Congress has capped Medicare insulin costs. Here’s how it works and what it means

North Carolina residents could soon be paying less for prescription drugs.

U.S. Reps Alma Adams and Jeff Jackson joined Department of Health and Human Services Secretary Xavier Becerra in Charlotte on Friday to highlight the Biden administration’s efforts to reduce healthcare costs as part of the Inflation Reduction Act.

“The Inflation Reduction Act is the most impactful health care bill since the Affordable Care Act because it works to close disparities in health care that have existed for generations,” Adams said.

Under the legislation, a month’s supply of each Medicare-covered insulin is capped at $35, and preventive vaccines would be free for people with Medicare prescription coverage.

According to the most recent data from the United Health Foundation’s annual America’s Health Ranking report, nearly 13% of adults in North Carolina — approximately 730,000 people — have some form of diabetes and almost 21% of them make less than $25,000 a year.

Forbes reported in 2022 that the newest versions of insulin cost anywhere from $175 to $300 a vial.

The new law also allows Medicare to negotiate better prices for select prescription drugs.

“I call it the Prescription Drug Lowering Prices Act because that’s what it’s doing,” Becerra said. “He [President Joe Biden] said he would promise to bring the American people, when it came to healthcare, lower costs for more Americans with better benefits.”

Here is how the law will help those with medical benefits:

How much will I pay for prescriptions?

Starting in 2023, the out-of-pocket cost of insulin for Medicare beneficiaries will be capped at no more than $35 for a month’s supply. The initiative will also require Medicare drug coverage plans to offer improved financial protections that would phase in starting in 2024, with the $2,000 out-of-pocket cap taking effect in 2025. Seniors and people with disabilities who have Medicare coverage will have new protections against costly prescription drug bills.

Will drug prices stay affordable under Inflation Reduction Act?

Companies will be required to pay Medicare a rebate if they increase drug prices faster than inflation.

How will the law impact low-income families?

The Act expands eligibility for full “Part D Low-Income Subsidies” – known as Extra Help – in 2024 to low-income beneficiaries with incomes up to 150% of poverty and modest assets.

What else will be covered?

While Medicare Part B covers vaccines such as the flu vaccine at no cost-sharing, patients receiving vaccines covered under Medicare Part D, such as the vaccine for shingles, must pay for a portion of the cost out of pocket. Starting in 2023, the legislation will require zero cost-sharing for vaccines for Medicare Part D beneficiaries.

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