The Senate's plan to cap insulin costs leaves diabetics without relief

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The Senate’s plan to cap insulin costs leaves millions of diabetics without relief

For the 30 million people living with diabetes in the United States, the sweeping spending bill that cleared the Senate this weekend is a mixed bag. Medicare recipients won’t have to pay more than $35 each month for insulin if the bill becomes law, but the millions of diabetics on private insurance will still have to pay substantially more — in some cases, more than they can easily afford.

Insulin costs about seven times as much in the U.S. as it does in peer countries, and costs have tripled over the past decade.

While lawmakers from both parties have acknowledged the problem, the latest effort to address it split largely down party lines on Saturday night. Senate Republicans voted against a Democratic proposal to make people on private insurance eligible for the $35-a-month cap on insulin costs.

The final bill, which moves to the House this week, will only include a cap for Medicare recipients.

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“This could enormously be helpful for people on Medicare who currently spend more than $35 on their insulin products,” said Tricia Neuman, executive director of the Kaiser Family Foundation’s Program on Medicare Policy. Medicare recipients spent an average of $54 per month on insulin products in 2020, with several products costing more than $80 per month. This bill would mean substantial savings for these individuals.

But “diabetes is not just an issue for people on Medicare,” she said. “Many younger people live with diabetes and struggle to afford the cost of insulin.” More than 1 in 5 Americans on private insurance who need insulin currently pay more than $35 a month.

“Insulin access is a matter of life or death for people with Type 1 diabetes, which is why it is unconscionable that 43 Members of the U.S. Senate voted today to strip away provisions from the budget bill to cap the out-of-pocket costs of insulin for those with commercial health insurance,” said the Juvenile Diabetes Research Foundation in a statement.

Those with private insurance or no insurance at all pay the highest costs for the lifesaving drug, according to research published last month in Health Affairs. About 14 percent of diabetics in the U.S. — nearly 1.2 million people — spend at least 40 percent of their income (outside of food and housing costs) on insulin, the study found. Nearly two-thirds of those individuals receive Medicare and will be helped by this bill. But the rest will not.

Out-of-pocket insulin costs for people with private insurance vary widely, but about 1 in 5 spend more than $35 a month, with 1 in 20 spending more than $150. People who purchased their plans on the individual market, or get covered by their small business employer, tend to pay more than those with large employers, according to the Kaiser Family Foundation.

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Senate Republicans have attacked the legislation — known as the Inflation Reduction Act — as too expensive at a time when the country’s economy is already struggling. Senate Minority Leader Mitch McConnell has released statements in recent days characterizing the bill as “prescription-drug socialism” and a “reckless taxing and spending spree.”

Despite voting to limit the insulin provisions in the latest bill, many Republicans in Congress had called for policies to broadly reduce the price of insulin in recent years.

In January 2021, for instance, Republican Sen. Chuck Grassley of Iowa touted a report from the Senate Finance Committee — where he is ranking minority member — documenting the high price of insulin. “INSULIN costs Prices hv gone THRU THE ROOF for patients/taxpayers bc of manufacturer, health plan & PBM biz practices They make $$ as % of ballooning list price so no incentive to lower price on 100 yr old drug,” he tweeted. But Grassley voted last weekend against extending the $35 price cap to people with private insurance. In 2020, former President Donald Trump instituted a Senior Savings Model for insulin, which allowed some Medicare recipients to enroll in plans that capped costs at $35 per month and tried to limit insulin prices at federal health centers. The latter rule was nixed by the Biden administration, which said the program would benefit too few people to justify the extra burden it would place on health centers.

Thanks to Alicia Benjamin for copy editing this article.

  • Jonathan Lambert
    Jonathan Lambert

    Public Health Reporter

    Jonathan Lambert is a public health reporter for Grid focused on how science, policy and the environment shape our collective well-being.

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