THE OUTLOOK FOR HEALTH CARE IN 2023:

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April 1, 2022

The House passed a $35/mo. cap on insulin prices. (But its future is hazy.)

Daily Briefing

    The House of Representatives on Thursday passed the Affordable Insulin Now Act, a bill that would cap insulin prices at $35 a month for many Americans, however it's unclear whether the bill will be passed in the Senate.

    Our take: 10 health policy topics—including drug pricing reform—to watch in 2022

    Details on the bill

    The bill, which was passed 232-193 with 12 Republican House members joining the Democrats, would cap the price of insulin at $35 a month or at 25% of an insurance plan's negotiated price, depending on which is lower.

    While the bill would lower the cost of insulin for consumers who take it, it would not address the prices companies pay to make it, the New York Times reports. According to an estimate from the Congressional Budget Office, the bill would increase government spending, as health insurers would be responsible for a larger share of the cost of insulin.

    The bill would go into effect in 2023; however, to become law, it will require the votes of at least 10 Republican senators to overcome a filibuster. According to the Times, few Republican senators have endorsed the bill, although Sen. Susan Collins (R-Maine) has worked with Sen. Jeanne Shaheen (D-N.H.) on a bill related to insulin prices.

    Multiple attempts have been made by the federal government to rein in insulin prices for consumers, which can reach up to $1,000 per month in out-of-pocket costs for patients with health insurance, according to a report from the Health Care Cost Institute.

    In March 2020, CMS announced a voluntary program aiming to encourage health plans and drug manufacturers to cap out-of-pocket costs for beneficiaries enrolled in Medicare Part D enhanced plans at $35 per month, in an effort to lower insulin costs for consumers.

    Similarly, Congress has worked on a number of bills aimed at addressing prescription drug prices more broadly, including insulin. Last year, the Elijah E. Cummings Lower Drug Costs Now Act, which would allow HHS to negotiate drug prices with pharmaceutical companies, was reintroduced in the House, as were the Freedom from Price Gouging Act and the Capping Drug Costs for Seniors Act of 2021. However, none of the bills have advanced far, The Hill reports.

    Reaction

    House Speaker Nancy Pelosi (D-Calif.) said insulin prices are "a kitchen table issue" for Americans. "One in four Americans is forced to skip or ration doses of insulin and that's life-threatening," she said, adding the bill "paves the way" for further legislation regarding drug prices.

    "No one should have to choose between taking their medication as prescribed and putting food on the table or a roof over their head," said Rep. Dan Kildee (D-Mich.).

    However, some critics of the bill argued it does nothing to address the underlying problem of rising prescription drug prices.

    "We want lower prices for drugs, particularly for insulin," said Rep. Buddy Carter (R-Ga.). "But instead of fixing a broken system, this bill aims to control it."

    "If the effort to address drug prices ends with this plan to cap out-of-pocket costs for insulin, it will amount to crumbs compared to Democrats' initial ambitions to allow the government to negotiate drug prices," said Larry Levitt, EVP for health policy at the Kaiser Family Foundation.

    Rep. Frank Pallone (D-N.J.) argued that insulin prices need to be addressed as soon as possible and can't wait for legislation that addresses drug prices more broadly.

    "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," he said. "Far too many Americans are struggling to afford this drug and it is time for Congress to say enough is enough." (Sprunt, NPR, 3/31; Sanger-Katz, New York Times, 3/31; Weixel, The Hill, 3/31; Choi, The Hill, 3/31; Bettelheim, Axios, 3/31)

    Health policy topics to watch in 2022

    The legislative, regulatory, and judicial outlook for health policy in 2022

    policy

    The Biden administration's first year in office was unsurprisingly dominated by the Covid-19 pandemic. While Democrats in Congress were able to pass part one of President Biden’s infrastructure package, other health care priorities were largely sidelined. As we look to 2022, there are 10 key health care topics that are ripe for congressional or regulatory action. If and how Congress and the Biden administration move on those actions will have strategic implications for industry executives across the health care ecosystem.

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