U.S. House votes to cap insulin cost at $35 per month
The U.S. House of Representatives approved a bill on November 19 that would cap insulin prices at $35 per month for Americans with diabetes.
The House approved the social spending bill H.R. 5376, also known as the Build Back Better bill, by a vote of 220-213. The bill will now be sent to the U.S. Senate for approval.
Among the bill’s provisions, beginning in 2023, Medicare Part D and private group or individual health care plans cannot apply a deductible or charge more than $35 for a 30-day supply of insulin. For Medicare Part D, plans could charge no more than $35 for whatever insulin products they cover in 2023 and 2024. In 2025, all insulin products will fall under the cap under a drug negotiation provision also included in the bill.
If the bill is later passed by the U.S. Senate and signed into law by President Joe Biden, the insulin cap will take effect beginning in 2023.
As Healio previously reported, insulin prices have been on the rise over the last 20 years. According to 2017 data from the Health Care Cost Institute, insulin prices nearly doubled from 2012 to 2016, with the average price for a 40-day supply of insulin increasing from $344 to $666 during that span.
In a press release, Carol H. Wysham, MD, president of the Endocrine Society, praised the House of Representatives for passing the bill, saying the cap has the potential to save the lives of many people with diabetes.
“This bill offers a once-in-a-generation opportunity to protect access to this life-saving medication,” Wysham said in a press release. “People with diabetes cannot wait any longer for Congress to take action. We urge the Senate to quickly follow suit.”
Anne Peters, MD, Endocrine Today Editorial Board Member and professor of clinical medicine at Keck School of Medicine, University of Southern California, Los Angeles, praised the passage of the bill and how it could significantly help people with diabetes afford insulin.
“It is a significant step forward for our patients with diabetes who require insulin because for many, who currently struggle with insulin costs and copays, this will make insulin more accessible and affordable,” Peters told Healio.
Several states have already passed legislation capping insulin copays. In May 2019, Colorado became the first state to cap insulin copays at $100 per month for people with private insurance. Since then, 19 other states along with the District of Columbia have passed legislation to cap copays on insulin, according to the American Diabetes Association.
References:
- H.R. 5376 - Build Back Better Act. Available at https://www.congress.gov/bill/117th-congress/house-bill/5376/text. Accessed November 19, 2021.
- Insulin and Drug Affordability. Available at https://www.diabetes.org/advocacy/insulin-and-drug-affordability. Accessed November 19, 2021.
Perspective
Back to Top
This new bill capping insulin at $35 per month is really exciting. All people with type 1 diabetes need insulin to live and many people with type 2 diabetes ultimately need insulin as well. I see so many patients rationing insulin due to the cost, so a bill like this would be life changing and life-saving for many.
I just hope that capping costs does not stifle innovation in this area. We are still in need of faster insulins that better mimic true physiologic insulin. There is also weekly insulin in the pipeline and I hope that price caps will still ensure that there is continued dollars for research in these areas. Also, for people with type 2 diabetes, SGLT2 inhibitors and GLP-1 receptor agonists are preferred before adding insulin or intensifying insulin and have amazing cardiovascular benefits. While insulin prices have been staying relatively consistent the last couple of years, these other drug classes have been rising a lot. I worry that if insulin is capped and other drugs are not, this will force some people with type 2 diabetes to use insulin instead of the preferred medications to reduce cardiovascular risk.
Overall though, I think this is a step in the right direction and hope to see continued efforts to control drug prices.
Perspective
Back to Top
The proposal to cap insulin co-pays at $35 per month for Medicare enrollees is a significant step toward improving diabetes control and outcomes for insulin-taking Medicare patients. This population of patients has experienced a 300% increased out-of-pocket expense for insulin between 2007 and 2017. The impact of the proposed change is clear when one realizes that 1 in 3 Medicare beneficiaries has diabetes and over 3.3 million require some form of insulin treatment. It is not unusual for many Medicare patients to have highly variable co-pays, depending on their insulin regimen and local coverage factors. Many patients exhaust their ability to afford their insulin by the fourth quarter of the year and therefore must depend heavily on availability of samples or alternative approaches to securing the necessary meds. Even for those patients with access to coupons, it may yet prove to be a financial strain for many patients given the explosive increase in insulin prices over the last few years. Providers further note that the adequacy of sampling is insufficient to meet the increased level of need encountered, and the affected patients will frequently go off insulin and modify their treatment regimens with resultant loss of control. Such patients get caught in a vicious and ill-advised cycle of “ping-ponging” control, with improvements restored once they are able to resume adequate insulin coverage. This erratic treatment strategy is undesirable for providers and for patients and has been in urgent need of some satisfactory resolution. The availability of a $35/month cap, ensuring more consistent affordability of insulin treatmen, will be clinically meaningful in driving improved metabolic control and better outcomes in an expanding population of persons faced with insulin-requiring diabetes.
Read more about