Senate bill proposes insulin price cap for diabetes patients
In this photo illustration, Novo Nordisk insulin pens are on display on March 14, 2023 in Miami, Florida.
Joe Raedle | Getty Images
Bipartisan Senate legislation introduced on Friday would limit the price of insulin to $35 a month for people with private insurance.
The bill, drafted by Sens. Jeanne Shaheen, DN.H., and Susan Collins, R-Maine, comes two months after President Joe Biden called on Congress during his State of the Union address to extend the insulin price cap to millions of people with diabetes who are privately insured.
“Americans living with diabetes and those who love them can no longer wait for Congress to act — the time is now,” Shaheen and Collins said in a statement.
“We urge the Senate leadership to submit this bill for consideration as soon as possible.”
Biden’s Inflation Reduction Act, which went into effect last year, capped the price of insulin for seniors on Medicare at $35 per month.
But efforts to include people with private insurance were stymied by Republican opposition last year in Congress.
More than 2 million diabetics who take insulin are privately insured, according to the Health Ministry.
About 150,000 patients who take insulin are uninsured, according to HHS.
In March, Eli Lilly, Novo Nordisk and Sanofi announced they were reducing the prices of their top insulin products in response to mounting public pressure to address rising costs.
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These three drug companies control 90% of the global insulin market, according to HHS.
Shaheen and Collins said Congress must step in and legislate the price cap to ensure insulin is affordable for patients.
“We are encouraged by the proactive steps taken by private companies, but this is a drop in the bucket of the measures needed to bring prices down across the board and keep them there,” the senators said.
The legislation would require that beginning in January 2024, private insurance plans limit the price patients pay to no more than $35 per month and waive deductibles for at least one of each insulin type and dosage form.
Types of insulin include fast, short, medium, long-acting, and premixed. Dosage forms include vials, pens, and inhalers.
In 2025, legislation would cap the amount patients pay at the lower of two possible rates — $35 a month, or 25% of the manufacturer’s list price.
The bill also seeks to rein in pharmacy service administrators, the intermediaries who negotiate drug prices with drug manufacturers on behalf of health plans.
Although pharmacy service administrators are said to negotiate lower prices, they have come under scrutiny for pocketing some of the rebates and rebates they receive from manufacturers.
Senate legislation would require administrators of pharmacy benefits to pass on 100% of discounts and rebates they negotiate off the insulin manufacturer’s list price to health insurers, which could help lower premiums for patients.
The bill would also give the Food and Drug Administration the power to expedite approval of biologic products like insulin that resemble branded products, which could help increase competition and drive down prices.
To date, the FDA has only approved two insulins — Rezvoglar and Semglee — that are interchangeable with branded products. These are manufactured by Lilly and Mylan Pharmaceuticals respectively.
