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insulin
What the Inflation Reduction Act Has Meant for Healthcare 2 Years Later
From the $35 insulin co-pay to capping insurance premium costs, the legislation has been health-changing and life-changing.
Aug 30, 2024
I was honored to be at the White House this month for the Inflation Reduction Act anniversary event, featuring Americans sharing their stories of saving money and saving lives.
Thank you to the millions of people fighting every day for lower drug prices, to Congress for passing the Inflation Reduction Act, U.S. Vice President Kamala Harris for casting the deciding vote in the Senate, and President Joe Biden for signing it into law.
Meet Bob Parant, from New York. He’s a 71-year-old man who has been living with type 1 diabetes for over fifty years. He lost his leg in 2010, and became eligible for Medicare. Before the Inflation Reduction Act, the last price Bob paid for a vial of insulin was $580, which was “horrendous.”
We have made so much progress on healthcare. But as everyone reading this knows, there is so much more to do.
Listen to Pam Parker, from Maryland: She’s a retired electrician, 62 years old, and has been diabetic since she was 30. “I had to decide, a lot of months, between mortgage, groceries, utilities, and other things… I would juggle my expenses, and really juggle my healthcare.. I would eat less, or ration my insulin to make it last.. I had high blood pressure, I fell into a coma, my kidneys failed… they told me I coded.”
Learn from Robin Craycroft, from Missouri: When she turned 65 and had access to Medicare, the pharmacist told her that one insulin for three months was $3,000. “Everything that we had planned, cancelled, and our life just changed. And I felt such guilt over that… We’re gonna spend $2,000 a month (two insulin vials) to keep me alive. You start going through, am I worth it? Should I do that to [my husband]?”
Hear Steven Hadfield, from North Carolina: “Before the $35 cap, sometimes you had to skip a dose, sometimes you had to not test yourself, watch what you eat because you couldn’t afford it…”
The $35 insulin co-pay cap for people on Medicare is just one of the health-changing and life-changing parts of the Inflation Reduction Act.
This year, people on Medicare have their out of pocket Part D drug costs capped at around $3,500. And next year, the maximum drops down to $2,000. This means seniors on a fixed income won’t have to choose medicine over food or housing or anything else. Also recommended adult vaccines such as the new shingles vaccine are now free for Medicare recipients.
Pharmaceutical companies that raise their prices higher than inflation are required to pay Medicare a rebate, to encourage them to stop price gouging patients. And in 2026, price negotiations for the first 10 drugs under Medicare go into effect: lowering the costs of those drugs for millions of Americans. The savings will continue for patients and taxpayers as more drug prices are negotiated each year.
But the Inflation Reduction Act doesn’t just help people on Medicare. Over 21 million Americans like me get their health insurance through the Affordable Care Act marketplaces. When I was diagnosed with stage 4 cancer in 2017, I did not qualify for financial help for insurance. Thankfully I was able to afford a plan anyway, and to pay the maximum deductible for that year. A bargain compared to the over half a million dollars it cost to save my life.
I am so grateful to still be here, and for the Affordable Care Act made truly more affordable to millions of working Americans like me.
The American Rescue Plan, and then the Inflation Reduction Act, provided financial help for health insurance to many more who needed it. This law caps the cost of premiums at no more than 8.5% of your income, meaning people—especially older folks who face higher premiums, or people in more expensive healthcare markets—don’t get penalized, and can still afford the care they need.
We have made so much progress on healthcare. But as everyone reading this knows, there is so much more to do.
First, we have to defend the advances in the Inflation Reduction Act. A new administration and a new Congress next year means everything we’ve gained could be on the chopping block.
Second, the health insurance tax credits piece expires in 2025. Without that renewal, millions of Americans would go back to being priced out of health insurance.
Third, the Medicare provisions such as the $35 insulin cap, the drug price negotiation, and more, need to be expanded to everyone.
We are grateful to still be here, and to keep fighting until every American can get the healthcare they need. We cannot go back.
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Make Insulin Affordable With Public Pharma
To create sustainable change in the insulin market and to truly lower costs to patients, we need to think outside of the dominant systems that rely on corporate actors.
Aug 24, 2023
In March, the Big Three manufacturers of insulin, who control over 90% of the insulin market in the U.S., announced highly publicized list price cuts to some insulins, after decades of
unchecked price increases on the 100-year-old drug that costs $6 a vial to produce. In response, some claimed that California’s foray into the insulin market (by way of a contract with the nonprofit CivicaRx to produce the state’s own insulin) was no longer needed. But recent findings confirm what advocates have known for a long time: The system of fully private, profit-driven production is not working for patients.
Lilly’s insulin Lispro was supposed to be available for $25 as of May 1. T1International recently shared that the average list price quoted to patient advocates attempting to acquire the $25 insulin since May 1 has been $107.31, while Sen. Elizabeth Warren’s (D-WMass.) office found chain stores charged uninsured customers an average of $123 per vial for the generic insulin, and nearly half (43%) of surveyed pharmacies did not stock it.
To create sustainable change in the insulin market and to truly lower costs to patients, we need to think outside of the dominant systems that rely on corporate actors to implement change—we need public pharma options.
Ultimately, insulin manufacturers and the pharmaceutical industry must be held accountable for putting profits over patients through legislation that permits price-lowering solutions to move quickly ahead.
“Public Pharma” refers to options in which state actors take or complement roles that private companies usually have in pharma: manufacturing, distributing, and pricing prescription drugs. Three variations of Public Pharma are: public manufacturing, in which the state manufactures the drug; public procurement, in which states purchase drugs in bulk quantities at a lower price and distribute them; and public PBMs, in which the state(s) negotiate lower prices for public or private entities to purchase.
States who invest in public manufacturing of insulin and other medicines are investing in the future of their citizens. The demand for insulin, which is as essential as water to a person with type 1 diabetes, will only increase in the coming years, with rates of diabetes in young U.S. populations predicted to rise dramatically. The current faulty system has resulted in an estimated 1.3 million Americans rationing their insulin in the last year. States that provide affordable and accessible insulin will save money through fewer emergency room visits for diabetic ketoacidosis (DKA), a consequence of rationing that costs an average of $30,000 per ER visit. They can also count on a reduction of long-term complications caused by the inability to correctly manage diabetes with insulin, such as amputations, kidney failure, vision damage, and more. In 2019, taxpayer-funded programs like Medicare and Medicaid spent over $120 billion (65% of total expenditures) on total health expenditures, including over $25 billion on insulin. If patients were able to buy their medicine at a price that is close to the manufacturing cost—or better yet, receive it for free—money would be saved and quality of life would be vastly improved.
Public manufacturing will also create new jobs and allow states to take ownership of the supply chain. There is opportunity to sell the publicly produced medicines to other states interested in contracting for lower cost options. And of course, states are not limited to only addressing insulin costs, but can focus on other high priced drugs in the future, as California is doing with Naloxone.
Public Pharma initiatives, most specifically targeting insulin, have already been started in Washington, Maine, Michigan, and California, with Michigan and California both budgeting significant funds for the efforts ($150 million and $100 million, respectively). Establishing a manufacturing facility and getting FDA approval is a longer process, so while public manufacturing should be the end goal among the various pathways, establishing interim solutions with public PBMs (as Washington, Oregon, Nevada, and Connecticut have done with ArrayRX) and public procurement options can lower prices quickly and save states money. Additionally, creating a public-private partnership by contracting with a nonprofit like Civica, as California has done for their state brand CalRx, could lower costs for some patients as soon as 2024, since they are further along in the drug development and approval process for insulin. Ultimately, insulin manufacturers and the pharmaceutical industry must be held accountable for putting profits over patients through legislation that permits these and other price-lowering solutions to move quickly ahead.
Public manufacturing has already been implemented successfully by several states. Massachusetts and Michigan have both developed, manufactured, and marketed biologics (including vaccines, monoclonal antibodies, and immunoglobulins) in the past, and Massachusetts continues to do so today through MassBiologics. The California Department of Public Health produces BabyBIG, a biologic drug used to treat infant botulism, which was developed and produced in response to a high incidence of infant botulism cases in the state.
It’s time to put people over profit, and join #insulin4all advocates across the country in urging our state legislators to prioritize public pharma.
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Progressives Call On Schumer to Go Further to Lower Insulin Prices for All
"It is vital that affordable insulin access is provided to everyone, including those who do not have insurance," wrote healthcare advocates.
Jul 10, 2023
More than three dozen healthcare and consumer advocacy groups on Monday applauded recently passed legislation to expand access to lifesaving insulin—but with more than a million people in the U.S. still forced to ration the diabetes treatment due to skyrocketing costs, the groups said U.S. Senate Majority Leader Chuck Schumer must take further action to ensure no more Americans risk their health, or even die, due to insulin prices.
With the Senate expected to advance a packages that will address high drug prices, groups including Public Citizen, Metro New York Health Care for All, and Patients for Affordable Drugs told the Democratic leader, who represents New York, that any legislation must pass "the Alec Smith test."
Alec Smith died at the age of 26, less than a month after he aged out of his parents' insurance plan. He made just enough money to not qualify for any insurance subsidies or patient assistance programs and so was forced to pay for insulin for his Type 1 diabetes out of pocket—$1,300 per month. Unable to afford the medication on top of housing costs, bills, and other essentials, Smith rationed his insulin supply and died of ketoacidosis in 2017.
"Any insulin legislation that would not have prevented this tragedy fails the Alec Smith test," wrote the groups. "It is vital that affordable insulin access is provided to everyone, including those who do not have insurance, in addition to those who are privately insured."
"Insulin legislation advanced through the Senate should put an end to perverse arrangements between drug corporations and middlemen that stifle potential savings from lower-priced insulins and put patients' lives at risk."
The groups said the legislation must include three key elements, including:
- Ensuring people with private insurance and those without insurance, who are most vulnerable to rationing, have access to the insulin they need;
- Stopping insulin manufacturers from charging excessive prices, which they have raised as much as 1100% since the 1990s despite the products remaining the same and companies benefiting from low production costs; and
- Preventing anti-competitive tactics from drug corporations and middlemen from interfering with patient access to lower-priced insulin products, including biosimilars.
"As pharmacy benefit managers (PBMs) demonstrated preferences for covering insulin products with higher list prices to secure larger rebates, insulin manufacturers responded by raising prices in lockstep," wrote the groups. "Patients who pay out of pocket for all or a portion of list prices that have been sharply increased by drug corporations suffer under this scheme."
"Insulin legislation advanced through the Senate should put an end to perverse arrangements between drug corporations and middlemen that stifle potential savings from lower-priced insulins and put patients' lives at risk," they added.
The organizations credited the Democratic Party with passing medication price reforms in the Inflation Reduction Act and the American Rescue Plan, guaranteeing access to insulin for Medicare recipients for no more than $35 per month and lifting a cap on Medicaid rebates.
A recent study published in the Annals of Internal Medicine, however, showed that 1.3 million people in the U.S. are still forced to ration insulin, including 29.2% of people without insurance and nearly 20% of those with private insurance.
"Hopefully soon, some of these patients will feel improvements in access and pricing due the policies that have been enacted," wrote the groups, "but many require further relief—the Senate's work is far from complete."
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