House Passes Insulin Cost-Sharing Bill

 Commentary  April 01, 2022 at 07:44 AM  Share & Print

 
 

What You Need to Know

  • H.R. 6833 would apply to people with commercial health coverage.

  • The bill does not limit how much drug manufacturers could charge health plans or health insurers for insulin.

  • Twelve House Republicans crossed party lines to vote for the bill.

House members voted Thursday to cap what diabetic patients with commercial health coverage pay for insulin at $35 per month.

The House passed H.R. 6833, the Affordable Insulin Now bill, by a 232-193 vote.

The bill may have a chance of attracting some Republican votes in the Senate. Rep. Angie Craig, D-Minn., the sponsor, attracted no Republican cosponsors in the House, but 12 Republicans crossed party lines to vote for it.

If the bill becomes law and works as supporters expect, it could decrease what insurance and retirement planning clients with diabetes pay for insulin.

It also could set the stage for more intense battles between health insurers and insulin manufacturers over the price of insulin.

H.R. 6833 Details

H.R. 6833 would not have a direct effect on the price of insulin.

Instead, the bill would require health insurers, self-insured employer health plans and Medicare Part D prescription drug plans to cover insulin before patients meet plan deductibles, and to limit any monthly copayments or other cost-sharing payments for insulin at $35.

If a coverage provider could negotiate an insulin price under $140, it would have to cap a patient’s monthly cost-sharing amount at less than $35.

The bill does not include a provision saying explicitly how high-deductible health plans that are compatible with health savings accounts should handle cost-sharing. HSA-compatible plans can pay for preventive care before patients meet their deductibles but are supposed to require insureds to pay for pre-deductible sick care with cash from their HSAs.

The Background

About 1% of the privately insured people in a health insurance claims database analyzed by Kaiser Family Foundation analysts earlier this month filled a prescription for insulin in 2018.

The share of insulin users who paid more than $35 per month out of pocket for insulin in 2018 was 26% in the individual market, 31% in the small-group market and 19% in the large-group market.

Both Democrats and Republicans have been complaining for years about the high cost of insulin.

House Republicans have complained that H.R. 6833 would do nothing to hold down the actual cost of insulin and instead would reduce patients’ scrutiny of insulin prices.

Republicans have proposed a bill, H.R. 19, that would emphasize insulin price and discount disclosure, encourage manufacturers to add more insulin products to market, and let HSA-compatible plans cover insulin before patients have met their deductibles.


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