“Novo Nordisk works to ensure people with diabetes have affordable access to our insulins
through patient support programs and by negotiating with insurers and PBMs for formulary
access with affordable co-pays. In 2016, we described how the demand for rebates,
discounts, fees and other price concessions affected the list price of our insulins and that we
spent 59 cents of every dollar of our total US gross sales for access. That number rose to 71
cents per dollar in 2019 totaling more than $20 billion. As a result, our net prices on insulins
declined between 2015 and 2019. Unfortunately, the healthcare market’s broader shift to
pushing costs down to patients has increased the number of people who struggle to afford
medicines overall.
Our commitment to access is matched by our commitment to developing innovative
medicines. In the last five years, we’ve launched four new insulins and continued supporting
our legacy insulins to meet the growing global prevalence of diabetes. There are
tremendous research and development costs associated with producing new medicines,
including the significant financial resources expended on the many drug candidates that
never make it to market. And, after development, producing and distributing our insulins is
complex, requiring raw materials, labor, facilities and a host of other factors.
We are very serious about our commitment to support people having difficulty affording
medicines due to gaps within the healthcare system. We now have three new options for all
patients looking for help: My$99Insulin; follow-on brand (also known as authorized
generics) insulins; and a short-term, immediate need program for a month’s worth of free
insulin. These work alongside our long-standing patient assistance program, co-pay cards
and partnerships to sell human insulin at about $25 per vial.
We encourage people to get help by visiting NovoCare.com.”

Hi Ken,
Thanks for sending this. I have a few follow-ups, as the statement does not address some of my
questions:
1. How did net revenue for Novo's insulin products still increase by more than 100% from 2008-2019
despite the drop in net price over the past couple years. Higher utilization probably explains some of
that, right? Yes, as do a lot of factors like increase of prevalence. How much? I don’t know. And how
much did hiked list prices in the earlier years contribute to this growth in net revenue? Remember,
we’ve launched four new meds in the last five years and you’re looking at global numbers, in which the
global rise of diabetes would’ve certainly contributed to the growth overall.
2. How much does it cost Novo to manufacture one unit of each type of insulin? As mentioned in the
original response, that cost is complex and manufacturing is simply one portion of the mix, and not a fair
assessment.
3. Has Novo ever engaged in patent “evergreening”? No. Does Novo support biosimilar competition? We
do when the regulatory pathway helps ensure new medicines are safe for patients to use.
4. Regarding Novo’s “affordability offerings”: Don’t those just address one part of affordability? They
address multiple facets of affordability and we’ve created offers based on what we heard from the
patient community. In other words, if they cap or reduce someone’s out-of-pocket cost, that just helps

 them get insulin at the pharmacy at a lower cost — which is good. It is a good and that’s the point. But
doesn’t that still allow Novo to charge higher actual prices to commercial insurance while insulating
people from those actual prices? Your question suggests there’s no negotiation toward a lower price
paid by the payer. Does Novo view copay and patient assistance programs as kickbacks since they pay
for someone’s cost-sharing in return for the steerage toward one’s product? (Medicare and Medicaid do
consider them as such.) No.
5. If rebates were eliminated and patient cost-sharing was capped, would Novo support accepting a net
price that is even lower today? This is a speculative question that is difficult to address.