Comment The Senate passed a sweeping budget package on Sunday aimed at providing financial relief to Americans, but not before Republican senators voted to remove a proposal that would have capped the price of insulin at $35 a month for many patients. A proposal capping the monthly cost of insulin at $35 for Medicare patients was left untouched. But using a parliamentary rule, GOP lawmakers were able to reject the part of the proposal that would have applied to privately insured patients. How the Deflation Act Could Affect You — and Change the US Seven Republicans joined Democrats in supporting the broader price cap, but that wasn’t enough to pass. Some Republican senators who voted for the repeal come from states with some of the highest death rates from diabetes, according to data from the Centers for Disease Control and Prevention, including Arkansas, Oklahoma and Tennessee. Cutting the price of drugs such as insulin, which is used by diabetics to manage their blood sugar levels, is widely popular with voters, according to polls. Senate Democrats blasted Republicans for voting against relief for Americans struggling to pay for the life-saving drug. More than 30 million Americans have diabetes, and about 7 million need insulin daily to manage their blood sugar levels. Here’s what we know about how Americans will be affected by the Senate vote: Republicans block cap on insulin costs for millions of patients
What would the insulin price cap do? The insulin price cap, part of a broader package of proposals to reduce prescription drug and other health care costs, was intended to cap monthly insulin out-of-pocket costs at $35 for most Americans who use insulin; More than 1 in 5 insulin users with private health insurance pay more than $35 a month for the drug, according to a recent analysis by the Kaiser Family Foundation. The same analysis found that the average monthly savings for these people would range from $19 to $27, depending on the type of insurance they purchased. The average Medicare patient using insulin paid $54 for prescriptions, according to KFF, an increase of nearly 40 percent since 2007. With the Republican vote to repeal the provision, only Medicare recipients would be eligible for the cap. The legislation still needs to pass through Parliament.
Why is insulin so expensive? Insulin was discovered in Canada in the 1920s, and the Nobel Prize-winning researchers sold their patent to the University of Toronto for $3. Since then, the drug has become a major commercial enterprise. The global insulin market is dominated by US-based Eli Lilly, French company Sanofi and Danish company Novo Nordisk. A report released in December by Democrats on the House Oversight and Reform Committee accused drugmakers of repeatedly raising prices and working to “maintain monopoly prices,” allegations the companies have denied. In a statement, Novo Nordisk said the complexity of the US health care system affects the insulin market and that “many factors” determine what a person pays out-of-pocket for insulin. The company said net prices for its products “have continued to decline over the past 5 consecutive years.” A Sanofi spokesperson said in a statement that “despite the rhetoric about insulin prices,” the net price of its insulin has declined for seven consecutive years, “making our insulins significantly less expensive for insurers.” Eli Lilly did not immediately respond to requests for comment. A generic insulin is due to hit the market in 2024 and could help lower prices. Researchers also blame issues such as increasingly complex supply chains for the dramatic increase in drug prices over the past decade. Insulin prices in the US are well above the average price paid in other developed countries, according to a government report. A Yale University study found that insulin is an “extreme financial burden” for more than 14 percent of Americans who use it. These people spend more than 40 percent of their income after food and housing costs on the drug.
What does this mean for uninsured patients and Medicaid recipients? The legislation does not cap insulin costs for uninsured patients, despite a last-minute push by some House lawmakers to add such protections. Uninsured Americans with diabetes are more likely to use less expensive insulin formulations than those with private insurance or Medicaid, yet are more likely to pay full price for the life-saving drug, according to a 2020 report from the Commonwealth Fund. health think tank. For those on Medicaid, many have no co-pays for insulin, although some states may have modest amounts that beneficiaries must pay, such as $2 for a typical prescription, according to Sherry Glied, dean of the Robert F. Wagner Graduate School of Public Service at New York University. But in general, costs for those with diabetes can vary greatly from person to person, except for those on Medicaid. “There is no average person with diabetes, right, and so no two people manage their diabetes exactly the same way,” said Aaron Turner-Phifer, director of advocacy for JDRF, an organization that funds type 1 diabetes research. .“People take different types of insulin, they take it through pens, they take it through pumps, some use different devices. … The amount of insulin they take varies from person to person.”
What are Republicans saying about the insulin price cap? Many Republicans have opposed the $35 cap, saying the measure did not address the underlying problem of soaring insulin prices. Instead, they said, it would force insurance companies to pass the cost on through premiums. The cap would also be a major win for Democrats ahead of November’s midterm elections, potentially fueling GOP opposition to the proposal. However, other Republicans denounced what they called “socialist” government interference in the free market. “Today the government sets the price of insulin,” said Rep. Cathy McMorris Rodgers (R-Wash.), the top Republican on the House Energy and Commerce Committee. “What’s next, gas? Food?”
Did President Donald Trump lower the price of insulin? In 2020, President Donald Trump claimed he had drastically reduced the price of insulin: “Insulin, it’s going to — it was destroying families, it was destroying people. The cost,” Trump said in a debate. “I get it so cheap it’s like water.” His statement drew criticism from patient advocates and people who still struggle to afford their drugs. In 2020, pharmacists reduced insulin costs for some patients who lost jobs, health insurance, or both as a result of the pandemic. Trump signed an executive order to lower the price of insulin as one of his last health care acts in office. The decision was limited, experts said, and would lower the cost of insulin for some patients who go to some federally-funded specialized health centers. Canceled by the Biden administration. Health officials said at the time that the rule would have imposed “excessive administrative costs and burdens” on health centers — and reduced resources for other health services.
Where have Democrats and Republicans historically stood on insulin prices? Both Democrats and Republicans have criticized the high price of insulin, including in congressional hearings and in bipartisan surveys. But they have taken different approaches to containing drug costs. Republicans have long proposed alternatives to Democrats’ drug pricing measures. In the House, key Democratic lawmakers released plans to put a $50 monthly cap on insulin and its supplies for Medicare drug beneficiaries after seniors hit their deductibles. In the Senate, top Republicans have created a bill to make permanent an existing temporary pilot program that gives those on Medicare the option to get a voluntary prescription drug plan where insulin costs $35 a month. Meanwhile, a bipartisan pair of senators introduced legislation in June aimed at addressing the cost of insulin, which was the result of months of work to reach a compromise. But the legislation has not come up for a vote and faces daunting political odds in trying to muster 10 Republican votes to pass the bill in the Senate. Evan Halper, Bryan Pietsch and Tony Romm contributed to this report.
