House passes bill to cap the cost of insulin

The House on Thursday passed legislation to cap the cost of insulin at $35 a month, a move that would significantly lower the price of the life-saving drug for more than 7 million diabetes patients.

The bill passed on a mostly party line vote, 232-193.

The measure was authored by three House Democrats facing competitive reelection races this fall: Reps. Angie Craig (Minn.), Dan Kildee (Mich.) and Lucy McBath (Ga.).

Under the bill, Medicare beneficiaries would pay no more than $35 for each 30-day insulin prescription. Cost sharing for beneficiaries in private plans would be limited to the lesser of either $35, or 25 percent of the health plan’s negotiated price for a 30-day prescription.

The insulin cap was originally part of the sweeping health reforms in Democrats’ Build Back Better legislation, including limited Medicare drug negotiation.

But Sen. Joe Manchin’s (D-W.Va.) opposition to the legislation put the larger bill on ice, and Democrats carved out the insulin provision as a standalone vote as a way to get a tangible victory on an issue of major importance to Americans.

“Make no mistake, I continue to strongly support comprehensive efforts to rein in the soaring cost of prescription drugs and empowering Medicare to negotiate fair prices, but we cannot afford to wait any longer to address the price of insulin,” Rep. Frank Pallone Jr. (D-N.J.) said on the House floor Thursday. 

“Far too many Americans are struggling to afford this drug and it is time for Congress to say enough is enough.”

But while it would save consumers thousands of dollars at the pharmacy, the bill does not lower the overall price of insulin, and does not solve the problem of skyrocketing drug prices. Instead, it would shift more of the cost onto insurers and employers. 

House Republicans latched onto that idea, accusing Democrats of “socialist price controls” that would allow pharmacy benefit managers to hide savings from patients. They did not fault manufacturers for setting the high list prices.

Bipartisan congressional investigations have faulted both pharmacy benefit managers and drug companies for the soaring price of insulin. 

Insulin has long been targeted by lawmakers as an example of the broken incentives in the U.S. health system. The drug hasn’t changed much since it was first discovered more than 100 years ago, and as newer forms of the drug have been introduced, the price has climbed.

Across the Capitol, a bill from Sen. Raphael Warnock (D-Ga.) would also implement an out-of-pocket cap on insulin at $35 per month.

But in an effort to gain Republican support, it may be combined with bipartisan legislation from Sens. Jean Shaheen (D-N.H.) and Susan Collins (R-Maine) that seeks to lower the underlying cost of insulin through a yet-to-be-defined process.  

Shaheen said the measure would build on a similar bill she and Collins introduced in 2019, which would have eliminated the discounts that drug companies pay to negotiators known as pharmacy benefit managers if the drug company lowered the overall price of insulin back to 2006 levels.