Biden will push for insulin cost caps, but it’s unlikely to get congressional approval

By Ahmed Aboulenein

WASHINGTON (Reuters) – U.S. President Joe Biden will call for a $35-a-month national cap on insulin costs during his State of the Union address on Tuesday, but he’s unlikely to grant his wish as it’s missing. Congressional support.

Democrats failed to pass a similar measure last year when they controlled both the US Senate and the House of Representatives. Back then they only needed 10 Republican votes in the US Senate to pass it.

Now that Republicans control the House, its chances are even slimmer, experts say.

“Capping insulin costs for patients is an idea that really resonates with people who are struggling with healthcare costs, but it’s highly unlikely to pass in a divided Congress,” said Larry Levitt, executive vice president for insulin. health policy at the Kaiser Family Foundation.

About 8.4 million of the 37 million people in the United States with diabetes use insulin, according to the American Diabetes Association (ADA).

Democrats were able to cross the limit for enrollees in the government’s Medicare health program for people ages 65 and older last year as part of signing Biden’s Inflation Reduction Act (IRA). It went off last month.

They tried, and failed, to extend the benefit to everyone with health insurance when voting on the IRA.

“This is a very powerful talking point, but not something that’s likely to result in actual legislation anytime soon,” said Levitt, a senior health care official during the Clinton administration.

Without congressional approval, the Biden administration cannot cap private insurance plans and is unlikely to create a subsidy for the uninsured, experts said.

Some Medicaid plans for low-income individuals and private insurance plans also cap the monthly cost of insulin at $35.

Monthly out-of-pocket costs for insulin are limited by 20 states and the District of Columbia. In nine of those states and DC, the limit is $35 or lower, according to the ADA.

The White House has said Biden will ask Congress to extend the limit to all Americans. It’s unclear whether his proposal would include those without health insurance, who often have to pay full price for the life-saving drug. Most previous Democratic proposals do not.

Most privately insured people who need insulin already pay less than $35 a month, while about 17 percent of insulin users aged 18 to 64 were either uninsured or had a gap in coverage , according to a 2020 Commonwealth Fund study.

Two-thirds of that group paid full price — an average of $900 a month — for the medicine. This has forced many people to ration or skip insulin shots, endangering their health or even their lives, said Laura Marston, co-founder of advocacy group The Insulin Initiative.

“From my perspective as a patient and advocate, any solution that excludes the uninsured is not helpful at all. The uninsured have to pay more for insulin,” Marston said.

Three companies, Sanofi SA, Eli Lilly and Co and Novo Nordisk make up 90% of the market for insulin, which was invented in the 1920s.

The original patent holders sold it in 1923 for $1, hoping this would ensure it became widely available at low cost.

Drugmakers currently price insulin at over $275 a vial, which represents a 1,200 percent price increase over the past 20 years, according to the Insulin Initiative.

(Reporting by Ahmed Aboulenein; Editing by Caroline Humer and Bill Berkrot)

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