The Affordable Insulin Now Act passed in the House Thursday, 232-193. One-hundred-and-ninety-three Republicans are opposed to the more than 30 million Americans with diabetes being able to afford the drug that their lives depend upon. Just 12 House Republicans thought that was a good idea.
It’s not like the bill even hurts anyone, including Big Pharma, because it doesn’t actually reduce the cost that the manufacturers are charging the insurance companies. It caps the amount insurers can pass on to patients to $35 a month, and it doesn’t include glucose monitoring supplies, test strips, syringes, readers, pump supplies, or other diabetes care products. That means that only people with Medicare prescription drug benefits and private health insurance would be protected by the cap. The majority of state Medicaid programs cover insulin, as does the Veterans Administration. But the uninsured won’t get the cost break.
The prospect for the bill in the Senate is uncertain. While it did get 12 Republican House votes, the Senate sponsors will need nine more besides Sen. Susan Collins (R-ME), who is working with Democratic Sens. Raphael Warnock (GA) and Jeanne Shaheen (NH) to pass it. “I intend to put a proposal on the floor as soon as we can after Easter,” Majority Leader Chuck Schumer said on the Senate floor last week.
This is fantastic for people with Medicare and with bare-bones private health insurance plans. If it passes the Senate, it would mean that they will only have to pay up to $35 a month, or 25% of a plan’s negotiated price, for the drug. That gives people the ability to budget for the monthly prescription and not be surprised by big cost fluctuations. It gives a lot more certainty. It would also save the people it covers a lot of money. A Kaiser Family Foundation analysis finds it would provide relief to at least 20% of people with private health insurance. Half of them would save at least $19 a month, and 25% would save at least $42 every month.
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But it has real limitations. First, it doesn’t cut the actual cost of insulin—manufacturers can still charge whatever they want to insurers, so the costs above the $35 co-pays will be passed on the employer groups and enrollees. While people would be saving on insulin, they wouldn’t be paying toward their deductible with prescriptions. That means they would have to pick up the full cost for all the other essentials for longer, until the deductible is met. They would also have to use the brand and type of insulin their insurance covers, not the brand that necessarily works best for them.
It doesn’t cover the uninsured diabetics, who get by as best they can with generics, getting it in Canada, paying hundreds of dollars every month, skipping doses, or running GoFundMe campaigns. Or going untreated and dying. A study from the American Diabetes Association released in 2018 found that uninsured diabetics had 60% fewer visits to a doctors, but 168% more visits to the emergency room. Communities of color are disproportionately affected as they are with most diseases in the U.S., a function of systemic racial inequality: 14.5% of American Indians/Alaskan Natives are diabetic, as are 12.1% of non-Hispanic Black people, 11.8% of Hispanic people, 9.5% of Asian Americans, and 7.4% of non-Hispanic white people.
So, yes, capping the cost of insulin for any group of people is important, and insured diabetics are the majority. It will definitely help them. What would help them even more, however, is forcing manufacturers to provide the drug at their cost to the federal government, which would then provide it for free to everyone who needs it.
Insulin has been around for 100 years. A study published in September 2018 in the journal BMJ Global Health estimated the cost of producing one vial of analog insulin at less than $10 per vial, depending on the type. But American patients are spending hundreds of times more than that. A 2020 Kaiser Family Foundation report found that based on a patient’s condition and choice of treatments, costs can range from $334 to $1,000 a month for insulin.
There is no reason for companies to be charging hundreds of dollars per vial. Canadians pay from $30 to $40 for it. Even there, the price has increased more than 50% in the past decade. While formulas have advanced, the manufacturers’ costs remain very low. The only reason costs are so high is because the U.S. system allows it—other wealthy nations don’t. It shouldn’t be that way.
So yes, make it more affordable for as many people as possible now, but this bill isn’t the final solution.
Insulin should be free.