A bipartisan group of lawmakers are pushing for bipartisan legislation that would both lower insulin prices and prohibit drug rebates for insulin. One of the top priorities of the lawmakers is to cap insulin out-of-pocket costs at $35 per month (between deductible and any cost sharing) and to support patient access to insulin by ensuring prior authorization or other similar formulary management tools “cannot be imposed to limit beneficiary use.”
Another priority of the group is to ensure that plans and pharmacy benefit managers (PBMs) “cannot collect rebates, which drive up drug costs at the point of sale, on insulins that roll prices back to 2006 or equivalent levels.”
Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) released a joint statement, saying that their “proposal holds all parties accountable by encouraging them to reduce list prices, and critically, it limits out-of-pocket costs for patients with diabetes.” Representatives Diana Degette (D-CO) and Tom Reed (R-NY) also joined the announcement. Senators Shaheen and Collins co-chair the Senate Diabetes Caucus while Degette and Reed co-chair the House Diabetes Caucus.
“Access to insulin is a life-or-death concern for many of the millions of Americans living with diabetes. Lowering skyrocketing costs to ensure this critical medicine is never out of reach is an urgent need and a crucial bipartisan priority in Congress. We’ve been working for years to find common ground to get this done and we now have an opportunity to get bipartisan legislation over the finish line and ensure that patients with diabetes and their families are no longer burdened with insurmountable costs for this critical, life-saving medication,” said Shaheen and Collins. “We have made great progress, and soliciting feedback is the next step in our process. With strong bipartisan leadership, we look forward to continuing to work together to deliver on this issue for Americans with diabetes and their families – we must seize the moment and uphold our commitment to finally combat the decades-long surging prices of insulin.”
This follows the prior Insulin Price Reduction Act that was sponsored by Shaheen and Collins, which was intended to hold those throughout the supply chain – including pharmaceutical companies, pharmacy benefit managers, and insurers – accountable for surging insulin costs by incentivizing reductions in list prices.
Other Legislation
In February 2022, Senator Raphael Warnock (D-GA) introduced legislation in the Senate that would also cap insulin costs at $35 per month, starting in 2023. Senator Ron Wyden (D-OR) said that he would like to merge the ideas, saying “I think both of these approaches have a lot to recommend.”