J. Scott Applewhite/AP Photo
From left, Rep. Dan Kildee (D-MI), House Majority Whip James Clyburn (D-SC), Rep. Angie Craig (D-MN), and Rep. Lucy McBath (D-GA) talk about their support for legislation aimed at capping the price of insulin, March 31, 2022, at the Capitol in Washington.
Since at least 2006 and in every election thereafter, Democrats have been promising the nation that they would tackle one of the most pressing problems voters identify, by lowering prescription drug prices. A drug pricing reform plan was a major facet of the past year’s Build Back Better bill and still may be included in whatever Joe Manchin allows Congress to pass. But the overwhelming power of the pharmaceutical industry has frustrated these efforts at every step.
The various options proposed for lowering drug prices have spanned everything from allowing Medicare to negotiate with drug companies over price, to importing lower-priced prescription drugs from Canada, to having the government directly manufacture generic medications. But the party has now trained its sights on a much more modest measure, one that has raised simultaneous joy and concern among health care activists.
Last Thursday, the House passed the Affordable Insulin Now Act, a bill that caps insulin co-pays at $35 a month. Despite being discovered over a century ago, insulin’s wholesale price tripled from 2007 to 2017, and remains unaffordable for millions of sufferers of Type 1 diabetes. The co-pay cap passed on a bipartisan basis, 232-193, signaling hope for its passage through the Senate.
Sen. Raphael Warnock (D-GA) has introduced a bill that’s similar to what passed the House, while Sen. Susan Collins (R-ME) reportedly has been working with Sen. Jeanne Shaheen (D-NH) on a more comprehensive package on insulin prices. Senate Majority Leader Chuck Schumer has vowed to hold votes on an insulin package this spring. The bill also has overwhelming popular support, according to Data for Progress polling.
But although the cap would apply for those with private health care as well as Medicare, it is estimated to at most save money for a little more than 1 in 4 people taking insulin, according to health care analyst KFF. That’s certainly positive for those individuals, reducing the chance of potentially lethal insulin rationing, or choosing between that and another basic necessity. “High out-of-pocket costs for insulin undermine human rights,” says Matt McConnell, researcher at Human Rights Watch.
But the bill, already limited in impact because it only covers a single drug, also fails to protect all people with diabetes. The bill caps co-pays for insulin, which only patients with insurance receive. It does nothing for the uninsured, who will continue to have to pay full price for the drug. The famous case of Alec Raeshawn Smith, who was forced off his parents’ insurance at age 26 and died of ketoacidosis from lack of insulin, would not be affected at all by a cap on co-pays.
Uninsured Americans are highly likely to be people of color: roughly 60 percent, according to KFF. McConnell also pointed out the almost two million uninsured people from states that have not adopted the Medicaid expansion. Most of those states are in the South, and as of 2019, a majority of those uninsured who fall into the Medicaid gap are people of color.
Even for insured Americans, the co-pay cap may not help. The insulin covered by the co-pay cap is only the one listed as “preferred” by a patient’s prescription drug plan. If patients use a different type of insulin, they won’t qualify for the assistance.
In addition, a cap on co-pays doesn’t change the list price that drug companies can charge for insulin. It just transfers who pays for it, from the individual patient to the insurance company. Ultimately, all patients will likely shoulder the cost in higher premiums. So a co-pay cap doesn’t lower the price of prescription drugs so much as it spreads the cost around. “It just shifts the cost to employer and individual premiums and the government,” noted Larry Levitt, executive vice president for health policy at KFF, on Twitter.
McConnell wonders whether the bill will end up applying to all insulin products, and whether it could cover those products to cap total monthly expenses. Under the current structure of the bill, each insulin product would have the $35 co-pay cap, meaning that an individual’s out-of-pocket costs could be higher if they use multiple drugs.
Health care activists worry over what actual impact the bill may have. Shaina Kasper, policy manager for T1International, a coalition of patients with Type 1 diabetes, told me over email that a cap on prices, which would hold manufacturers responsible for price-gouging, could lower insulin prices “across the board,” rather than just for those with insurance.
“While insulin has become the poster child of pharmaceutical price gouging and must be addressed,” Kasper said, “we need comprehensive and structural prescription drug reforms to make medicines affordable.”
