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November 19, 2021
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U.S. House votes to cap insulin cost at $35 per month

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The U.S. House of Representatives approved a bill on November 19 that would cap insulin prices at $35 per month for Americans with diabetes.

The House approved the social spending bill H.R. 5376, also known as the Build Back Better bill, by a vote of 220-213. The bill will now be sent to the U.S. Senate for approval.

insulin syringe
Source: Adobe Stock

Among the bill’s provisions, beginning in 2023, Medicare Part D and private group or individual health care plans cannot apply a deductible or charge more than $35 for a 30-day supply of insulin. For Medicare Part D, plans could charge no more than $35 for whatever insulin products they cover in 2023 and 2024. In 2025, all insulin products will fall under the cap under a drug negotiation provision also included in the bill.

If the bill is later passed by the U.S. Senate and signed into law by President Joe Biden, the insulin cap will take effect beginning in 2023.

As Healio previously reported, insulin prices have been on the rise over the last 20 years. According to 2017 data from the Health Care Cost Institute, insulin prices nearly doubled from 2012 to 2016, with the average price for a 40-day supply of insulin increasing from $344 to $666 during that span.

In a press release, Carol H. Wysham, MD, president of the Endocrine Society, praised the House of Representatives for passing the bill, saying the cap has the potential to save the lives of many people with diabetes.

“This bill offers a once-in-a-generation opportunity to protect access to this life-saving medication,” Wysham said in a press release. “People with diabetes cannot wait any longer for Congress to take action. We urge the Senate to quickly follow suit.”

Anne Peters, MD, Endocrine Today Editorial Board Member and professor of clinical medicine at Keck School of Medicine, University of Southern California, Los Angeles, praised the passage of the bill and how it could significantly help people with diabetes afford insulin.

“It is a significant step forward for our patients with diabetes who require insulin because for many, who currently struggle with insulin costs and copays, this will make insulin more accessible and affordable,” Peters told Healio.

Several states have already passed legislation capping insulin copays. In May 2019, Colorado became the first state to cap insulin copays at $100 per month for people with private insurance. Since then, 19 other states along with the District of Columbia have passed legislation to cap copays on insulin, according to the American Diabetes Association.

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