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. [MedPage Today 4.19.2022]

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. 

The Crisis

We are in the midst of a diabetes epidemic. In Medicare alone, about one-third of beneficiaries had diabetes in 2017, up from 18% in 2000. Beneficiaries' mean out-of-pocket spending on insulin has nearly doubled over the last decade. In a recent study, we found that out-of-pocket spending increased considerably in the coverage gap for most users with Part D coverage, which was associated with a substantial reduction in adherence.

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