Caught by an outcry over high insulin prices, Eli Lilly recently unveiled an authorized generic version of its Humalog insulin at half the price of the original brand. Now the question is: Will Sanofi and Novo Nordisk follow suit to ease the tension?

Based on the comments from the two insulin giants, the answer is likely "no," even though Novo’s NovoLog has already gone off patent and a biosimilar rival has eroded Sanofi’s sales of Lantus.

"[E]very company approaches affordability differently and we’re continuing to find ways to improve affordability as well as respond to the changes in the health care system," a Novo spokesperson said in a statement sent to FiercePharma. In a separate statement, a Sanofi spokesperson said that "there are different ways" to increase affordable access to insulins, and that the company "can’t speculate on future commercial approaches or pricing actions."

Sanofi also referred to its Insulins Valyou Savings Program, which offers all uninsured patients—regardless of income level—one set price to help lower out-of-pocket costs for its insulins, including Lantus. Through the program, its Admelog or Apidra could be up to 43% lower for patients than the new list price offered by Eli Lilly, according to Sanofi.

What Sanofi has been doing to ensure affordability clearly hasn’t impressed everyone, though. On Tuesday, the Right Care Alliance took it to Sanofi’s office building in Cambridge, Massachusetts, urging the French drugmaker to cut its insulin prices, according to WBUR, Boston’s NPR branch. The small group of 10 protesters made makeshift tombstones that were written with the names of people who have died because they couldn’t get insulin.

Even for Lilly, the headache doesn’t seem to have gone away with generic Humalog. "There will be a lot of PR acrobatics about generic insulin. I’m not going to stop investigating how @LillyPad and other insulin makers keep raising prices on a decadesold drug," Democratic Sen. Ron Wyden of Oregon, the ranking member of the Senate Finance Committee, wrote in a Twitter post on Monday. Wyden, together with committee chairman Chuck Grassley of Iowa, recently co-launched a bipartisan investigation into insulin prices.

Lilly and partner Boehringer Ingelheim already have a biosimilar version of Lantus, marketed as Basaglar, but it’s not considered substitutable with the Sanofi originator. Merck & Co. recently ditched a Lantus biosim project with Samsung Bioepis, leaving Mylan and its partner Biocon with one less competitor in pursuit.

Currently, Lilly’s Humalog (insulin lispro), Sanofi’s Lantus (insulin glargine) and Novo’s NovoLog (insulin aspart) are the three major fast-acting insulin products sold in the U.S. They generated U.S. revenue of $1.79 billion, €1.61 billion ($1.82 billion) and 9.42 billion Danish krone ($1.42 billion), respectively, in 2018.

But their price increases have drawn special scrutiny from lawmakers and the public. In their investigation, Grassley and Wyden cited data from different sources, noting that Humalog’s price jumped from $35 to $234 between 2001 and 2015 and NovoLog’s sticker climbed from $289 to $540 between 2013 and 2019, while Lantus’ list price went from $244 to $431 in the same period.

However, all but Lilly pointed to a continued decline in realized price, as competition among the insulins themselves and from newer drugs and payer pressure intensified.

In his testimony before the Senate Finance Committee on Feb. 26, Sanofi CEO Olivier Brandicourt said the average net price of Lantus has declined by more than 30% since 2012. Novo Nordisk, in its 2018 annual report, noted that rebates and discounts given to private and public payers accounted for 68% of gross U.S. sales across its portfolio in 2018, up from 64% in 2017 and 59% in 2016. Humalog, though, enjoyed higher realized prices in the U.S. in 2018, according to Lilly.

The drugmakers have in one way or another blamed pharmaceutical benefit managers (PBMs) to divert criticism.

"The significant rebates we pay on insulins do not directly benefit all patients. This needs to change," Lilly CEO David Ricks said in the company's generic Humalog statement on Monday.

Brandicourt, in his prepared remarks at the hearing, noted that the average out-of-pocket cost of Lantus for patients with commercial insurance and Medicare has increased by about 60% since 2012.

"In this case, not only are discounts apparently not being passed on to patients, but patients are in fact being asked to pay more when PBMs and health plans are paying less for the medicine," he said. "This situation defies logic and should not happen."

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