Legislation to limit insulin costs for people with diabetes is getting revived in the Senate. Democrats say they want to move quickly, but they’ll need Republican support to get anything through an evenly divided chamber — and they’re not there yet.
Curbs on insulin costs have the backing of President Joe Biden, and before that, even enjoyed support from his Republican predecessor Donald Trump. The goal reemerged this week after Senate Majority Leader Chuck Schumer, D-N.Y., wrote colleagues that “negotiations are underway with Senate Republicans on legislation to lower the cost of insulin,” part of an urgent push to address economic pain points for American families.
Democrats want to regain momentum on drug costs that they frittered away when endless rounds of intraparty disagreements stalled Biden’s domestic agenda. Some Republicans would also like to notch an accomplishment in a policy area that galvanizes voters across the political spectrum. House Democrats say insulin legislation that musters 60 votes in the Senate would also pass their chamber.
Schumer is a prominent cosponsor of a recent bill from Sen. Raphael Warnock, D-Ga., that would limit insulin copays to $35 a month for patients covered by private insurance and those on Medicare. Although it would expand on a Medicare option launched as an experiment by the Trump administration, the bill's roster of cosponsors includes no Republicans.
Sen. Susan Collins, R-Maine, says she is getting ready to introduce bipartisan legislation that takes a broader approach, also helping uninsured patients who bear the brunt of high and rising list prices for insulin. Collins says she's working with New Hampshire Democratic Sen. Jeanne Shaheen, and their bill could incorporate something along the lines of Warnock's proposal.
“I think that there ought to be enough support to get this passed in a bipartisan way,” Warnock said. “Something as puny as politics shouldn't get in the way of providing access to a life-saving drug.” Health care has been a central issue for the freshman senator.
Collins says a limit on copays for insured people is only a partial solution, since it doesn't help uninsured patients. The uninsured get stuck with high list prices because they're excluded from deep discounts available through insurers and middlemen companies that manage prescription benefits.
“We are looking more broadly at the whole system of insulin pricing,” Collins said. “It is a priority for both Jeanne and me, and we believe we are positioned to advance a well-thought-out bill.” They plan to introduce it later this month.
On Wednesday, Senate Finance Committee Chairman Ron Wyden, D-Ore., announced he will hold a hearing next week on drug costs. Wyden wants Congress to pass a major pricing overhaul to cut costs for Medicare recipients as well working-age people. Insulin is a piece of it.
Nearly 30 million Americans have diabetes, and more than 6 million use insulin to keep their blood sugars under control. It's an old drug, refined over the years, that has seen relentless price increases. Patients who can't afford the cost of their insulin often skip doses, a risky strategy that can lead to serious complications and even death.
Juliette Cubanski, a Medicare expert with the nonpartisan Kaiser Family Foundation, says the idea of limiting insulin costs seems to have started in the states and eventually gotten the attention of the federal government.
The Trump administration negotiated with drugmakers and insurers to offer Medicare enrollees the option of signing up for prescription plans that covered insulin for $35 a month. Warnock's bill takes that further, codifying Medicare's demonstration program in federal law. All Medicare drug plans, as well as employer and individual policies, would be required to cover a range of insulin products for $35 a month.
“It would be a clear benefit for people with insurance who have a high deductible that they have to get through,” Cubanski said. The reason a $35 cap would help is that the share of costs insured patients must pay themselves is usually based on the list price of insulin, not the discounted prices their insurers have negotiated.
It's worse for uninsured people. “Those who struggle the most affording insulin are people who don't have health insurance," said Cubanski.
The drug pricing provisions in Biden's domestic agenda would tackle insulin costs from multiple angles. In addition to a similar $35 monthly cap on patient costs, the bill would authorize Medicare to negotiate insulin prices. More broadly, the legislation would rein in annual cost increases on all medications — including insulin — and limit out-of-pocket drug costs for Medicare recipients.
Democrats say those drug pricing provisions still have a chance, along with a health care package that would expand access to insurance and keep premiums more affordable. An encouraging sign for Warnock's bill: Sen. Joe Manchin, D-W.Va., whose opposition has been the bane of Biden's policy ambitions, is listed as a cosponsor.