House caps insulin costs at $35 a month for Medicare Beneficiaries

Insulin prices in the United States have increased dramatically over the past decade. This has hit Medicare Part D enrollees hard, with insulin prices increasing around 10% per year under Medicare pricing.

Recently, the U.S. Congress has sought to change this, easing pricing for American patients. The Affordable Insulin Now Act (H.R. 6833, which the U.S. House of Representatives passed in March 2022, is now pending action in the U.S. Senate (S. 3700). The Act aims to lower the cost of insulin for both private health insurance plans as well as Medicare Part D plans.

The bill aims to lower the cost of insulin products and would take effect on January 1, 2023. Copays for insulin products would not be able to exceed $35 for a 30-day supply, or 25% of a plan’s cost for the insulin, whichever is less. Further, a person would not have to pay a higher amount to meet any outstanding insurance deductible. The copays however would count towards both a person’s deductible and their total out-of-pocket maximums.

Not all insulins would be covered by the law. However, at least one type of insulin per dosage form (including vials, pump products, and inhalers) would be required to meet the law’s standards. In addition, the law would require at least one insulin be available for each duration of action. This includes at least one of each of the following:

• Rapid-acting insulin

• Short-acting insulin

• Intermediate-acting insulin

• Long-acting insulin

• Ultra long-acting insulin

• Premixed insulin

However, there are exceptions to the law. For example, the law would not require insurance plans to provide low-cost insulin prescribed by out-of-network providers. Patients who see an out-of-network provider for their insulin could be required to pay higher costs.

It is unclear whether the U.S. Senate will take up the Affordable Insulin Now Act. As of June 2022, the bill is in the Senate Finance Committee, where it is pending action. If the bill is introduced to the full U.S. Senate and passed, it will be sent to President Biden, and would then become law upon his signature.

Even if the bill does not pass the U.S. Senate, some seniors may still benefit from the bill’s influence. Currently, the Centers for Medicare and Medicaid Services (CMS) is pilot testing a program under the Medicare Part D prescription drug benefit. In this program, the cost of insulin is capped at $35 a month for participating plans. CMS estimates that seniors who are enrolled in a participating plan and who take insulin have an average out-of-pocket savings of $446, or about 66% of their prior insulin costs. Medicare beneficiaries can enroll in eligible plans that fit their needs through Hella Health or Medicare Plan Finder website.

Because it is a pilot program, however, it is not permanent and is set to expire at the end of 2025. After that time, it is unclear what will become of the program if the Affordable Insulin Now Act is not signed into law.

This article does not necessarily reflect the opinions of the editors or management of EconoTimes