Sen. Shaheen pushes forward bill to reduce insulin costs

Sen. Jeanne Shaheen, D-N.H., speaks to media after a Senate Democratic policy luncheon, Tuesday, Oct. 24, 2023, on Capitol Hill in Washington. (AP Photo/Stephanie Scarbrough)

By Isabel Soisson

December 1, 2023

US Senator Jeanne Shaheen (D-NH) continues to advance her legislation to lower insulin costs, announcing in November that 12 additional bipartisan cosponsors signed onto a bill she introduced with Sen. Susan Collins (R-ME). 

The pair—who are co-chairs of the US Senate Diabetes Caucusintroduced The Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act of 2023 earlier this year, claiming the legislation that would “comprehensively address the skyrocketing costs of insulin,” according to a press release. 

“Access to insulin is a financial burden for many Americans who rely on it to survive,” Shaheen and Collins said in a joint statement. “Keeping this medication within their reach is literally a matter of life and death, which is why we’ve long led action in the US Senate to cut costs and why we’re redoubling our efforts through the INSULIN Act to comprehensively address the scope of this problem.”

The bill would limit out-of-pocket costs for patients with diabetes by requiring group and individual marketplace health plans to waive any deductible and limit cost-sharing to no more than $35 or 25% of list price per month for at least one insulin of each type and dosage form.

Pharmacy benefit managers would also be prohibited from requiring prior authorization—which requires doctors to get insurance companies’ approval for prescriptions before they’re covered—on products with capped out-of-pocket costs. Step therapy, a process that requires patients to try a cheaper or less risky medication before moving onto pricier or riskier treatments, would also be barred on medications with capped out-of-pocket costs. 

In other words, PBMs would not be able to add any restrictions to the use of insulin when there’s already a capped price in place, which in turn removes additional barriers to life-saving medication. 

The legislation would also mandate that these managers pass through 100% of insulin rebates received from manufacturers to plan sponsors, reducing premiums and minimizing incentives that encourage high list prices.

The legislation would also promote generic and biosimilar drugs–medication that is almost identical to name brand products, but tends to be much cheaper. The act aims to make it easier for the Food and Drug Administration to approve these generic and biosimilar drugs. Medicare Part D prescription drugs plans would also be allowed to cover these generic drugs under the act. 

“Our legislation would address structural issues in the insulin market, create policies to foster more competition and expand access to insulin medications,” Shaheen and Collins said in their statement. “This bill is the product of continued negotiations, with input from advocates, lawmakers, and experts.” 

Joining Shaheen and Collins in sponsoring this bill are US Senators Debbie Stabenow (D-MI), Katie Britt (R-AL), Jon Tester (D-MT), Tommy Tuberville (R-AL), Mark Kelly (D-AZ), Roger Wicker (R-MS), Jacky Rosen (D-NV), Lisa Murkowski (R-AK), Angus King (I-ME), Mike Braun (R-IN), Tammy Baldwin (D-WI), and Chuck Grassley (R-IA).

“We are pleased that so many of our colleagues—on both sides of the aisle—agree and are joining us on this effort,” Shaheen and Collins said. “Americans living with diabetes and the ones who love them cannot wait any longer for Congress to act – the time is now.”

The Biden administration has also taken considerable steps to lower the cost of prescription drugs, including insulin, since the president took office. 

The Inflation Reduction Act (IRA)—which Shaheen voted for—implemented a $35 monthly cap on insulin for Medicare recipients, which went into effect in January and is saving thousands of New Hampshirites an average of $536 per year.

The law also extended generous subsidies that helped make Affordable Care Act (ACA) health insurance plans more affordable for working- and middle-class families. Those subsidies were introduced as part of Biden’s American Rescue Plan of 2021, and were set to expire at the end of last year, but the IRA extended them through the end of 2025.

Roughly 11,000 New Hampshirites were set to lose their individual coverage and become uninsured had those subsidies expired at the end of 2022, but thanks to the Inflation Reduction Act, those people got to keep their insurance.

The IRA also reformed Medicare to lower drug costs for many of the roughly 237,000 New Hampshire seniors with Medicare Part D coverage, which covers prescription drugs. For example, beginning this past January, all vaccines covered under Medicare Part D are free. 

The law will also implement a $2,000 cap on Medicare recipients’ annual out-of-pocket prescription drug costs, beginning in 2025. In New Hampshire, an estimated 73,000 seniors are expected to save $490 a year each due to this provision, according to an analysis by the US Department of Health and Human Services.

Author

  • Isabel Soisson

    Isabel Soisson is a multimedia journalist who has worked at WPMT FOX43 TV in Harrisburg, along with serving various roles at CNBC, NBC News, Philadelphia Magazine, and Philadelphia Style Magazine.

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