Advocates for affordable diabetes medications are regrouping and reconsidering strategies for legislation to lower the cost of insulin and other diabetes medications after the Senate passed a limited cost-saving measure that will leave out the majority of insulin users.
They still hope that Congress will pass a monthly spending cap of $35 for people with private health insurance. The Inflation Reduction Act, which cleared the Senate over the weekend and now awaits House passage, will implement a $35 cap only for people enrolled in Medicare, the federal healthcare program for seniors. This means that a fraction of insulin users, 3 million out of a total 8 million, will benefit from the out-of-pocket maximum.
The massive bill had initially extended that cap to people with commercial health plans, but that provision was dropped because of a lack of support. Now, diabetes advocates are thinking through how to get legislation that covers all patients.
HHS APPROVES STRETCHING MONKEYPOX VACCINES THROUGH FIFTH-DOSES AS OUTBREAK GROWS
“It’s got to be covered. We’ve got to put a cap on it because they cover half of America. So half the country got left out when you weren’t able to get that done,” said George Huntley, CEO of the Diabetes Leadership Council.
The Senate did vote on an amendment to the Inflation Reduction Act to keep the $35-a-month cap on private plans, but the measure got less than the supermajority required. Seven Republicans voted with all 50 Democrats to keep the price ceiling for private plan enrollees in the legislation: Bill Cassidy of Louisiana, Susan Collins of Maine, Josh Hawley of Missouri, Cindy Hyde-Smith of Mississippi, John Kennedy of Louisiana, Lisa Murkowski of Alaska, and Dan Sullivan of Alaska. But other Republicans who opposed the amendment blamed Democrats’ partisan procedure for passing it, not because they disagreed with the contents.
Roughly 8.3 million Americans use insulin to control their diabetes. Of that total, 3.3 million are seniors enrolled in Medicare and will benefit from the price cap. Congress has been trying for years to lower the high costs of insulin, which are only getting worse for patients with diabetes. Newer, more effective, and more easily administered forms of insulin are much more expensive than older forms. Spending per person on insulin nearly doubled from 2012 to 2016. The price per person for insulin was roughly $2,900 in 2012 and shot up to $5,700 in 2016, according to an analysis from the Health Care Cost Institute.
“We were extremely disappointed that Senate Republicans removed the insulin copay caps for patients with commercial insurance that were included by Senate Democrats in the Inflation Reduction Act,” said David Mitchell, cancer patient and founder of Patients For Affordable Drugs Now. “We will be continuing the work to pass additional reforms to lower prices for patients on commercial insurance and the uninsured, including those who rely on insulin.”
“It’s time for people with diabetes to not be played like a political football, it’s time to cut the shenanigans,” Huntley said. “And hopefully we can get this $35 insulin copay through. If we can get that through, we’ve come a very long way.”
The DLC has trained its sights on a bill in the Senate put forward by Sens. Jeanne Shaheen (D-NH) and Susan Collins. Their bill would entice insulin manufacturers to reduce list prices to 2021 net Medicare rates by ensuring that pharmacy benefit managers are blocked from negotiating drug rebates or other discounts on insulin. The bill also includes a $35 monthly out-of-pocket cap on insulin, which was first proposed by Sen. Raphael Warnock (D-GA). But passage of the bill likely won’t come any time soon, as it remains stalled in the Senate, which has disbanded for the August recess.
The group has also launched an education campaign targeted at employers that use self-insured health insurance, meaning company leaders contract with an insurer or independent third-party administrator for plan administration, but the actual claims costs are covered by the employer’s own funds. Self-insured employers have vast freedom to implement cost-saving measures for their workers, such as adding insulin to the preventive drug list, which allows people to buy certain preventive drugs by paying a copay even if they have not met their deductible.
Diabetes patient advocates are also engaging state legislatures to pass reforms, such as an effort to compel pharmacy benefit managers to pass drug price rebates on to patients at the pharmacy counter. At the moment, though, patients are frustrated.
“In the meantime, you work every other angle possible,” said Huntley, who also leads the DLC’s political action arm, the Diabetes Patient Advocacy Coalition. “We’re trying in the states. We’re trying to educate employers to do the right thing in their health plans. There’s a number of angles to go about this work to make sure patients have affordable access.”
CLICK HERE TO READ MORE FROM THE WASHINGTON EXAMINER
Senate Majority Leader Chuck Schumer (D-NY) assured the public that Congress would resume discussions concerning popular insulin pricing reforms when the upper chamber returns to D.C. in September.
