Bipartisan Senate Bill Seeks to Roll Back a Decade's Worth of Insulin Price Hikes

A bipartisan group of senators Monday introduced legislation that calls for cutting insulin prices up to 75%, which would give more patients with diabetes the ability to take the right dose and more families a chance to recover from years of rising out-of-pocket costs.

The Insulin Price Reduction Act, introduced by Senators Jeanne Shaheen, D-NH; Susan Collins, R-ME; Tom Carper, D-DE; and Kevin Cramer, R-ND; bars insurers and pharmacy benefit managers (PBMs) from engaging in rebate schemes with insulin manufacturers that bring their 2020 list prices in line with 2006 levels. Going forward, price hikes could not exceed medical inflation for that year. According to a bill summary from Shaheen’s office, the rebate limits would apply to private insurance plans and Medicare Part D plans.

“For the most popular insulins, this would result in more than a 75% decrease in prices compared to what we can expect to see in 2020,” Shaheen's office said in a statement.

JDRF, an advocacy and research organization focused on those with type 1 diabetes (T1D), said that the bill would take aim at drug rebates that make up 70% of the current list price of insulin. “JDRF supports eliminating their use and requiring insulin manufacturers to drop their prices, as this bill would do,” said Aaron J. Kowalski, PhD, JDRF president and chief executive officer. “At the same time people with diabetes need access to affordable insulin year around, and JDRF supports the bill’s provisions to cover insulin outside the deductible, to prevent spikes in costs at the beginning of the year.”

The cost of insulin, which patients with T1D need to stay alive, has become the symbol of Congress’ and President Donald Trump’s frustration with efforts to rein in prescription drug prices. The cost of drugs has been a bipartisan concern since the 2016 campaign, and in May 2018 Trump contained efforts to halt rising drug prices in a 50-point blueprint, America’s Patients First.

Months of hearings in Congress were marked by stories of young adults dying due to insulin rationing, of trips to Canada to buy cheaper insulin, and of a decade of price increases for which no party would accept blame. A statement released with the bill said the average price of a 40-day supply of insulin had nearly doubled between 2012 and 2016, from $344 to $666; this came on top of costs that tripled between 2002 and 2013. But manufacturers insist the higher prices mask the fact that net prices are actually lower, due to a system of rebates paid to PBMs and insurers.

Meanwhile, as newer, faster-acting insulins have reached the market at higher prices, some health plans have experimented with prescribing older insulins to keep patients’ out-of-pocket costs to a minimum.

Changes to health benefit design have affected the landscape as well. The rise of high deductible plans mean that many with diabetes are forced to pay full price during parts of the year. “For these individuals, the prices are hitting a tragic breaking point, as patients have died from diabetic ketoacidosis complications that result from rationing insulin due to its high cost,” the bill summary read.

Insulin manufacturers have responded with cost-saving programs, such as Sanofi’s offer for a monthly supply of insulin for $99 for those outside Medicare affected by high cost-sharing.

Both JDRF and American Diabetes Association (ADA) have endorsed the bill. “Insulin is a matter of life and death,” LaShawn McIver, MD, MPH, senior vice president of government affairs for ADA, said in a statement. “For many Americans who cannot afford their insulin, the consequences can be dire, including dangerous complications and even death. The American Diabetes Association applauds Senators Shaheen, Collins, Carper and Cramer for their leadership to address this urgent issue. We implore all members of Congress to act swiftly to bring down the cost of this life-saving medication by supporting the Insulin Price Reduction Act.”

ADA first called for transparency across the supply chain in 2016 to bring a solution to escalating insulin costs. The ADA’s Make Insulin Affordable petition has collected more than 487,000 signatures.

"No one should suffer or die because they cannot access insulin. We are very grateful for Senators Shaheen, Collins, Carper, and Cramer for introducing this important piece of legislation, which would treat insulin like the life-saving drug that it is,” said JDRF's Kowalski. “It’s unacceptable for anyone who needs insulin to not have access.”

The American Journal of Managed Care® sought comment from the Pharmaceutical Research and Manufacturers of America (PhRMA), an industry trade group, as well as insulin manufacturers Novo Nordisk, Sanofi, and Eli Lilly. None had released a statement by press time.

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