healthcare Insulin copay cap passes House hurdle
The chances of passing election-year legislation to help people afford insulin — which weeks ago seemed mired in political fighting — are looking brighter as a bipartisan effort to tackle the issue takes root in the
That effort is still in the early stages, but it is moving forward with the support of Senate Majority Leader
House on
Collins said in an interview
“It tackles the broader issue of the high list price for insulin, and the conflicts of interests that occur in the chain from manufacturer to the consumer buying it at the pharmacy counter,” Collins said.
The idea of reducing patients’ out-of-pocket insulin costs is immensely popular, and more than half of the public sees it as a “top priority” for
It had been a key selling point of President Joe Biden’s Build Back Better plan, but when that legislation stalled, Biden and Schumer gave Sen.
The political climate, however, presented roadblocks. The odds that a bill sponsored by a Democrat facing a tough reelection in the fall could get enough
Insulin prices have spiked dramatically since the early 2000s, with Americans paying 10 times what people in other developed countries pay.
Although Collins said details are still being worked out, her legislation would be based on the pair’s earlier bill, the Insulin Price Reduction Act of 2019, which aimed to roll insulin costs back to what they were in 2006. It would have done that by barring rebate payments for insulin to pharmacy benefit managers — those intermediaries who negotiate price breaks for insurance companies and determine which drugs the insurance plans cover.
Collins and other critics of PBMs believe they inflate prices because they favor higher-priced drugs from which they can extract a larger rebate and therefore more profit, which gives drugmakers extra incentive to raise list prices.
Under that 2019 plan, drug manufacturers who agreed to return to 2006 costs could then raise prices each year only at the rate of medical inflation. The senators estimated the plan would lead to a 75% cut in prices from those listed in 2020.
“There’s a very complex system which essentially encourages high list prices, because the pharmacy benefit managers frequently receive a percentage of the list price,” Collins said. “So their incentive is to choose one that is higher-cost. And so we are trying to address that broader issue, as well as looking at the out-of-pocket costs.”
Warnock’s proposal to cap the cost of insulin is silent on list prices and benefit managers, an omission some
“This bill does not lower the price of insulin by one penny,” said Rep.
Collins also noted that the uninsured would not benefit from the House cap, which applies to Medicare and insurance companies but doesn’t affect drugmakers’ prices.
“It doesn’t help someone who’s uninsured,” Collins said. “When you address the high list price, then it’s going to help more people.”
Collins warned that much could change as lawmakers keep working with various stakeholders on a final bill, including diabetes advocacy groups, the
“We’re talking to CBO, which says it’s so complex that they need a new model,” Collins said.
The politics also remains tricky. Collins and Shaheen never got their measure close to the
While that opens the door to
Such objections could not block the bill in the House. But in the
Although
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