Senate bill would cap monthly insulin costs at $35 for Americans with commercial insurance
Key takeaways:
- A proposed bill would cap out-of-pocket insulin costs at $35 for Americans with diabetes and commercial health insurance.
- The bill includes provisions to promote the development of generic and biosimilar drugs.
A bill proposed in the U.S Senate would limit out-of-pocket insulin costs for Americans with diabetes who have commercial health insurance, according to a press release.
On April 20, U.S. Sen. Jeanne Shaheen (D-NH) and Sen. Susan Collins (R-ME) introduced the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act of 2023. If passed, the bill would implement an out-of-pocket insulin cap for many U.S. residents, require pharmacy benefit managers to pass all insulin rebates and discounts received from manufacturers to health care plan sponsors, and promote the development of generic and biosimilar drugs to further lower costs.
“We are encouraged by the proactive steps taken by private companies, but that is a drop in the bucket on action that is needed to lower prices across the board and keep them there,” Shaheen and Collins said in a press release. “Our legislation would address structural issues in the insulin market, create policies to foster more competition and expand access to insulin medications.”
Under the proposed bill, group heath plans and health insurance issuers would be required to cap out-of-pocket insulin costs at $35 per month in 2024 and the lesser of $35 or 25% of the list price for a 30-day supply for at least one insulin of each type beginning in 2025.
In the second part of the bill, pharmacy benefit managers will be required to remit 100% of rebates, fees, alternative discounts and all other remuneration received from pharmaceutical companies, distributors and other third parties to the group health plan.
The final part of the bill would create a new FDA approval pathway for biologic drugs that lack adequate biosimilar competition, ensure adequate oversight of the FDA citizen petition process to ease the approval of generic and biosimilar drugs, allow Medicare Part D plans to place biosimilar drugs on their formulary immediately upon approval, and require a report to Congress on issues and market dynamics delaying or restricting biosimilar insulin competition.
As Healio previously reported, the Inflation Reduction Act signed into law by Pres. Joe Biden in August 2022 included a $35 monthly out-of-pocket cap on insulin costs for Medicare Part D beneficiaries. The cap went into effect at the start of 2023. In March 2023, the three leading insulin manufacturers in the U.S., Eli Lilly, Novo Nordisk and Sanofi, all announced reductions in insulin prices. Eli Lilly and Sanofi also announced they would cap out-of-pocket insulin costs at $35 per month for patients.
News of the proposed bill earned the endorsement of multiple medical societies, including the American Diabetes Associations and The Endocrine Society.
“The American Diabetes Association has been the leading advocate for limiting cost-sharing for insulin, and we are proud to endorse the bipartisan INSULIN Act,” Lisa Murdock, chief advocacy officer at the ADA, said in a press release. “This legislation takes important steps to immediately improve access and reduce costs for patients, while also getting to the root of the problem by making sure rebates stop inflating the price of insulin, biosimilar insulins can come to market more quickly, and insurers make these more affordable options available to patients. The ADA urges Congress to act right away to pass the INSULIN Act.”
“People with type 1 diabetes depend on insulin to stay alive since their bodies cannot produce this hormone,” Joshua J. Joseph, MD, MPH, chair of The Endocrine Society Clinical Affairs Core Committee, said in a press release. “Privately-insured individuals with diabetes cannot wait any longer for Congress to take action to address their insulin costs. We are pleased to endorse this comprehensive legislation, which will make insulin more affordable for those who rely on it.”
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