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PDAB reviews insulin (glargine) data; staff to correct unit and WAC assumptions before vote
Summary
Board members reviewed carrier and APAC data on insulin glargine products and questioned assumptions used to compute per‑supply prices and WAC/WACC comparisons. Staff committed to check unit assumptions (600 units per 30‑day supply) and update packets; voting is scheduled for January after packet updates and additional data review.
The Oregon Prescription Drug Affordability Board devoted part of its Oct. 15 meeting to a technical review of data for seven insulin glargine products that are part of this year’s drug reviews. Staff presented both APAC gross spend tables and a data‑call sample from 11 carriers that included net prices and price concessions; board members pressed staff on units, price indices and aggregation methods.
Why it matters: Insulin is a high‑volume therapeutic with significant patient and system impacts; accurate per‑supply units, rebate accounting and consistent price metrics are essential for the board’s affordability determinations.
Key details and data issues: Staff displayed tables that show payer gross spend, price concessions and net cost per claim. Board members noted the carrier sample does not include Medicaid/Medicare and therefore cannot be extrapolated to statewide net spending without caveats. Dr. Dan Hartung observed significant rebate/discount percentages in the carrier sample for some glargine products, and staff confirmed the discounts align roughly with literature expectations for insulin rebates.
A critical data correction: Staff used a clinical assumption of 600 units for a 30‑day supply when calculating WAC and per‑supply figures. Several board members and pharmacists said that assumption produced implausible per‑supply costs (one board member noted the numbers appeared to be orders of magnitude too large for a 30‑day vial). Pei (staff) said she would verify unit assumptions and correct the calculations before updated material packets are posted: "I will check on that and then, circle back to this next month," she told members.
Market developments: Staff noted some manufacturers (Sanofi for Lantus and Lantus SoloStar) have committed to lower list prices in 2024–25; members said that will affect future APAC comparisons but may not be reflected in the retrospective dataset used for current reviews.
Access and plan design: The packet showed percent of plans imposing prior authorization, step therapy or nonpreferred coverage. Board members asked staff to develop a combined binary metric that flags whether any utilization edit or noncoverage exists for a drug across reporting carriers so that the rubric can capture an overall access burden while avoiding identification of individual plans.
Next steps: Staff will correct unit/WAC assumptions, finalize carrier and APAC tables and post updated drug packets; the PDAB will discuss the finalized packets in November/December and hold votes on whether each drug presents an affordability challenge in January.
