisine#

15 to 30 minutes

1 to 3 hours

4 to 6 hours

Regular

30 minutes

1.5 to 3.5 hours

8 hours

Basal Insulin

Insulin Type

Half-life^

Effective Peak

Approximate Duration of Action*

NPH

4.4 hours

4 to 6 hours

12 hours

Insulin glargine
(U-100)

12 hours

No pronounced peak

20 to >24 hours

Insulin glargine
(U-300)

19 hours

No pronounced peak

20 to >24 hours

Insulin detemir

5 to 7 hours

3 to 9 hours

6 to 24 hours~

Insulin degludec
(U-100, U-200)

25 hours

No pronounced peak

>24 hours

 
* Glucose-lowering action may vary considerably in different individuals or within the same individual; the duration of action is dose dependent.
 
# Lispro-aabc and faster aspart have quicker pharmacokinetic profiles than standard lispro and aspart.
 
^ In general, it takes 4 half-lives to reach steady state. Dose adjustments should not be made until after steady state is achieved.
 
~ At higher doses (>0.8 units/kg), mean duration of action is longer and less variable (22 to 23 hours).
 

Sources: IPD Analytics and Uptodate

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