US House passes bill to cap insulin cost at $35 per month
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A bill to cap the cost of insulin prices at $35 per month for Americans with diabetes was approved by the U.S. House of Representatives this afternoon.
The House approved H.R. 6833, also known as the Affordable Insulin Now Act, by a vote of 232-193.
According to the bill, beginning on January 1, 2023, group health plans and health issuers offering insurance coverage cannot apply a deductible on insulin and cannot require Americans with diabetes to pay more than $35 or the amount equal to 25% of the negotiated price of the selected insulin product, whichever is lower. The bill was introduced on February 25, 2022, by Reps. Angie Craig, D-Minn., Dan Kildee, D-Mich., and Lucy McBath, D-Ga.
The approval of the bill comes a little more than 4 months after the U.S. House voted to approve H.R. 5376, also known as the Build Back Better Bill, on November 19, 2021. H.R. 5376 included a provision to cap insulin costs at $35 for a 30-day supply. The bill stalled in the U.S. Senate.
H.R. 6833 will now be sent to the U.S. Senate for approval. A similar bill, S. 3700, was introduced in the U.S. Senate by Sen. Raphael Warnock, D-Ga., on February 17, 2022. S. 3700 would also cap the cost of insulin for private health insurance at the lesser of $35 or 25% of the plan’s negotiated price beginning on January 1, 2023. For the Medicare prescription drug plan, insulin products would be capped at $35 from October 1, 2022, to January 1, 2024, and then the lesser of $35 or 25% of the plan’s negotiated price thereafter.
If passed by the U.S. Senate and signed into law by President Joe Biden, the bill would sharply reduce the cost of insulin for Americans. As Healio previously reported, the average price of insulin for a 40-day supply was $666 in 2016.
Insulin prices have already been capped in many areas of the U.S. According to the American Diabetes Association, 20 states and the District of Columbia have passed legislation to cap copayments on insulin, devices or diabetes supplies.
Robert H. Eckel, MD, professor of medicine emeritus in the division of endocrinology, metabolism and diabetes and the division of cardiology at the University of Colorado Anschutz Medical Campus, past president of the American Heart Association and past president of medicine and science for the American Diabetes Association, said the proposed bill would provide immense relief for Americans with diabetes.
“For all patients with type 1 diabetes, insulin is absolutely necessary for survival and the rising cost has been a substantial barrier for many,” Eckel told Healio. “This bill, if passed, is a major step forward to make an already complex disease less burdensome.”
Irl B. Hirsch, MD, professor of medicine at the University of Washington School of Medicine, said while he believes the bill will be a major step forward in providing relief for Americans with diabetes, more work needs to be done to combat the rising cost of insulin.
“As an endocrinologist, I am ecstatic about this bill which hopefully will become law,” Hirsch told Healio. “For the one-out-of-four American patients who ration their insulin, this is the best gift possible.
“The problem is, it doesn't fix the problem; it simply shifts the costs, and the concern is premiums and other co-pays will be higher to allow profit margins to remain stable,” Hirsch added. “I have no doubt the pharmacy benefit managers will not blink over this new legislation, and while the topic of the month is conflict of interest, I'm curious to better understand the lobbying money our lawmakers receive from the pharmaceutical industry. With all of that being said, in my small world of taking care of patients and their families with diabetes, this indeed is good news.”
Similarly, in a statement released prior to the vote, the Endocrine Society praised the bill, but added that further action is needed to address the rising cost of insulin and not only out-of-pocket costs.
“While the Affordable Insulin Now Act is a promising step toward improving insulin affordability for some individuals, Congress must still address the underlying problem of soaring insulin prices, which tripled over a 15-year period, and continue to rise,” the Endocrine Society said in a statement. “Policies must be implemented to address the drivers of rising insulin prices, not just out-of-pocket costs. An insulin co-pay cap is an important component to solving this problem. However, we caution against passing this as a standalone measure without including additional protections that address rising price, prevent premium increases or result in a rising rate of uninsured Americans.”
References:
- H.R. 6833 – Affordable Insulin Now Act. Available at https://www.congress.gov/bill/117th-congress/house-bill/6833/text. Accessed March 31, 2021.
- S. 3700 – Affordable Insulin Now Act. Available at https://www.congress.gov/bill/117th-congress/senate-bill/3700/text. Accessed March 31, 2021.
- Insulin and Drug Affordability. Available at https://www.diabetes.org/advocacy/insulin-and-drug-affordability. Accessed March 31, 2021.
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