The House Passed… Something
What's missing from the Affordable Insulin Now Act
The House of Representatives passed a bill yesterday called the Affordable Insulin Now Act. The bill caps cost sharing of insulin at $35 for people with commercial insurance and Medicare. An effort to include a provision for those without insurance was rejected.
Meaning, should this bill eventually pass the Senate, people without insurance in the U.S. will continue to be exposed to the full list price of insulin. Those trips to Canada, GoFundMe campaigns, clandestine parking lot insulin swaps, routine trips to the ER for diabetic ketoacidosis — these situations and worse will remain the reality for people with diabetes in the U.S. who don’t have insurance.
The authors of this bill and others in the Democratic party are claiming a kind of victory over insulin rationing as a result of passing this bill. Some in the media are even ready to call this a moment of “rare bipartisanship” as 12 Republicans voted in favor of it as well. But the limitations within the bill even for people with insurance cast doubt on those claims.
If you do have insurance, copays would be limited to $35 per month per insulin prescription starting in January 2023, or at 25% of the negotiated price your insurance plan pays. The thinking here is that those who will benefit the most are people who are “underinsured” — that is the roughly one third of Americans with high deductible plans or high “cost sharing” (don’t we love these insurance industry terms of art).
It is true that if you have, let’s say, a $5000 prescription deductible, a $35 copay cap makes it more likely you can fill your prescription in January. That is good — we need insulin every month.
But the reality is for many people with diabetes, insulin is not the only thing counting toward your deductible. Meaning, it will just take longer to meet your deductible, leaving you potentially more exposed to the list price for other diabetes essentials — test strips, continuous glucose monitor supplies, insulin pump supplies, syringes, pen needles, etc. Not everyone meets their deductible even while paying for insulin out of pocket, and now with insulin counting for less, out of pocket costs are simply shifted to other essential items.
There are further limitations to what the $35 copay applies to. Your insurance plan still picks a prefered insulin brand for you to use, and the $35 cap only applies to copays on that particular insulin.
When a version of this bill was included in President Biden’s Build Back Better, #insulin4all advocates Hannah Crabtree and Laura Marston made this handy flow chart for people with diabetes to understand whether it would pertain to them. Going through it is like a depressing game of Chutes and Ladders, each question revealing how very narrow the use case for this intervention would be.
The limitations are not the only issue critics have raised. The Affordable Insulin Now Act would, in the best case scenario, shift costs from patients to insurance plans. That creates a situation in which insurance premiums rise proportionally — as well as government subsidies of ACA plans, as Larry Levitt explains.
For whatever you think the bill is worth (you can guess how I feel), it must now contend with the U.S. Senate. Over there, two ideas have been floated: Senator Raphael Warnock’s version hewing closely to what the House just passed, and a yet-to-be revealed collaboration between Senator Susan Collins and Senator Jeanne Shaheen.
Over the past six years, I’ve watched insulin — the medicine I take everyday in order to survive — go from something #insulin4all advocates were desperate to shed light on, to something of a daily political Super Bowl. Politicians, from state representatives to Trump and Biden, all want to claim victory over this moral outrage. But so far, in the face of the powerful pharmaceutical lobby, not a single political actor has ever lowered the price of insulin, and people with diabetes continue to suffer the consequences.