Posted: April 4, 2022
Washington – Today, Rep. Mike Thompson (CA-05) voted to pass the Affordable Insulin Now Act to cap out-of-pocket costs of insulin at no more than $35 per month in Medicare Part D and commercial health insurance. This bill ensures vital and affordable access to life-saving medication for the more than 37 million people in the United States who have diabetes, including one-third of Medicare beneficiaries and the over 7 million Americans who rely on insulin to maintain their health and well-being.
“In the wealthiest nation on earth, no one should go bankrupt trying to pay for life-saving medication,” said Thompson. “Today, I was proud to vote for the Affordable Insulin Now Act to ensure that every American who depends on this vital medication can afford it by capping the cost of insulin at $35 per month. While this is a strong step to address the costs of health care, there is still work to be done to lower costs and provide health care for every American. The Senate must take up this bill expeditiously to cap the cost of insulin and ensure broad access to this live-saving medication.”
The Affordable Insulin Now Act requires Medicare Part D plans and commercial health insurance plans to cover insulin and cap cost-sharing at no more than $35 per month. Beginning in 2023, the bill requires private health plans to cover at least one of each type and dosage form of insulin and caps cost-sharing for a 30-day supply at the lesser of $35 or 25 percent of a plan’s negotiated price. The bill also requires all Medicare prescription drug plans to cap cost-sharing for insulin at no more than $35. Among individuals with private insurance, half would save at least $19 per month and a quarter would save at least $42 per month. Individuals who buy their own insurance will experience the most savings. This bill is paid for by delaying the implementation for one year of the Rebate Rule that was published by the Office of the Inspector General of the Department of Health and Human Services on November 30, 2020.
Right now, insulin is too expensive for millions of Americans.
- 1 in 4 Americans who rely on insulin have cut back or skipped doses due to costs.
- 34 percent of families with children dependent on insulin have been impacted by rising insulin costs, including adverse health effects and increased stress and anxiety.
- 26 percent of Americans with diabetes ration their insulin at least once a year – putting themselves at grave health risk because of cost. In 2018, more than a dozen people died while rationing their insulin due to the high cost.
Insulin prices in the United States are much higher than other countries and continue to increase.
- Americans pay more than 10 times the price of insulin compared to other similar high-income countries.
- From 2014 to 2019, the average retail price of insulin rose by 54 percent.
- Among those with private coverage, 1 in 5 people who take insulin have out-of-pocket costs of more than $35 per month. High cost-sharing is especially common in the individual and small group markets.
- In a recent study, insulin out-of-pocket costs among all insulin users averaged $64 in 2017, almost double what the out-of-pocket costs would be with H.R. 6833.