$35 monthly insulin cap: Republicans decry how White House, Dems plan to pay for it
As the House preps to vote on a $35 monthly insulin cap later today (the Senate has plans for a vote next month too), there remain several outstanding questions on how the uninsured will be covered, how Democrats plan to pay for the cap and what the after-effects might be (i.e. will this cap be offset by premium increases?).
Kicking off discussion on the White House-backed cap Wednesday, the House Rules Committee split almost evenly along party lines. Democrats called for something to be done to stop people from rationing their lifesaving insulin due to price, while Republicans have sought other plans to lower insulin costs, including market-based solutions like biosimilars, which have struggled to take off so far, or providing PBM rebates directly to patients.
Under the bill proposed, Medicare beneficiaries and those insured through private plans would pay no more than $35 for a 30-day insulin prescription, or the lesser of $35 or 25% of the plan’s negotiated price for a 30-day prescription.
Frank PalloneHouse Energy & Commerce Chair Frank Pallone (D-NJ) testified Wednesday on behalf of the bill, explaining how most who rely on insulin to save their lives pay more than double this $35 cap, and the reason that these prices have continued to rise is because three drugmakers control the more than $20 billion insulin market — Eli Lilly, Novo Nordisk, and Sanofi — and keep the price high.
“We have so many people with diabetes who are dependent on insulin and whose costs are skyrocketing,” Pallone said, while also openly musing about whether the Senate could see some Republican defections on this, and nab the 60 votes necessary to pass the bill.
The bipartisan duo of Sens. Susan Collins (R-ME) and Jeanne Shaheen (D-NH), who previously worked on insulin in 2019, will lead the Senate’s efforts. The issue of insulin prices in the US has been lingering for years with no solution. The current price of insulin in the US is more than 10 times that of 33 other comparable countries, even as the net price of insulin has declined in recent years.
Rep. Cathy McMorris Rodgers (R-WA) testified against the House insulin bill on Wednesday, raising questions about the CBO’s score of it, which said it would cost the government about $11 billion over 10 years.
Capping out-of-pocket costs for insulin at $35 per month would increase government spending by $6.6 billion over 10 years and decrease government revenue by $4.8 billion. https://t.co/uKNTkQBaKu
— Larry Levitt (@larry_levitt) March 30, 2022
Rep. Michael Burgess (R-TX) also raised concerns about where the Democrats were seeking to pay for this insulin price cap, questioning Pallone about why the plan was to cap insulin at $35 per month and not $10.
“You’re paying for it with money that doesn’t exist in the rebate rule, so why not,” he said.
What Burgess referred to is the way the insulin bill also would delay, for one year, the implementation of a Trump-era rule affecting certain pharma rebates in Medicare Part D. The Biden administration likely has no intention of ever implementing that rule, as it would end up costing the federal government almost $200 billion over 10 years. Democrats have previously sought to use delays in the rule, which is technically still on the books as taking effect, as a way to pay for other drug pricing initiatives.
Meanwhile, the committee on Wednesday also did not take up an amendment to this bill, co-sponsored by Lloyd Doggett (D-TX) and other Democrats, that would’ve also extended this insulin price cap to those who are uninsured, and which would’ve cost another $9 billion, according to the amendment text.
