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).

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

Sources: IPD Analytics and Uptodate