The bipartisan Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act would lower out-of-pocket insulin costs to $35 per month but will likely increase Medicare and health care costs and premiums.
The INSULIN Act, introduced by Sens. Shaheen (D-NH) and Collins (R-ME) would:
- Eliminate rebates for PBMs and insurers on drug manufacturers that limit the list price of insulin to the 2021 net prices for Medicare Part D or equivalent levels;
- Waive deductibles and limits copays or coinsurance to no more than $35 per month for at least one insulin on group and individual market plans; and
- Prohibit prior authorization and other medical management requirements which limit use of insulins.
Outlook: A House version of the legislation with a $35 cap on insulin only received 12 Republican votes as many consider the bill a form of price control, making crossing the 60-vote threshold in the Senate a challenge. The addition of the measure eliminating rebates for PBMs and insurers was included to attract more bipartisan support and incentivize manufacturers to lower their list prices. Support will also depend on the CBO score and whether that shows an impact on Medicare and employer premiums.