Under the bill, a Medicare beneficiary’s cost would be capped at $35 for each 30-day insulin prescription. Americans who are part of private plans would be able to employ the cost-sharing feature for beneficiaries, which would limit the cost to the lesser of either $35 or 25% of the negotiated price their health plan negotiated for a 30-day prescription.
Insulin has been like gold to drug companies since its creation in 1921. It's so valuable that, at one point, insulin manufacturer Eli Lilly and drug maker E.R. Squibb were accused of antitrust violations for overcharging for it.
Nonetheless, the price for insulin has continued to grow, skyrocketing over the last 18 years from an out-of-pocket cost of $25 in 2004 to about $112 in 2018. The FDA believed that current prices are so over-the-top that it took steps of its own to try and bring costs down. Walmart also tried going the low-cost route by launching its own private label “analog” insulin product.
On to the Senate
The measure that passed in the House was authored by a trio of House Democrats – Reps. Angie Craig (MN), Dan Kildee (MI), and Lucy McBath (GA).
“Michigan families and seniors are paying too much for insulin. Today, with bipartisan support, the House passed my legislation to cap the cost of insulin at $35 per month,” Kildee said. “As the father of a diabetic, I have seen first-hand how the extremely high price of prescription drugs, like insulin, hurts patients and families.”
A cap on insulin prices was originally part of the health reforms in Democrats’ Build Back Better legislation, but Sen. Joe Manchin’s (D-WV.) resistance to that bill forced House proponents to carve out the insulin clause as a standalone measure in an effort to move it forward.
With the bill separated from Manchin’s opposition to its more comprehensive parent legislation, capping the cost of insulin probably has a better chance in the Senate. In fact, it already has its first champion in Sen. Rev. Raphael Warnock (D-GA), who, in February, introduced the Affordable Insulin Now Act, a nearly identical version of the House’s bill.
“I’m glad the House took a major step today toward making my bill the law of the land,” Warnock said. “The bill now comes to the Senate, and I’m going to use every tool at my disposal to get it across the finish line.”
Warnock thinks this bill’s chances are pretty good and says he has some across-the-aisle support in the works. He said he has spoken with Senator Susan Collins (R-ME) and met with Senator Jeanne Shaheen (D-NH) multiple times to ensure any bipartisan insulin proposal also includes his critical provision to cap out-of-pocket costs.