Experts say the legislation, which passed 232-193 on Thursday, would provide significant relief to privately insured patients with tighter plans and Medicare enrollees facing increased out-of-pocket costs for their insulin. Some could save hundreds of dollars a year, and all insured patients would benefit from predictable monthly insulin costs. The bill would not help the uninsured.
But the Affordable Insulin Now Act will serve as a political vehicle to rally Democrats and force opposing Republicans into uncomfortable votes before the midterms. For the legislation to pass Congress, 10 Republican senators would need to vote in favor. Democrats acknowledge they don’t have an answer on how this will play out.
“If 10 Republicans are stopping the American people from having access to affordable insulin, that’s a good question for 10 Republicans to answer,” said Rep. Dan Kildee, D-Mich., co-sponsor of the bill. Bedroom. “Republicans have diabetes too. Republicans are dying of diabetes.”
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Public opinion polls have consistently shown all-party support for congressional action to contain drug costs.
But Rep. Cathy McMorris Rodgers, R-Wash., complained that the legislation is just “a small piece of a larger package around government control of prescription drug prices.” Critics say the bill would increase premiums and not target pharmaceutical intermediaries seen as contributing to high insulin list prices.
Sen. Chuck Grassley, R-Iowa, said Democrats could get a prescription drug deal if they drop their bid to allow Medicare to negotiate prices. “Do Democrats really want to help seniors, or would they rather have the campaign stake?” said Grassley.
The insulin bill, which would take effect in 2023, represents just one provision of a much larger prescription drug package in President Joe Biden’s social and climate legislation.
In addition to a similar $35 cap on insulin, the Biden bill would allow Medicare to negotiate prices for a range of drugs, including insulin. It would penalize drugmakers that raise prices faster than inflation and revise Medicare’s prescription drug benefit to limit out-of-pocket costs for enrollees.
Biden’s agenda passed in the House only to stall in the Senate because Democrats could not reach a consensus. Party leaders have not given up hope of wiggling the legislation again and keeping its drug price restrictions largely intact.
The idea of a $35 monthly cost cap for insulin actually has a bipartisan pedigree. The Trump administration had created a voluntary option for Medicare enrollees to get insulin for $35, and the Biden administration continued it.
In the Senate, Republican Susan Collins of Maine and Democrat Jeanne Shaheen of New Hampshire are working on a bipartisan insulin bill. Georgia Democratic Sen. Raphael Warnock has introduced legislation similar to the House bill, with support from Majority Leader Sen. Chuck Schumer of New York.
Stung by criticism that Biden’s economic policies are boosting inflation, Democrats are stepping up to show how they would help people meet the costs. On Thursday, the Commerce Department reported that a key inflation indicator jumped 6.4% in February from a year ago, the biggest year-over-year rise since January 1982.
But experts say the House bill would not help uninsured people, who face the highest costs for insulin. Also, people with diabetes often take other medications in addition to insulin. This is done to treat the diabetes itself, as well as other serious health conditions often associated with the disease. House legislation would also not contribute to these costs. Collins says she is looking for a way to help uninsured people through her bill.
About 37 million Americans have diabetes and about 6-7 million use insulin to control their blood sugar. It is an old drug, refined and improved over the years, which has seen relentless price increases.
The high list prices do not reflect the rates that insurance plans negotiate with manufacturers. But these list prices are used to calculate the cost-sharing amounts that patients owe. Patients who cannot afford their insulin reduce or skip doses, a strategy born out of desperation, which can lead to serious complications and even death.
Economist Sherry Glied of New York University said the insulin market is a “total disaster” for many patients, especially those with meager insurance plans or no insurance.
“It will make private insurance for people with diabetes much more attractive,” Glied said.
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