Two Bills addressing cost of Insulin

The Democrats Bill which passed the House on March 31:

Introduced in House (02/25/2022)

H.R. 6833 —Affordable Insulin Now Act (The Democrats’ Bill)

CRS Summary:

This bill limits cost-sharing for insulin under private health insurance and the Medicare prescription drug benefit.

Specifically, the bill caps cost-sharing under private health insurance for a month’s supply of selected insulin products at $35 or 25% of a plan’s negotiated price (after any price concessions), whichever is less, beginning in 2023.

The bill caps cost-sharing under the Medicare prescription drug benefit for insulin products at (1) $35 in 2023 regardless of whether a beneficiary has reached the annual out-of-pocket spending threshold, and (2) $35 beginning in 2024 for those who have not yet reached this threshold.

Currently, the Centers for Medicare & Medicaid Services is testing a voluntary model under the Medicare prescription drug benefit (the Part D Senior Savings Model) in which the copayment for a month’s supply of insulin is capped at $35 through participating plans. The model is set to expire on December 31, 2025.

The Republicans Bill

Introduced in House (04/21/2021)

H.R. 19 — Lower Costs, More Cures Act of 2021 (The Republicans’ Bill)

CRS Summary:

This bill establishes and modifies several programs and requirements to address prescription drug prices.

The bill modifies provisions under Medicare and Medicaid relating to prescription drug coverage and price transparency. Among other changes, the bill

  • requires the Centers for Medicare & Medicaid Services to publish certain information, as reported by pharmacy benefit managers (PBMs), relating to generic dispensing rates, drug discounts and rebates, and payments between PBMs, health plans, and pharmacies;
  • reduces the annual out-of-pocket spending threshold, and eliminates beneficiary cost-sharing above this threshold, under the Medicare prescription drug benefit;
  • allows prescription drug plan sponsors under the Medicare prescription drug benefit to offer additional plans in a region;
  • requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid; and
  • allows states to include in the Medicaid Drug Rebate Program covered outpatient drugs that are provided as part of physician or outpatient hospital services.

The bill also generally modifies other provisions relating to the regulation and costs of generic and brand-name drugs. Among other changes, the bill

  • prohibits the manufacturer of a brand-name, generic, or biosimilar drug from entering into certain agreements to resolve or settle a patent infringement claim in connection with the sale of a drug or biological product;
  • permanently allows high deductible health plans to waive deductibles for insulin and associated products; and
  • establishes the position of Chief Pharmaceutical Negotiator in the Office of the U.S. Trade Representative.

Assuming CRS summaries are accurate, the Democrats bill caps cost-sharing under the Medicare prescription drug benefit for insulin products at $35 in 2023. The Republican bill permanently allows high deductible health plans to waive deductibles for insulin and associated products.

The CRS notes:

Currently, the Centers for Medicare & Medicaid Services is testing a voluntary model under the Medicare prescription drug benefit (the Part D Senior Savings Model) in which the copayment for a month’s supply of insulin is capped at $35 through participating plans. The model is set to expire on December 31, 2025.

Thus the Republican bill would allow insurers to voluntarily cap insurance copayments for insulin.

Rep. Tom Reed, who is co-chair of the House Diabetes Caucus with Rep. Diana DeGette, explains his no vote:

We care about lowering the out-of-pocket cost of insulin for those impacted by diabetes. Unfortunately, this bill does nothing to lower the true cost of insulin; it uses government price-setting to shift those costs elsewhere. Rather than engage in pure partisan politics like yesterday’s vote, we have been working for months on a bipartisan, bicameral bill with Representative DeGette in the House and Senator Susan Collins and Senator Shaheen in the Senate to achieve a solution to the root causes of this problem and solve it once and for all. All indications are we will get such a bill to the President’s desk soon.

The Democrats bill doesn’t lower the cost of manufacture, but it does lower the price some consumers pay. If a bill is bipartisan only if numbers of members of both parties support it, then “not bipartisan” is an empty claim. What bill Tom Reed advocates, he doesn’t say. Rep. DeGette may not be a big fan of the bill, she wasn’t a cosponsor, but she did vote in favor. Republicans have a bill, H.R. 19. It isn’t clear why another doomed bill is needed or why a different bill might soon become law. H.R. 3, which would allow Medicare to negotiate drug prices, would likely result in lower cost to the public.

If the Democrats’ bill shifts the cost of insulin from those who need help to the general public, that isn’t undesirable–that’s what insurance does.

Rep. Claudia Tenney explains her no vote:

I voted No on H.R. 6833, the so-called Affordable Insulin Now Act. This bill is a misguided attempt by House Democrats to address a serious problem but in a manner that falls well short of meaningfully lowering insulin prices for Americans. I opposed the bill because it will not fix the serious issue of high insulin costs, but instead simply shift those costs to higher health insurance premiums. In addition, I opposed the bill because it inexplicably delays the Trump Administration’s Medicare Part D rebate rule, which would have ensured that drug rebates are directed to patients rather than to the pockets of Pharmacy Benefit Managers (PBMs) who are responsible for negotiating drug prices between insurance companies and pharmacies. Over the past 10 years, the actual cost of insulin has gone down; however, the amount consumers pay has continued to rise as PBMs deepen their pockets and widen their profit margins. The problem is clear: PBMs are enriching themselves at the expense of Americans who need to access life-sustaining drugs and treatments. Unfortunately, the Affordable Insulin Now Act is a giveaway to special interests and a half-hearted messaging effort, rather than a genuine attempt to fix the cost problems or incentivize additional innovation and cost-effective solutions to diabetes care. By delaying the Trump rebate rule even further, Democrats are ensuring PBMs will continue raking in high profits while Americans are stuck footing the bill. Any solution to rising drug prices must end this exploitative practice. The Republican alternative, H.R. 19, the Lower Costs, More Cures Act, which I cosponsored, would also cap the monthly cost of insulin while keeping PBMs in check and fast-tracking new brand-name, generic, and biosimilar competitors to the marketplace, further driving down costs while increasing access. Americans need results-oriented solutions H.R. 19, not industry giveaways under the guise of patient protections like the bill considered today in the House. 

H.R. 19, with only Republican cosponsors, is unlikely to be considered by the House. Rep. Tenney is known as a fan of business, large and small, thus this diatribe is surprising. Rep. Tenney’s views may reflect a belief that the former president (he said he would make insulin as cheap as water) already solved the problem, or would have had his efforts not been thwarted by a cabal. Rep. Tenney, like Rep. Reed, prefers “pie in the sky” to a bill favored by Democrats.

Kudos to Tom Zoidal for finding the linked article. Read more here:





About whungerford

* Contributor at NewNY23rd.com where we discuss the politics, economics, and events of the New New York 23rd Congressional District (Allegany, Cattaraugus, Chautauqua, Chemung, (Eastern) Ontario, Schuyler, Seneca, Steuben,Tioga, Tompkins, and Yates Counties) Please visit and comment on whatever strikes your fancy.
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