Bernie Sanders-led Senate committee takes pharma and PBMs to task—even after insulin price cuts

After years of public pressure, the industry’s leading diabetes players recently made the landmark decision to slash insulin prices by around 70%. But the companies, along with pharmacy benefit managers (PBMs), aren’t off the hook just yet.

The Senate Committee on Health, Education, Labor and Pensions (HELP) met Wednesday to press pharma and PBM leaders in a hearing dubbed "The Need to Make Insulin Affordable for All Americans." In effect, bringing in both sets of executives together allowed them to play the blame game on the Senate floor.

Eli Lilly’s CEO David Ricks, Novo Nordisk’s chief Lars Fruergaard Jørgensen and Sanofi’s head Paul Hudson all offered testimony, along with CVS Health’s executive vice president and president of pharmacy services David Joyner, Express Scripts President Adam Kautzner and OptumRx CEO Heather Cianfrocco.

While Lilly, Novo and Sanofi have heard insulin pricing criticism plenty of times before, PBMs haven’t caught as much congressional heat—yet. During the hearing, the committee made sure to fire questions, and heated commentary, at the PBM leaders along with the pharma chiefs.

Sen. Markwayne Mullin, R-Oklahoma, called PBMs “the fox guarding the henhouse,” going after the executives for essentially “rebating themselves." He said the situation “isn’t working for America.”

At the hearing, all three pharma chiefs committed to “keeping their drugs affordable,” including Lilly’s Mounjaro upon its potential approval for weight loss.

But asked whether the companies would no longer raise prices on their existing insulins, only Ricks gave a definitive answer. The Sanofi and Novo Nordisk chiefs did not.

Further, the CEOs pointed out that PBMs don't always go for the lowest list prices. Oftentimes, PBMs choose higher-priced products to get larger rebates.

On this topic, the three PBMS execs committed to placing low-cost insulins on their formularies.

Even after the insulin price cuts earlier this year, there's still work to be done, the senators argued. The committee harped on inflated U.S. drug prices compared with other countries, including the high prices of new medicines.

Sen. Bernie Sanders, I-Vermont, chairman of the HELP committee, and Rep. Cori Bush, D-Missouri, proposed legislation in March to “finish the job” and cap the price of insulin at no more than $20 per bottle.

“This committee is going to stay on this issue," Sanders said Wednesday. "We need profound change in the industry and in PBMs."