GOP senators have blocked a $35 insulin price cap: What you need to know

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The Senate on Sunday passed a sweeping budget package intended to provide financial relief to Americans, but not before Republican senators voted to withdraw a proposal that would have capped the price of insulin at $35 a month for many patients.

A proposal that limits the monthly cost of insulin to $35 for Medicare patients has not been changed. But by using a House rule, GOP lawmakers were able to drop the part of the proposal that would apply to privately insured patients.

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Seven Republicans joined Democrats in supporting the broader price cap, but it was not enough for passage. A number of Republican senators who voted to withdraw the proposal come from states with some of the highest diabetes death rates, according to data from the Centers for Disease Control and Prevention, including Arkansas, Oklahoma and Tennessee.

Lowering the price of drugs such as insulin, which is used by diabetics to manage their blood sugar levels, is widely popular with voters, according to polls. Senate Democrats denounced Republicans for voting against aid to Americans hard to pay for life-saving medicine.

More than 30 million Americans have diabetes and about 7 million need insulin daily to manage their blood sugar.

Here’s what we know about how Americans would be affected by the Senate vote:

Republicans block insulin cost cap for millions of patients

What would the insulin price cap do?

The insulin price cap, part of a larger package of proposals to reduce the costs of prescription drugs and other health care, was intended to limit monthly insulin costs to $35 for most Americans who use insulin.

According to a recent Kaiser Family Foundation analysis, more than one in five insulin users with private medical insurance pay more than $35 a month for the drug. The same analysis found that the median monthly savings for these individuals ranged from $19 to $27, depending on their type of insurance market.

The average Medicare patient using insulin paid $54 for prescriptions, according to KFF, an increase of nearly 40% since 2007.

With the Republican vote to remove the provision, only Medicare beneficiaries would be eligible for the cap. The bill still needs to be passed in the House.

Why is insulin so expensive?

Insulin was developed in Canada in the 1920s and its Nobel Prize-winning creators sold their patent to the University of Toronto for $3. Since then, the drug has become a major commercial enterprise.

The global insulin market is dominated by Eli Lilly, the French company Sanofi and the Danish company Novo Nordisk. A report released in December by Democrats on the House Oversight and Reform Committee accused drugmakers of repeatedly raising prices at the same pace and working to “maintain monopoly pricing,” allegations that drugmakers companies have denied.

In a statement, Novo Nordisk said the complexities of the US healthcare system influence the insulin market and that “many factors” determine what a person pays out of pocket for insulin. The company said the net prices of its products have “continued to decline for the past 5 consecutive years.”

Eli Lilly and Sanofi did not immediately respond to requests for comment.

A generic insulin is expected to hit the market in 2024 and could help bring prices down.

Researchers also blame issues such as increasingly complicated supply chains for the dramatic rise in drug prices over the past decade. US insulin prices are well above the average price paid in other developed countries, according to a government report.

A Yale University study found that insulin is an “extreme financial burden” for more than 14% of Americans who use it. These people spend more than 40% of their income after food and housing costs for medicine.

What does this mean for uninsured patients and Medicaid recipients?

The legislation does not limit the cost of insulin for uninsured patients, despite last-minute lobbying by some House lawmakers to add such protections. According to a 2020 report by the Commonwealth Fund, a healthcare think tank.

According to Sherry Glied, dean of the Robert F. Wagner Graduate School of Public Service at New York University.

But in general, costs for people with diabetes can vary widely from person to person, except for those on Medicaid.

“There’s no average person with diabetes, is there, and so no one manages their diabetes in exactly the same way,” said Aaron Turner-Phifer, advocacy director for JDRF, an organization funding type 1 diabetes research. “People take different types of insulin, they take it through pens, they take it through pumps, some use different devices. … The amount of insulin they take varies from one person to another “

What Are Republicans Saying About Insulin Price Caps?

Many Republicans have opposed the $35 cap, saying the measure does not address the fundamental problem of skyrocketing insulin prices. Instead, they said, it would force insurance companies to pass the cost on to premiums.

The cap would also have been a major victory for Democrats ahead of the midterm elections in November, possibly fueling GOP opposition to the proposal.

Yet other Republicans denounced what they called the “socialist” government’s interference in the free market. “Today, it is the government that sets the price of insulin”, said Rep. Cathy McMorris Rodgers (R-Wash.), the top Republican on the House Energy and Commerce Committee. “What’s next, gas?” Food?”

Did President Donald Trump lower the price of insulin?

In 2020, the president Donald Trump claimed he had dramatically lowered the price of insulin: “Insulin is fine — it was destroying families, destroying people. The cost,” the president said during a debate. “I get it for so cheap it’s like water.” Her statement drew criticism from patient advocates and people who still struggle to pay for their medications.

In 2020, drugmakers reduced the cost of insulin for some patients who lost their jobs, health insurance, or both as a result of the pandemic.

Trump signed an executive order to lower the price of insulin as one of his last health acts in office. Experts say the decision was narrow and would have lowered the cost of insulin for some patients who visit certain federally licensed health centers.

It was canceled by the Biden administration. Health officials said at the time that the rule would have imposed “excessive administrative costs and burdens” on health centers – and reduced resources for other health services.

What is the historical position of Democrats and Republicans on insulin prices?

Democrats and Republicans have spoken out against the high price of insulin, including in congressional hearings and bipartisan investigations. But they have taken different approaches to reducing drug costs.

Republicans have long offered alternatives to Democrats’ drug pricing measures. In the House, top GOP lawmakers released plans to impose a $50 monthly cap on insulin and its supplies for people on Medicare drug coverage after seniors hit their deductibles. In the Senate, senior Republicans have crafted a bill to make permanent an existing temporary pilot project that gives those on Medicare the option to get a voluntary prescription drug plan where insulin costs only $35 per month.

Meanwhile, a pair of bipartisan senators unveiled legislation in June aimed at tackling the cost of insulin, which was the byproduct of months of work to find a compromise. But the legislation has not been put to a vote and faces daunting political hurdles in its quest to secure 10 Republican votes to pass the bill in the Senate.

Evan Halper, Bryan Pietsch and Tony Romm contributed to this report.

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