Us House Votes To Cap Insulin Cost At $35 Per Month
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The U.S. House of Representatives approved a bill on November 19 that would cap insulin prices at $35 per month for Americans with diabetes.
The House approved the social spending bill H.R. 5376, also known as the Build Back Better bill, by a vote of 220-213. The bill will now be sent to the U.S. Senate for approval.
Among the bills provisions, beginning in 2023, Medicare Part D and private group or individual health care plans cannot apply a deductible or charge more than $35 for a 30-day supply of insulin. For Medicare Part D, plans could charge no more than $35 for whatever insulin products they cover in 2023 and 2024. In 2025, all insulin products will fall under the cap under a drug negotiation provision also included in the bill.
If the bill is later passed by the U.S. Senate and signed into law by President Joe Biden, the insulin cap will take effect beginning in 2023.
As Healio previously reported, insulin prices have been on the rise over the last 20 years. According to 2017 data from the Health Care Cost Institute, insulin prices nearly doubled from 2012 to 2016, with the average price for a 40-day supply of insulin increasing from $344 to $666 during that span.
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Why Is Insulin So Expensive
For the past few years, the price of insulin has skyrocketed â due in large part to the extended monopoly a handful of companies have over insulin manufacturing.
While annual out-of-pocket costs are expected to rise with inflation, the annual price increases for insulin are disproportionate to overall inflation. Studies demonstrate that diabetes is the most expensive chronic disease in the United States, costing more than $327 billion in 2017.
How Can I Afford My Insulin
Co-pays for insulin or out of pocket cost to some individuals are quite manageable while others have unaffordable co-pays. If you have difficulty paying your co-pay then talk to your health care provider who may prescribe a different type of insulin or provide samples from the office. Older insulins including Novolin or Humulin R or NPH are human insulin which may be able to be prescribed instead. They do not provide the flexibility of Novolog or Humolog which are analog insulins but are much more affordable.
The under-insured and uninsured are the most impacted groups when it comes to insulin/drug pricing. They are responsible for the sticker price or average wholesale price since no one has negotiated on their behalf. They are not part of a group.
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The Role Of Insurance
The ADAs Insulin Access and Affordability Working Group report found that nearly half of Americans have employer-sponsored health insurance. About 20% are insured through Medicaid, and 14% are insured through Medicare. Approximately 7% of Americans purchase health insurance on their owneither directly from an insurer or through a health insurance exchange. About 9% of Americans remain uninsured.
Diabetes is considered a pre-existing condition. According to research published in Diabetes Care, an estimated 1.9 million uninsured people with diabetes gained insurance coverage after the Affordable Care Act went into effect. More than half of those who gained insurance were low-income.
Still, having insurance doesn’t mean insulin is affordable. Insured patients will often pay a copay or a percentage, rather than the list price, for their insulin. Redmond says that cost could range from $30 to $50.
In cases of high-deductible health plans, patients have to pay the list price for their insulin until their deductible is met, which often translates to thousands of dollars out of pocket. Many patients just have a problem paying that much, says Redmond.
Usc Schaeffer Study Tracks Down The Insulin Pricing And Distribution Chain
Despite being discovered nearly 100 years ago, insulins list price has been going up, not down, with trade secrets and other protections preventing researchers from pinpointing who is receiving profits from its sale. Meanwhile, the net price what manufacturers receive after accounting for all discounts and payments to distribution system entities has been falling. So, why arent patients seeing the savings?
USC researchers analyzed the flow of money across all distribution system participants manufacturers, wholesalers, pharmacies, pharmacy benefit managers and health plans. They found that middlemen in the distribution process now take home more than half about 53% of the net proceeds from the sale of insulin, up from 30% in 2014. Meanwhile the share going to manufacturers has decreased by a third.
This redistribution of profits has led net expenditures, or the total cost to the health care system, to remain relatively flat.
Although manufacturers have been receiving less, the savings from manufacturers taking less are not flowing to patients, said Karen Van Nuys, executive director of the Value of Life Sciences Innovation Project at USC Schaeffer Center for Health Policy & Economics. Those savings are being captured by others in the distribution system, and any policy solution has to look at the entire supply chain.
Several parties besides patients are benefitting from drug manufacturer savings on insulin.
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Hanie Redmond Pharmd Cde Bc
Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
If someone has type 1 diabetes or if someone has had damage to their pancreas, these are instances where their body doesnt produce any insulin, Stephanie Redmond, PharmD, CDE, BC-ADM, founder of Diabetes Doctor, tells Verywell. Without a doubt, insulin is lifesaving, and just a day or so without it will require hospitalization and could lead to death for those patients.
Robin Feldman Professor Of Law Uc Hastings College Of Law San Francisco
One would have to see how these orders were implemented to know how powerful and effective they will be.
We are still seeing many struggle in clinical practice with affordability, says Redmond. So it is unclear to most healthcare providers who gets these insulin cap benefits. Even myself as an expert would really love any more guidance on this. There are eligibility requirements that many patients still dont meet.
As with any legal order, the devil’s in the detail, Robin Feldman, Arthur J. Goldberg Distinguished Professor of Law at UC Hastings College of Law San Francisco, tells Verywell. One would have to see how these orders were implemented to know how powerful and effective they will be. We are, however, going to need some systemic changes to try to address the problems that are driving drug prices higher in general, and insulin prices higher specifically.
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Building A Unique Data Set Of Insulin Expenses
Due to lack of transparency in the system, the researchers had to leverage several sources to develop a data set that enabled them to map expenditure flows at each step in the distribution system. Sources included data from Medicare and Medicaid, Securities and Exchange Commission filings as well as state-level audit reports that were the result of state drug pricing transparency laws passed in recent years.
It is telling that we had to combine data from more than a dozen sources to understand expenditures on a single class of drug over a five-year period, said Ribero, research scientist at the USC Schaeffer Center.
New Product Features Can Come With A High Price Tag
Xultophy and Soliqua both contain a long-acting insulin and another non-insulin diabetes medication. Xultophy is a combination of insulin degludec plus liraglutide , and Soliqua is a mix of insulin glargine plus lixisenatide . Average retail prices for Soliqua and Xultophy are more than double the price of cheaper alternatives like Basaglar and Tresiba, which have the same exact insulin ingredient.
Approved in June 2020, Lyumjev contains insulin lispro, the same insulin in Humalog, and some additional ingredients. In studies, Lyumjev was found to start lowering blood glucose sooner than Humalog, though this doesnt necessarily make Lyumjev more effective than Humalog or generic insulin lispro at lowering blood sugar. At present, per insulin unit prices for Lyumjev are about double that of generic insulin lispro.
Fiasp contains insulin aspart, the same insulin in Novolog, but it also has vitamin B3. Like Lyumjev, Fiasps added ingredient may speed up insulin absorption. Interestingly, the retail prices for Fiasp and Novolog are about the same on a per insulin unit basis.
Then theres Tresiba, an ultra-long-acting insulin that stays active for up to 42 hours. For this unique property, its average retail price is about $630 for a carton of 5 KwikPens .
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Insulin Pricing Have They Gone Down For You
HeartofSoul said:With a HMO plan by Blue Shield, it would only be in the context of co-payment for a box of 5 humalog pens per month and a box of lantus with 5 pens every 6 weeks with each being $25. if it were paying retail price i would shop around but it could be $350 to $550 a box.
Adjusted for Inflation%
coravh said:From what I’ve read , the various insulin producers starting putting in huge ‘discounts’ and other ‘offers’ to insulin users because of Covid. They’re worried that so many people are losing their work and their healthcare that the whole system would collapse. So they’re taking action to help keep everyone alive. I don’t think anyone knows what will happen with pricing once Covid is under control.
A Young Life Lost To High Insulin Prices
HealthDay Reporter
TUESDAY, May 29, 2018 — Alec Smith was diagnosed with type 1 diabetes shortly before his 24th birthday. When he turned 26, he lost his health insurance. Less than a month later, he lost his life because he couldn’t afford the exorbitant price of his life-saving insulin.
“Alec had a full-time job that didn’t offer health insurance. But because he was working full-time, he didn’t qualify for subsidies under the Affordable Care Act. The insurance he could get, the premium and the deductible were so high, he couldn’t afford to pay for a policy. His deductible would’ve been $7,600,” his mother, Nicole Smith-Holt, said.
When he was diagnosed with type 1 diabetes, Smith-Holt said, her son was determined not to let the disease change his life. Type 1 diabetes is an autoimmune disease that causes the body’s immune system to mistakenly attack healthy insulin-producing cells in the pancreas. Insulin is a hormone that helps transport the sugar from foods into cells for use as fuel.
People with type 1 diabetes make little to no insulin, so they must replace the lost hormone through injections or a tiny tube inserted under the skin and attached to an insulin pump. But replacing that lost insulin doesn’t come cheaply.
It was the high price that led Smith to try to ration his insulin he simply couldn’t afford to buy another vial. He didn’t realize that even if someone with type 1 diabetes eats a low-carbohydrate diet , they cannot get by without insulin.
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Us Rep Gaetzs Diagnosis Of Whats Driving Insulin Costs Misses The Root Cause
By Victoria Knight and Colleen DeGuzmanApril 22, 2022
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Reasons Why Insulin Is So Outrageously Expensive
20 Jan 2019, 6:08 p.m. in #insulin4all USA by T1International
Why does insulin cost so much to patients in the USA and around the world? Why is insulin, a widely sold drug of which most forms are now off-patent, so incredibly expensive? These are simple questions, but ones with a number of complicated answers. This post will break some of those answers down and point you in the direction further reading if you want to dive deeper.
1. Only 3 Companies Control 90% of the Global Insulin Market
The big three insulin producers Eli Lilly, Novo Nordisk and Sanofi dominate more than 90% of the world insulin market by value. Often only one of these companies supplies insulin in a country, which means they more or less hold a monopoly there and can set prices as they wish. In some countries, notably China and India, there are domestic insulin companies that can help drive down the price. This means we need more companies in markets like the USA to help bring prices down. Well touch on that a bit further down the list.
2. No Generic Insulin
3.Pay-for-Delay Schemes & Lawsuits
4. Patents
5. Politics
6. Price Fixing
These Business Insider graphs pretty much say it all.
Several lawsuits alleging some form price-fixing are currently in the works. You can read more here and here.
7. Pharma Marketing Schemes
8. Payment for Influence
What Can be Done?
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More Attention Needs To Focus On Pharmaceutical Middlemen
A bill recently passed by the House and under consideration in the Senate caps insulin payments at $35 a month for individuals with Medicare or private health insurance. The legislation speaks directly to the crisis in affordability for a life-saving medicine, but in the long term it is just shuffling the deck rather than changing the game of insulin costs.
Like a lot of high stakes games, this one takes place in back rooms, and certainly out of view of patients and doctors. Many believe drug manufacturers run the game because it involves steadily rising list prices, which they set.
Human Rights Watch seems to agree. A new report on insulin costs by the international advocacy group charges that the human rights of people with diabetes are being violated when they’re unable to afford their insulin and that makes insulin makers complicit in human rights abuses.
But our research reveals a different picture of who bears responsibility for driving up insulin costs. Manufacturers have been accepting lower and lower prices for insulin, while intermediaries in the drug supply chain have been demanding, and pocketing, more. To get a fair deal, much more attention needs to focus on pharmaceutical middlemen.
The Crisis
Meanwhile, the list prices of insulin products doubled between 2012 and 2019, putting insulin at the center of public outrage over high drug costs in the U.S.
Where the Money Goes
Time to Redirect Discounts
Both Yearly Spending By People With Diabetes And Cost Per Milliliter Up Sharply Outpacing Costs For Other Blood Sugar Medications
ANN ARBOR, Mich. People with diabetes who rely on insulin have seen the cost of that drug triple in just a decade — even as doctors have prescribed higher doses to drive down their blood sugar levels.
Meanwhile, the cost of other diabetes drugs has stayed about the same or even gone down.
The rise in insulin costs was so large that since 2010, the per-person spending on insulin has been higher than per-person spending on all other diabetes drugs combined.
Published today in theJournal of the American Medical Association, the findings estimate in constant dollars what patients and their insurance plans paid from 2002 to 2013 for all antihyperglycemics, or medicines that reduce blood sugar levels.
The cost of insulin has shot up, while other blood sugar medication costs have not. All costs are in constant 2013 dollars.
The authors of the study say the rise in insulin compared with other therapies means its time to look again at the effect, and the cost-effectiveness, of non-insulin therapies. They also note that the price of insulin is not likely to drop because of competition from generic forms, because of the way it is regulated.
The research was done by a team from the University of Melbourne in Australia and the University of Michigan, using data from the federal Medical Expenditure Panel Survey that asks patients and insurers about care and costs.
William Herman, M.D., MPH
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Monthly Insulin Price As High As A Playstation 5
Catie Santos, a 28-year-old from New Orleans, grew up knowing about Type 1 diabetes because her brother was diagnosed with the disease at age 10. On her 23rd birthday, she was horrified to learn she had the same disease.
Since then, she has met people who were diagnosed in their 50s with the disease once known as juvenile diabetes.
The monthly price of her insulin, she said, ran as much as the new Sony PlayStation 5, which can carry a price tag of more than $1,000.
Santos went on her parents insurance, but that assistance ended when she turned 26. You really have to figure out this insurance thing quickly, she said. Ive known diabetics who had to take corporate jobs just to stay alive.
Some have to move back home with their parents to make it financially, she said. She is one of them.
Her most recent scare took place in the wake of Hurricane Ida, which left her family without power for three weeks. She had to cram a months worth of her insulin into the refrigerator of her aunt, who happened to have a generator.
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The high cost of insulin has prompted some Americans to head for Canada or Mexico and still others manage to get the medicine or diabetic supplies through an underground network.
Through social media, she connects people, she said. If I hear people are in need, Ill start a Twitter thread. Were not trying to profit off of people were trying to work the system that profits off of people.