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The Senate on Sunday passed a sweeping budget package aimed at bringing financial relief to Americans, but not before Republican senators voted to kill 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 apply to patients with private insurance.
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Seven Republicans joined Democrats in supporting the broader price cap, but that wasn’t enough for passage. Some Republican senators who voted to kill the proposal come from states with some of the highest diabetes death rates, according to data from the Centers for Disease Control and Prevention, including Arkansas, Oklahoma and Tennessee .
Lowering the price of drugs like insulin, which diabetics use to control their blood sugar levels, is popular with voters, polls show. Senate Democrats blasted Republicans for voting against relief for Americans struggling to pay for life-saving medicine.
More than 30 million Americans have diabetes, and about 7 million need insulin daily to control their blood sugar levels.
Here’s what we know about how Americans would 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 lower prescription drug and other health care costs, was aimed at cap monthly insulin 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 their type of insurance market.
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 eliminate the provision, only Medicare beneficiaries would be eligible for the cap. The law still needs to pass the House.
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 America’s Eli Lilly, France’s Sanofi and Denmark’s Novo Nordisk. A report released in December by Democrats on the House Oversight and Reform Committee accused drugmakers of repeatedly raising their prices and working to “maintain monopoly prices,” allegations the companies have denied.
In a statement, Novo Nordisk said the complexities of the U.S. health care system influence the insulin market and that “many factors” determine what a person pays out of pocket for insulin. The company said the net prices of its products “have continued to decline for the past 5 consecutive years.” A Sanofi spokesman said in a statement that “despite the rhetoric about insulin prices,” the net price of its insulin has fallen for seven years in a row, “making our insulins significantly less expensive for companies of insurance”.
Eli Lilly did not immediately respond to requests for comment.
A generic insulin is expected to hit the market in 2024 and could help lower prices.
Researchers also blame issues such as increasingly complicated supply chains for the dramatic increase in drug prices over the past decade. Insulin prices in the United States are far 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 medicine.
What does this mean for uninsured patients and Medicaid recipients?
The legislation does not cap the cost of insulin for uninsured patients, despite last-minute lobbying by some House lawmakers to add those protections. Americans with uninsured diabetes are more likely to use less expensive insulin formulations compared with those with private insurance or Medicaid, but have a higher tendency to pay full price for life-saving medication, according to a 2020 report by the Commonwealth Fund, a 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 standard 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 people with diabetes can vary widely from person to person, except for those on Medicaid.
“There is no average person with diabetes, right, and therefore no two people manage their diabetes the same way,” said Aaron Turner-Phifer, director of advocacy for JDRF, an organization that funds the research. about type 1 diabetes. “People are taking different types of insulin, they’re taking it with pens, they’re taking it with pumps, some are using different devices. … The amount of insulin they take varies from person to person other”.
What are Republicans saying about the insulin price cap?
Many Republicans have opposed the $35 cap, saying the measure does not address the fundamental problem of rising insulin prices. Instead, they said, it would force insurance companies to pass the cost on through premiums.
The limit would also have been a big win for Democrats ahead of November’s midterm elections, possibly fueling GOP opposition to the proposal.
Still, other Republicans denounced what they called “socialist” government interference in the free market. “Today it’s the government setting 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 dramatically lowered the price of insulin: “Insulin, it will, it was destroying families, destroying people. The cost,” Trump said in a debate. “I have it for so cheap that it is like water.” His statement drew criticism from patient advocates and people who still struggle to afford their medication.
In 2020, drugmakers reduced the cost of insulin for some patients who lost their 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. According to experts, the ruling was limited and would have reduced the cost of insulin for certain patients who go to certain federally qualified health centers.
It was overturned by the Biden administration. Health officials said at the time that the rule would have imposed “excessive costs and administrative 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 investigations. But they have taken different approaches to reduce the cost of the drug.
Republicans have long proposed alternatives to Democrats’ drug pricing measures. In the House, top GOP lawmakers have released plans to put a $50 monthly cap on insulin and its supplies for Medicare drug benefits after seniors reach their deductibles. In the Senate, top Republicans have drafted a bill to make permanent an existing temporary pilot that gives Medicare users the option to get a voluntary prescription drug plan where insulin costs $35 a month.
Meanwhile, a pair of bipartisan senators introduced legislation in June aimed at tackling the cost of insulin, which was the result of months of work to forge a compromise. But the legislation has not been voted on, and he faces daunting political odds in his quest to get 10 Republican votes to pass the bill in the Senate.
Evan Halper, Bryan Pietsch and Tony Romm contributed to this report.