Drug Makers Vie for Insulin Market Share, Patients Wait for Relief

Price competition in the US insulin market is heating up; Novo Nordisk reported in its second-quarter earnings call that its 2018 US insulin prices could drop below 2017 levels.

The Danish drug maker said that it is currently negotiating its next-year’s basal insulin prices with pharmacy benefit managers (PBMs) and managed care organizations in the United States. These negotiations are expected to bring the prices, after rebates, lower than the company commanded in the US market during 2017.

While Novo Nordisk believes that market access for its key products will likely remain unchanged compared with 2017, the United States has what CEO Lars Fruergaard Jørgensen called “a tough competitive environment.” The company assured investors it was focusing on new products in order to reach its US financial growth targets, and cited the development of “innovative products within diabetes and obesity care” as an ongoing focus.

Rival drug maker, the France-based Sanofi, has already seen sales for its insulins (Lantus and Toujeo) erode by 23.9% due to competition from European biosimilars and US follow-on insulins such as Boehringer Ingelheim (BI)'s Basaglar.

In an attempt to slow that erosion from new competitors, Sanofi announced this week that it has filed a new patent infringement suit against Merck. The suit follows the FDA’s tentative approval of Merck’s insulin glargine follow-on (Lusduna) referenced on Lantus, and claims that Merck has violated 2 patents for the top-selling innovator insulin. The FDA cannot issue a final approval for Merck’s product until patent infringement litigation brought by Sanofi has concluded.

Novo Nordisk’s price negotiations and Sanofi’s legal maneuvers that attempt to retain market share for their products echo comments made by Steven B. Miller, MD, senior vice president and chief medical officer of the PBM Express Scripts, in a recent webinar hosted by Oncology Business Review. Miller said that he expects that innovator product manufacturers are “going to do everything they can to prevent loss of market share. We’ve already seen this with rituximab, so we see them bundling products together, offering different discounts, and doing all sorts of interesting deals in the marketplace to preserve their market share. I think they’re going to make it extremely hard for biosimilars to penetrate the market.” Even so, he noted that 5 companies are currently engaged in developing follow-ons to Lantus, with $5.6 billion in revenue potentially at stake.

As drug makers fight for a share of insulin profits, many clinicians are focused on seeing prices decline for the benefit of their patients. Robert Gabbay, MD, PhD, FACP, in a recent Peer Exchange™ panel discussion hosted by The American Journal of Managed Care®, said, “From the patient level, it’s, in some ways, a travesty, really. People with type 1 diabetes depend on insulin to stay alive, and the cost of insulin has skyrocketed over the last decade…Unfortunately, this is one of those situations where the patient loses in the end.”

However, Gabbay sees the potential for change ahead: “The good news is that there’s enough of an outcry around this, and it’s been documented, now, in a number of studies to show the plot of increasing insulin costs versus other drugs. We’re on the verge, I think, of seeing something happen to mitigate this issue.”