Insulin cap for Medicare patients signals hope for others

Years before he came to the Senate, Raphael Warnock spent time bedside with Georgia residents suffering from the long-term effects of diabetes, a condition made worse by limited access to life-saving drugs like insulin.

“I’ve seen the human face of this up close as a pastor. I’ve been there and witnessed what happens when diabetes goes on untreated,” Warnock said in an interview with The Associated Press. “I’ve been there with families when they received the news that a loved one will have to receive an amputation.”

That work as a pastor helped the freshman senator push Congress to take its first step in limiting the high cost of insulin for millions of Americans.

The passage of the expansive climate change and healthcare bill this month delivered key Democratic priorities to voters months before the midterm elections, including provisions to lower healthcare costs.

As a result, by 2026, Medicare will gain the power to start negotiating costs for pharmaceuticals and its beneficiaries’ out-of-pocket prescription costs will be limited to $2,000 starting in 2025.

But the most immediate relief will take effect in January when the cost of insulin for patients on Medicare will be capped at $35 a month.

Not a Modern Healthcare subscriber? Sign up today.

The provision, a longstanding priority for Democrats, will bring relief to an estimated nearly 2 million people across the country who currently pay an average of $572 annually out-of-pocket for insulin, according to a recent analysis by the Kaiser Family Foundation.

In Warnock’s state, the annual average is higher, coming in at $591 for more than 50,000 Georgia residents whose lives are dependent on the drug.

Around 7 million Americans require insulin daily and 14% of them are spending nearly half of their income after food and housing costs on the medicine, according to a Yale University study.

“It’s devastating for a family to have to make those choices,” Lisa Murdock, chief advocacy officer for the American Diabetes Association, told the AP. “This is a life-saving medication. You can’t live without it, and we shouldn’t have people in this country who are having to choose to do that.”

The issue of insulin pricing is more pronounced in the U.S. than in other nations, and it has gotten worse over the past two decades. According to a 2016 study published in the Journal of the American Medical Association, between 2002 and 2013, the price of insulin tripled. And between 2012 and 2016, prices continued to climb, nearly doubling, a congressional report released in March found.

The issue has been a perennial one in Congress, with a broad bipartisan consensus recognizing the problem, but little agreement on a solution. That is why organizations like the American Diabetes Association have sought to fight the battle for affordable insulin in the states, starting in 2019 when Colorado became the first state to institute a cap on copays for insulin.

“From there, we just ran with it,” Murdock said. “We currently have 22 states and the District of Columbia with a monthly copay cap in place and we will continue to work on that as long as we need to raise the conversation.”