Last fall, the U.S. House of Representatives narrowly passed a $2.2 million domestic spending plan called Build Back Better (BBB) that included several health care provisions including one that would limit what patients with diabetes would pay for insulin to $35 per month. One month later, Sen. Joe Manchin (D-West Virginia) effectively killed the legislation when he announced that he could not support the law.
Efforts to cap what patients pay for insulin, however, are still under consideration in Congress; some legislation could pass in the coming weeks. If so, health care journalists will need to know how any new law would work. One useful source could be a report last week from the Peterson Center on Healthcare and the Kaiser Family Foundation (KFF), “Out-of-pocket spending on insulin among people with private insurance.”
For health care reporters, there are at least three important concerns to understand about efforts to limit what patients with diabetes pay for their care.
First, putting a cap on out-of-pocket costs is crucial but amounts to little more than tinkering around the edges of the issue. Patients with diabetes need insulin and supplies to monitor their blood sugar and store and inject insulin. In 2020, researchers for the Commonwealth Fund reported that some 30 million Americans have diabetes, and about 31% of them need insulin to manage the condition. The list prices of many of the newest forms of insulin have risen by 15% to 17% each year since 2012, the report noted.
Second, it’s important to understand that any limit on what patients pay out of pocket for insulin would not address the underlying price of insulin in the U.S., as the Peterson-KFF report explained. What diabetes patients pay for insulin in the U.S. is much higher than it is in other countries, according to a report that the U.S. Department of Health and Human Services (HHS) issued in 2020. For that report, HHS contracted with RAND Health Care to compare what pharmaceutical companies charged for insulin in the U.S. in 2018 against what drug companies charged in 32 other countries that are members of the Organisation for Economic Co-operation and Development (OECD).
The RAND researchers found that the average gross manufacturer price for a standard unit of insulin in 2018 was $98.70 in the U.S., which was more than 10 times higher than the $8.81 price of a standard unit of insulin in 32 other countries.