GOP senators have blocked a $35 insulin price cap: What you need to know


The Senate passed a sweeping budget package on Sunday intended to provide financial relief to Americans, but not before Republican senators voted to withdraw a proposal this would have capped the price of insulin at $35 per month for many patients.

A proposal that limits the monthly cost of insulin to $35 for Medicare patients was left intact. But by using a House rule, GOP lawmakers were able to drop the part of the proposal that would apply to privately insured patients.

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Seven Republicans joined Democrats in supporting the broader price cap, but it was not enough for passage. A number of Republican senators who voted to withdraw the proposal come from states with some of the highest death rates for diabetes, according to data from the Centers for Disease Control and Prevention, including Arkansas, Oklahoma and Tennessee.

Lowering the price of drugs such as insulin, which is used by diabetics to control their blood sugar levels, is widely popular with voters, polling shows. Senate Democrats hit out at Republicans for voting against aid to Americans hard to pay for life-saving medicine.

More … than 30 million Americans suffer from diabetes and about 7 million people need insulin daily to manage their blood sugar.

Here’s what we know about how Americans would be affected by the Senate vote:

Republicans block insulin cost cap for millions of patients

What would the insulin price cap do?

The insulin price cap, part of a larger package of proposals to reduce the costs of prescription drugs and other health care, was intended to limit monthly insulin costs to $35 for most Americans who use insulin.

More than one in five insulin users with private medical insurance pay more than $35 a month for the drug, according to a recent analysis of the Kaiser Family Foundation. The same analysis found that the median monthly savings for these individuals ranged from $19 to $27, depending on their type of insurance market.

The average Medicare patient using insulin paid $54 for prescriptions, according to KFFan increase of almost 40% since 2007.

With the Republican vote to remove the provision, only Medicare beneficiaries would be eligible for the cap. The bill still needs to be passed in the House.

Why is insulin so expensive?

Insulin was discovered in Canada in the 1920s, and researchers who won the Nobel Prize, sold their patent to the University of Toronto for $3. Since then, the drug has become a major commercial enterprise.

The global insulin market is dominated by the American Eli Lilly, the French company Sanofi and the Danish company Novo Nordisk. A report released in December by Democrats on House Oversight and Reform Committee accused the drugmakers of repeatedly raising prices at the same rate and working to “maintain monopoly prices”, allegations the companies have denied.

In a statement, Novo Nordisk said the complexities of the US healthcare system influence the insulin market and that “many factors” determine what a person pays out of pocket for insulin. The company said the net prices of its products have “continued to decline for the past 5 consecutive years.” A Sanofi spokesperson said in a statement that “despite the rhetoric about insulin prices”, the net price of its insulin has fallen for seven consecutive years, “making our insulins significantly cheaper for healthcare companies. insurance”.

Eli Lilly did not immediately respond to requests for comment.

A generic insulin is expected to hit the market in 2024 and could help bring prices down.

Researchers also blame issues such as increasingly complicated supply chains for the dramatic rise in drug prices over the past decade. US insulin prices are well above the average price paid in other developed countries, according to a government report.

A Yale University study found that insulin is an “extreme financial burden” for more than 14% of Americans who use it. These people spend more than 40% of their income after food and housing costs for medicine.

What does this mean for uninsured patients and Medicaid recipients?

The legislation does not limit the cost of insulin for uninsured patients, despite last-minute lobbying by some House lawmakers to add such protections. Americans with uninsured diabetes are more likely to use less expensive insulin formulations than those with private insurance or Medicaid, but are more likely to pay full price for the life-saving drug , according to a 2020 report of the Commonwealth Fund, a health care think tank.

According to Sherry Glied, dean of the Robert F. Wagner Graduate School of Public Service at New York University.

But in general, costs for people with diabetes can vary widely from person to person, except for those on Medicaid.

“There’s no average person with diabetes, is there, and so no one manages their diabetes in exactly the same way,” said Aaron Turner-Phifer, advocacy director for JDRF, an organization funding type 1 diabetes research. “People take different types of insulin, they take it through pens, they take it through pumps, some use different devices. … The amount of insulin they take varies from one person to another “

What Are Republicans Saying About Insulin Price Caps?

Many Republicans have opposed the $35 cap, saying the measure does not address the fundamental problem of skyrocketing insulin prices. Instead, they said, it would force insurance companies to pass the cost on to premiums.

The cap would also have been a major victory for Democrats ahead of the midterm elections in November, possibly fueling GOP opposition to the proposal.

Yet other Republicans have decried what they have called interference of the “socialist” government in the free market. “Today, it is the government that sets the price of insulin”, said Rep. Cathy McMorris Rodgers (R-Wash.), the top Republican on the House Energy and Commerce Committee. “What’s next, gas?” Food?”

Did President Donald Trump lower the price of insulin?

In 2020, the president Donald Trump claimed he had dramatically lowered the price of insulin: “Insulin is fine — it was destroying families, destroying people. The cost,” Trump said during a debate. “I get it for so cheap it’s like water.” His statement sparked criticism patient advocates and people who still struggle to pay for their medications.

In 2020, drug manufacturers reduces the cost of insulin for some patients who lost their jobs, health insurance, or both as a result of the pandemic.

Trump signed a Executive Decree lowering the price of insulin as one of his last health-based acts. The decision was narrow, the experts saidand would have reduced the cost of insulin for some patients visiting certain federally licensed health centers.

It was canceled by the Biden administration. Health officials said at a time when the rule would have imposed “excessive administrative burdens and costs” on health centers – and reduced resources for other health services.

What is the historical position of Democrats and Republicans on insulin prices?

Democrats and Republicans have spoken out against the high price of insulin, including in congressional hearings and bipartisan investigations. But they have taken different approaches to reducing drug costs.

Republicans have long offered alternatives to Democrats’ drug pricing measures. In the House, top GOP lawmakers released plans to place a monthly $50 cap on insulin and its supplies for people on Medicare drug coverage after seniors have reached their deductibles. In the Senate, the best Republicans wrote an invoice make permanent an existing temporary pilot project that gives those on Medicare the chance to get a voluntary drug plan where insulin costs $35 a month.

Meanwhile, a bipartisan pair of senators unveiled legislation in June to tackle the cost of insulin, the result of months of work to find a compromise. But the legislation has not been passed and faces steep political hurdles in its quest to get 10 Republican votes pass the bill in the Senate.

Evan Halper, Bryan Pietsch and Tony Romm contributed to this report.

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