Bipartisan Senate Bill Takes Aim at Insulin Prices

A bipartisan bill introduced in the Senate Monday calls for cutting insulin prices up to 75% via a measure aimed at insurers and pharmacy benefit managers (PBMs). The bill, introduced by Senator Jeanne Shaheen, D-New Hampshire, would prohibit PBMs and insurers from receiving rebates for insulin if the drug maker has lowered its 2020 list prices to 2006 levels.

The Insulin Price Reduction Act is co-sponsored by Senators Susan Collins, R-Maine, Tom Carper, D-Delaware, and Kevin Cramer, R-North Dakota.

To retain the rebate restriction treatment for the following year, any increases in the insulin list price must be limited to no more than the increase in medical inflation for the year. The rebate restrictions would also apply to all private insurance plans and Medicare Part D plans.

In addition, the bill would require that PBMs and insurers waive the deductible for private insurance plans for any insulin that meets the list price reduction requirements each year.

“For the most popular insulins, this would result in more than a 75% decrease in prices compared to what we can expect to see in 2020,” Shaheen's office said in a statement.

Both JDRF and the American Diabetes Association (ADA) have endorsed the bill. “Insulin is a matter of life and death,” LaShawn McIver, MD, MPH, senior vice president of government affairs for ADA, said in a statement. “For many Americans who cannot afford their insulin, the consequences can be dire, including dangerous complications and even death.”

Due to the rising cost of insulin, the ADA and other groups have been highlighting stories about patients rationing their insulin; rationing is a global problem, but it is even more so in the United States.

The price of insulin, needed by those with type 1 diabetes, has been the topic of numerous hearing on Capitol Hill. For example, earlier this year, a House of Representatives subcommittee heard testimony that 1 in 4 patients with diabetes are skipping doses or rationing their insulin due to price, which can lead to severe complications or death.

Some companies have responded by introducing authorized generics or by capping prices, such as Sanofi’s offer for a monthly supply of insulin for $99 for those who are uninsured and paying cash for their insulins.

Still, some patients resort to buying insulin in Canada, where it is less expensive.

A statement released with the bill said the average price of a 40-day supply of insulin had nearly doubled between 2012 and 2016, from $344 to $666; this came on top of costs that tripled between 2002 and 2013. Manufacturers insist the higher prices mask the fact that net prices are actually lower, due to a system of rebates paid to PBMs and insurers.

The rise of high-deductible health plans means that many with diabetes, similar to other patients with chronic diseases who use specialty drugs, are forced to pay full price during parts of the year.

“For these individuals, the prices are hitting a tragic breaking point, as patients have died from diabetic ketoacidosis complications that result from rationing insulin due to its high cost,” the bill summary read.