INSULIN Act would expand insulin co-pay cap to commercial market and encourage competition.
The Endocrine Society today endorsed the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, a bipartisan bill to address insulin affordability introduced by Sens. Jeanne Shaheen (D-NH), Susan Collins (R-ME), Raphael Warnock (D-GA), and John Kennedy (R-LA).
This historic legislation would cap out-of-pocket insulin costs at $35 per month for people on private insurance, protecting access to this life-saving medication for millions of people with diabetes. The legislation also would create a program to provide insulin to the uninsured.
The INSULIN Act expands the $35 cap on out-of-pocket costs of insulin currently available for Medicare beneficiaries, extending the cap for those with private insurance, and addresses the underlying problems in the insulin market that contribute to escalating prices. The bill also includes provisions ensuring that patients are receiving any insulin rebates and discounts that are normally collected by Pharmacy Benefit Managers (PBMs), and a provision to encourage more competition for generic and biosimilar insulins.
Insulin affordability is a life-or-death matter for millions of people living with diabetes in the United States. People with type 1 diabetes rely on insulin to live, and many people with type 2 take insulin as part of their treatment plan. The U.S. Centers for Disease Control and Prevention estimates 38.4 million people — or 11.6% of the U.S. population — have diabetes. In 2021 alone, nearly one in five American adults with diabetes — about 1.3 million people — rationed their insulin.
“Many people living with diabetes struggle to pay for the insulin they need to survive,” said Endocrine Society Clinical Affairs Core Committee Chair Whitney Goldner, MD. “This important legislation would ensure that people living with diabetes on private insurance are able to access this life-saving medication at no more than $35 per month. The legislation also includes provisions to help people who are uninsured afford their insulin. We are pleased to endorse this bipartisan bill and thank Sens. Shaheen, Collins, Warnock, and Kennedy for their commitment to addressing this urgent issue.”
The INSULIN Act aligns with recommendations in the Society’s Insulin Access and Affordability Position Statement, which calls for lowering the price of insulin through rebate reform and limiting co-pays to no more than $35 per month for insulin.
Here is a more detailed breakdown of the policies in the legislation to improve access and affordability of insulin:
- Ensuring group and individual health plans waive any deductible and limit cost-sharing to no more than $35 per month or 25% of list price, for at least one insulin of each type and dosage form.
- Mandating Pharmacy Benefit Managers (PBMs) pass through 100% of insulin rebates and other discounts to insurance plan sponsors so that patients can share in any savings.
- Promoting competition from generic and biosimilar drugs.
- Creating a competitive grant program that would provide 10 states with funds to create programs to identify people with diabetes who are uninsured and provide them with insulin.
- Establishing an insulin resource center and hotline for people with diabetes who are uninsured to connect them with resources about diabetes and programs to help them secure insulin.
The Endocrine Society looks forward to working with Congress to ensure the legislation is passed this year.
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