A Democratic push in Congress to cap insulin costs for patients is gaining momentum. It may be a sign that some in the party are giving up on trying to pass comprehensive drug pricing legislation and focusing now on trying to pass what they think is most feasible, to give themselves an achievement to point to in their re-election campaigns.
White House Press Secretary Jen Psaki said yesterday that President Biden will talk about “lowering costs for prescription drugs” in his State of the Union message tonight. He might clarify his preferred strategy for moving drug pricing legislation through Congress.
“There is strong support across the country for lowering costs for prescription drugs,” Psaki said during a press briefing yesterday afternoon. “It’s incredibly popular. Who wants to pay more for prescription drugs?”
In addition to addressing the cost of insulin, the congressional Democrats’ comprehensive legislation includes letting the government negotiate prices for some high-cost drugs covered under Medicare Parts B and D and an inflation penalty on Medicare drugs when the price of a product rises faster than inflation.
Groups that represent 340B covered entities have asked Congress to consider how any drug pricing reforms would affect entities’ ability to benefit from 340B discounts.
Democratic Reps. Angie Craig (Minn.), Daniel Kildee (Mich.), and Lucy McBath (Ga.) introduced the Affordable Insulin Now Act (H.R. 6833) last week Thursday in the House, eight days after Democratic Sen. Raphael Warnock (Ga.) and 19 Democratic co-sponsors did so in the Senate (S. 3700). The bills would cap out-of-pocket costs of insulin products at $35 per month for people with private health plans, Medicare Part D plans, and Medicare Advantage drug plans. For commercial plans, the cap would apply to one of each dosage form of each different type of insulin. For Medicare plans, the cap would apply to all covered insulin products.
Senate Majority Leader Chuck Schumer (D-N.Y.) pledged last week to call for a Senate vote on S. 3700 in March. Its co-sponsors include Senate Finance Committee Chair Ron Wyden (D-Ore.) and other Senate Democratic health policy stalwarts including Richard Blumenthal (Conn.), Tammy Baldwin (Wis.), Debbie Stabenow (Mich.), Jack Reed (D-R.I.), Amy Klobuchar (D-Minn.), Christopher Murphy (Conn.), Margie Hassan (N.H.), Jeanne Shaheen (N.H.), and Tina Smith (Minn.).
The $35-per-month out-of-pocket cap on insulin has been a pillar of the comprehensive drug pricing legislation that congressional Democrats and the Biden administration wanted to enact as part of the president’s far-ranging Build Back Better Act. Senate Democrats failed to secure the 50 votes needed to pass the act. Sen. Joe Manchin (D-W.Va.), whose decision to vote against the act sealed its fate, has declared the Build Back Better Act dead.
In late January, Wyden said there was an “urgent need to pass robust drug pricing reforms” including giving Medicare “the tools to fight back against high prices.” He has not issued a statement or been quoted on the subject since then.
Patients for Affordable Drugs (P4AD), the bipartisan national patient group focused solely on lowering drug prices, continues to press for comprehensive reform.
“While we support copay caps (like those in Sen. Warnock’s bill) as part of these comprehensive reforms, such caps must be coupled with measures that directly constrain prices,” P4AD Communications Director Audrey Baker said. “Advancing copay caps individually will simply shift costs and lead to higher premiums and taxes for consumers.”
“The Senate must pass the package of comprehensive reforms passed through the House in the Build Back Better Act to authorize Medicare to negotiate, limit year-to-year price increases, and cap out-of-pocket costs,” Baker said. “These policies have the support of all 50 Senate Democrats and a clear path forward through the reconciliation process. They will provide relief to millions of patients struggling to pay for medications for a diverse array of conditions, including diabetes.”
Some other influential patient advocacy groups have also raised concerns about the insulin-only legislation, pointing out it does not require drug companies to lower their prices.