The good news: Congress just passed legislation to address the national crisis of insulin affordability for those in Medicare. Unfortunately, we need to keep fighting, because the bill does not do enough to ensure ALL Americans have access to affordable insulin.
Here’s what happened, what changed, and what comes next.
The Inflation Reduction Act Becomes Law
On August 7, the U.S. Senate passed the Inflation Reduction Act (IRA), which included some provisions regarding insulin. Due to the difficulty of passing bipartisan legislation in an evenly divided Senate, the Inflation Reduction Act was brought up through a process called budget reconciliation. (This process was used because it cannot be indefinitely delayed or blocked via filibuster). This wide-ranging piece of legislation also contains additional healthcare, tax, and climate measures. Its passage comes after months of negotiations between Congress and the Executive Branch.
On August 12, the House passed the IRA and President Biden is expected to sign it next week.
Several of the provisions included in the Act are the direct result of Breakthrough T1D’s advocacy and the work of our champions in Congress. Every Breakthrough T1D Advocate who sent an email, met with their Member of Congress, or signed an action alert should feel proud of this progress.
Insulin Provisions Included
The IRA will address the cost of insulin in several ways. This includes:
- Capping the monthly insulin cost at $35 for people enrolled in Medicare
- Limiting overall Medicare prescription drug costs to $2,000 per year
- Removing insulin from the deductible for Medicare Part B and D; allowing high-deductible health plans to exempt insulin from the deductible
- Currently, people typically must pay full price for their insulin before they meet their deductible. This change means people won’t have to pay the full price before they hit their deductible.
- Extending existing tax credits that enable people to obtain health coverage at a low cost via the Affordable Care Act’s insurance marketplace
These provisions will make insulin more affordable for several million Americans. However, the bill originally capped the monthly cost of insulin at $35 for both people on Medicare and commercial insurance. It is galling that 43 Senators voted to remove the commercial provision from the legislation; it could have remained in the bill if no one had objected. The good news is that based on years of engagement by our volunteers and staff, 7 Republican Senators joined all Democrats to support keeping the provision in the bill and more have said they’ll vote for it outside of the budget bill. This gives us hope that this can be revisited in the future, which Senate Majority Leader Schumer has stated will happen in September.
One more note: the Act included language that allows Medicare to negotiate drug prices; however, we anticipate most insulin products will not be eligible for negotiation.
INSULIN Act
Breakthrough T1D and our countless advocates have fought for affordable insulin for years and we will not stop until all Americans can access this life-saving drug at a predictable, reasonable cost. There is a lot of work left to be done—and we are committed it seeing it through.
Right now, the most important thing we can do is support the bipartisan INSULIN Act – a discussion draft led by Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) that should be introduced in September.
The INSULIN Act would lower the cost of insulin for those on commercial plans and bring relief to the uninsured by addressing the systemic problems that have caused the rising cost of insulin to become a unique, American crisis.
Specifically, the INSULIN Act:
- Caps monthly out-of-pocket costs at the lesser of $35 or 25% of the net insulin price in commercial plans.
- Waives insulin from applying to the deductible in commercial plans.
- Incentivizes manufacturers to lower list prices via a certification process.
- Certified insulins will not be subject to methods health plans use to restrict access such as rebates, prior authorization, and other utilization management requirements.
Breakthrough T1D has been working for years with the lead sponsors of the INSULIN Act to develop viable policy solutions for insulin affordability that will have the greatest impact for the most people with diabetes. The INSULIN Act is the best, bipartisan solution yet—and we look forward to it coming to the floor for a vote soon.
What about the uninsured?
Unfortunately, the Inflation Reduction Act does nothing for the uninsured. The INSULIN Act does, via the creation of an incentive structure to lower the list price of insulin that would dramatically lower the out-of-pocket cost for those who are uninsured.
The Breakthrough T1D-supported Civica Insulin Project is another ongoing effort to bring affordable insulin to the uninsured, and it is not dependent on Congress. Civica, a non-profit, will produce biosimilar insulins for no more than $30 per vial starting in 2024. Breakthrough T1D is proud to have played a leadership role in launching the Civica Insulin Project, and we look forward to sharing progress with you.
What comes next?
In the very near future, President Biden will sign the Act and it will become law. That is a win made possible by the dedicated hard work of our community. But, together, there is more work to do.
We will not stop until insulin is available to all people with T1D at a low, predictable, out-of-pocket cost. Right now, that means continuing to advocate for our principles and legislation that will meaningfully address the problem in addition to supporting Civica.
If you’re not already, please sign up to be a Breakthrough T1D Advocate. It’s the best way to stay current on our progress in this space so you can communicate to lawmakers that our community deserves more. Also – take action today – tell your Senators to vote for the INSULIN Act once it is introduced.
Thank you for all you have done to get us here. Let’s keep fighting.
