The Inflation Reduction Act of 2022 was poised to pass in the House of Representatives on Friday, after clearing the Senate the weekend before. The good news for millions of seniors on Medicare is that the bill caps out-of-pocket drug costs at $2,000 a year, including a $35 price cap on insulin copays. Considering one in three Medicare beneficiaries has diabetes, and more than 3.3 million of them use insulin, this cap can ease the financial burden of diabetes treatment for millions of people.
But 43 Republicans in the Senate blocked this $35 insulin copay cap from extending to patients on private insurance. Which means that millions more Americans will still struggle to afford a treatment that is essential to staying alive.
Everyone needs insulin to survive, as this hormone secreted by the pancreas regulates the amount of sugar in the blood. But people who are not creating enough insulin develop diabetes, and often need to inject themselves with insulin to help their bodies break down sugar and create energy. More than 37.3 million Americans have diabetes (or 11.3% of the U.S. population), according to the American Diabetes Association, and 8.4 million Americans rely on taking insulin.
So what happens when someone does not get enough insulin into their body? Severe hyperglycemia (aka high blood sugar) sets in, which can lead to diabetic ketoacidosis (DKA), meaning the body begins to break down fats for energy instead of sugars. This leads to an excessive amount of acids called ketones building up in the bloodstream and urine. Untreated, it leads to death.
“14% of Americans who rely on insulin face ‘catastrophic’ spending on it, meaning at least 40% of their income after food and housing goes toward insulin. ”
Problem is, a standard vial of insulin now runs between $175 and $300 in the U.S., with some running up to $1,000 — despite costing less than $10 to produce — and the average patient needs about two vials a month. So as the price of insulin has tripled in the U.S. over the past decade, it’s not surprising that a recent Yale study found 14% of Americans who rely on insulin face “catastrophic” spending on it, meaning at least 40% of their income after food and housing goes toward insulin. And this estimate, which covered costs in 2017 and 2018, didn’t even include other diabetes-related costs like glucose monitors, insulin pumps and other medications. Insulin has become so expensive that some people are rationing or skipping their doses — sometimes with fatal results.
“Insulin is too expensive for too many people with diabetes. We appreciate the Senate approving copay cap for seniors, but disappointed 43 senators opposed making insulin affordable for those with private insurance,” Dr. Robert Gabbay, the American Diabetes Association’s chief scientist and medical officer, said in a statement after the Senate vote. “We stand ready to work with Congress to make insulin affordable for all Americans who need it.”
And it’s not just diabetics affected by insulin costs. Although insulin is familiar to most people as something diabetics must take, it is also used in cancer treatment, organ preservation, managing septic shock and other critical illnesses in intensive care units.
While many measures in the Inflation Reduction Act have made headlines, the insulin cap became a buzzworthy topic, likely because it impacts so many people. It has led “insulin” to trend on Twitter since the Senate vote. Many called out Republicans who voted against capping the insulin copay on private insurance, or some people shared how much they are spending on insulin each month.
This could indeed be a hot-button issue in the November midterms. In the week running up to the House vote on the bill, Google searches for “insulin prices” spiked 800% in the U.S., and Americans looking up “insulin” were also googling “voting” in the past week. What’s more, “$35 cap on insulin” and “insulin cap vote” were breakout searches over the past week.
So why is insulin so expensive when it takes just dollars to produce? Part of the problem is “evergreening,” which is when drug companies extend the life of their patents by making incremental improvements to their products, such as changing the delivery system of insulin by using insulin pens instead of vials. When patents are extended, it discourages the development of cheaper, generic drugs, and the patent-holders with exclusive rights to their insulin can charge whatever the market will bear. Add in supply chain challenges, and prices have spiked.
So what happens next? And what can people do if they can’t afford their insulin?
Senate Majority Leader Chuck Schumer, a New York Democrat, said Monday that he plans to bring a $35 cap on insulin copays back up for a vote this fall. “We’re going to come back and make them vote on that again,” he said. Earlier this year, a bipartisan insulin measure from Sens. Jeanne Shaheen, a New Hampshire Democrat, and Maine Republican Susan Collins, to cap the cost of insulin at $35 also stalled after failing to get GOP support; it’s unclear whether Schumer’s plan would work with this bipartisan effort.
And some states and drugmakers
are also working to bring down the cost of insulin. Civica Rx plans to produce and sell generic insulin to consumers at less than $30 per vial, and under $55 for a box of five pen cartridges. And California Gov. Gavin Newsom recently approved a budget allocating $100 million for the state to start making its own low-cost insulin.
What’s more, 22 states and the District of Columbia have capped copayments on insulin and diabetes supplies, the American Diabetes Association shared. But there’s a big “but” here — many state healthcare laws and state caps don’t apply to patients on job-based plans, aka self-funded plans or self-insured plans –– which is what 61% of workers with health insurance were covered by in 2016, according to the Kaiser Family Foundation. So even in states with caps on diabetes treatments, patients may still end up bearing the brunt of the expense by themselves.
The American Diabetes Association has also consolidated resources for anyone struggling to pay for insulin and other diabetes treatments at insulinhelp.org.
And this is what else the Inflation Reduction Act does for climate, drug prices and taxes.
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