The U.S. Congress is closer than ever to passing a law limiting out-of-pocket costs for insulin, which would ensure than almost nobody with diabetes pays more than $35 each month for the drug under a proposal from two senators.
As the cost of insulin has climbed steadily in the United States over the years, the issue has gained media attention and calls for action from people with diabetes and advocacy groups — and, in the last couple of years, from political leaders. Earlier this year, President Joe Biden called for Congress to pass a law that would cap monthly insulin costs at $35 per month under all health insurance plans. The U.S. House of Representatives quickly responded to this call, passing a bill called the Affordable Insulin Now Act — a move that was applauded by the American Diabetes Association and JDRF, the type 1 diabetes advocacy and research organization. But the U.S. Senate didn’t take a vote on the bill right away, with some senators saying they wanted to pass a broader bill tackling insulin costs from more than one angle.
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The INSULIN Act
Now, that broader bill has been introduced as the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act. It was authored by Senators Susan Collins of Maine, a Republican, and Jeanne Shaheen of New Hampshire, a Democrat, who presented the bill at a joint press conference that included leaders of the American Diabetes Association and JDRF. The bill includes incentives for insulin manufacturers to reduce their list prices, while at the same time capping insulin costs under insurance plans.
In their joint statement, the senators noted that the average list price of a month’s supply of insulin in the United States rose from $344 in 2012 to $666 in 2016. At the same time, the average net cost to consumers — what they pay out of pocket — has actually decreased steadily since 2014. But even though insulin is now somewhat affordable to many people with diabetes, this isn’t true across the board — many people with health insurance face high deductibles or copays, and some people without insurance have no feasible way to afford insulin.
Under the proposal, insurance plans and pharmacy benefit managers — which are companies that negotiate on behalf of insurance companies — would be prohibited from collecting rebates (discounts) for insulin types that have a list price equivalent to the 2021 average net price under Medicare Part D plans. In other words, insulin manufacturers could lower their list prices to these levels without having to price in discounts negotiated by insurance companies or their representatives.
At the same time, insurance plans would be required to waive any deductible for insulin, and out-of-pocket copays would be limited to $35 per month or 25% of the list price of the drug. Insurance plans would also not be allowed to require prior authorization, step therapy, or other limitations on covering insulin.
While the INSULIN Act would not directly cap out-of-pocket costs for people without health insurance, two of the three major insulin manufacturers in the United States — Lilly and Sanofi — now offer assistance programs for people without insurance that cap monthly costs at $35. Lilly announced its $35 cap in 2020, while Sanofi just lowered its monthly cap under this program from $99 to $35 a few weeks ago. Currently, Novo Nordisk still offers a $99 monthly cap, as well as a separate income-based patient assistance program.
“JDRF is tremendously grateful for Senators Jeanne Shaheen and Susan Collins for working tirelessly to find a bipartisan solution that would address the exorbitant cost of insulin,” said JDRF CEO Aaron Kowalski, PhD, in a statement from the group. “We are very pleased that the INSULIN Act includes several key provisions we have long been advocating for and are eager for the Senate to approve a finalized bill.”
Want to learn more about saving money on insulin? Read “Insulin Prices: Four Ways to Pay Less” and “Cheaper Insulin: Older Insulins May Be Answer to High Prices.”
