September 27, 2022


Washington (AP) — Curbing rising insulin prices has so far been elusive in Congress, though Democrats say they will try again — as part of their health and climate-focused economic package.

The price of the 100-year-old drug has more than tripled in the past two decades, forcing the nation’s diabetics to pay thousands of dollars a year for the life-saving drug. Democrats are considering capping the cost of that drug for at least some, though it’s unclear what the final proposal will look like and how many insulin users will get a price cut.

Here’s a look at how insulin became so expensive and why it’s so hard to lower the price of the drug.

HOW MANY PEOPLE IN THE US USE INSULIN AND WHAT FOR?

About 8.4 million Americans use insulin, according to the American Diabetes Association. Not everyone with diabetes needs insulin, but for those who do, it is an important medication. For more than 1 million of these people with type 1 diabetes, regular access to the drug is a necessity, and they will die without it.

“People need insulin, it’s not a choice, and no one should have to decide between life-sustaining drugs or food and rent,” said Dr. Robert Gabbay, chief scientific and medical officer of the American Diabetes Association.

Insulin also helps control glucose levels in patients with other forms of diabetes. Some insulin users have turned to the drug because of its cost and have suffered numerous health complications as a result.

HOW ACCURATE IS INSULIN?

Price varies.

Some people with private insurance pay hundreds of dollars a month for the drug. For most Medicare beneficiaries, the average cost per insulin prescription was $54 in 2020 — a nearly 40% increase from 2007; a study released last month from the Kaiser Family Foundation found. Others live in one of the 22 states where the co-pay for a 30-day supply has been capped at between $25 and $100.

The cost has led some to use less insulin than their doctor prescribes or to delay paying for other medical care.

WHY IS INSULIN SO PRECISE?

Only three manufacturers—Eli Lilly, Novo Nordisk, and Sanofi—make insulin, allowing these companies to control much of the market.

“Historically they have raised their list prices for their respective products in close correlation with each other,” said Dr. Jing Luo, a professor of medicine at the University of Pittsburgh. “There hasn’t been much price pressure.”

And making a generic for insulin hasn’t been easy, as new manufacturers must overcome regulatory hurdles and questions about how a generic should be classified, Luo added. A generic insulin is expected to hit the market in 2024 for no more than $30 a vial, which could lower some of the price.

HOW DO THE DEMOCRATS PLAN TO CAP THE PRICE OF INSULIN?

That remains to be seen.

Senate Majority Leader Chuck Schumer said some language capping the price of insulin would be added to the finance billbut it is not clear what that price will be and who will be protected by this price cap.

Democrats had proposed a $35 monthly cap for those getting the drug through Medicare or private insurers as part of a larger package that derailed in the Senate. But it was left out of the cuts package now headed for a vote in Congress.

WHY IS IT SO DIFFICULT TO COVER THE COST OF INSULIN?

Capping the price of insulin will be too expensive.

Not only is insulin becoming more expensive, but the number of people using it is also increasing.

A bipartisan bill proposed earlier this year that would cap insulin prices could cost about $23 billion over the next decade, according to Congressional Budget Office estimates. While the bill would lower insulin costs for many consumers, it would increase public costs and the premiums charged by Medicare and private insurers, according to the bureau’s analysis.

And this is one of the reasons why price caps can be controversial.

“If your health insurance company says, voluntarily, nobody who buys insulin in our plan will have to pay more than $25, the question is who pays the rest?” Luo said. “That means their costs are going to go up, which means they’re going to raise premiums for everyone.”



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