Tuesday’s decision by pharmaceutical giant Eli Lilly to lower the cost of its insulin for people exposed to the list price is a “good start,” according to a longtime critic of the pricing practices of the three companies that manufacture insulin for the country’s diabetics.

Dr. Irl Hirsch, an endocrinologist at the University of Washington, told 9Wants to Know he still worries diabetics will continue to feel the pinch.

“It’s all going to depend on the individual’s plans,” he said. “There’s going to be a great deal of confusion however.”

Tuesday, Eli Lilly announced starting next year it plans on offering the non-insured and patients with high deductibles up to a 40 percemt discount on the price they pay for Humalog, Humulin, and the soon-to-be introduced Basaglar.

As documented in 9Wants to Know’s “Side Effects” series, many patients must pay close to the list price for drugs even though both manufacturers and insurance companies admit almost no one should be paying that price.

The reason: the growing popularity of high-deductible health care plans requires patients to frequently pay thousands up front before their deductibles kick in.

Half of people in the U.S. who receive insurance through work have a deductible of $1,000 or more, according to the Kaiser Family Foundation. That’s up from 10 percent in 2006.

The problem with Tuesday’s announcement, according to Dr. Hirsch, is that people who purchase the discounted insulin from Eli Lilly cannot use their payments against their deductibles.

That means diabetics will have to crunch their annual costs, both projected and actual, to see if the discounts will actually lower their payments.

In addition, Eli Lilly’s decision to offer insulin directly through a separate online platform bypasses the traditional wholesaler, insurance, and pharmacy benefit manager supply system that typically provides large rebates.

Those rebates can climb upward of 50 percent of the list price.

If Eli Lilly goes directly to patients, it skips having to offer large rebates to the middlemen.

“The amount of money flowing into [Eli Lilly’s headquarters in} Indianapolis is likely to be about the same, even with the discounts,” said Dr. Hirsch.