With limited Republican support and a vote of 232-193, the U.S. House of Representatives passed the Affordable Insulin Now Act (Act). The Act, although narrower than President Biden’s Build Back Better framework, will have an impact on many of the 1.9 million diabetics in the United States. Type 1 diabetics are dependent on insulin every day and face an average monthly cost for the life-sustaining medicine of $375 to as high as $1,000 each month.

The Health Care Cost Institute, an independent nonprofit that studies healthcare prices, notes that the price of insulin doubled between 2012 and 2016.

The Build Back Better bill takes a broader approach to prescription coverage.

Build Back Better limits price increases on all drugs, allows Medicare to negotiate directly on some prescription drugs and caps insulin at $35. Pharmaceutical companies and Republicans opposed to the comprehensive bill have left the Affordable Insulin Now Act stalled in the Senate. Although there is more appetite for the Act, its critics assert that it shifts costs rather than addressing them.

The Act caps individuals’ cost-share for a 30-day supply of selected insulin products at $35 or 25% of the negotiated price, whichever is less.

The capped cost-share would apply to deductible and out-of-pocket maximums and does not apply to out-of-network coverage. The coverage affects individuals covered by a group health plan or an individual plan.

There is no doubt that a cost cap on insulin will benefit covered diabetics.

The cap may also result in a long-term reduction to plan and insurers’ costs as medication adherence improve, thereby reducing complications and emergency room (ER) visits. The opposition states that the Act does nothing to reduce the prices paid to the companies that manufacture the insulin. Ultimately, any reduction in cost-share to the participant is shifted as a cost increase to the plan.

Bipartisan support in the House bodes well for the Affordable Insulin Now Act, although historically, Republicans have balked at price caps.

As President Biden stated in his December 2021 speech on prescription drug costs, “This is not a partisan issue.” Still, to become law, ten Republicans in the Senate will need to give their approval.

 


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