A new bipartisan Senate bill would cap insulin costs at $35 for Americans with private insurance, targeting one of the most persistent affordability problems facing the roughly 40mn people in the US living with diabetes.
The bill was introduced on Wednesday by Democrats Jeanne Shaheen of New Hampshire and Raphael Warnock of Georgia, along with Republicans Susan Collins of Maine and John Kennedy of Louisiana.
It would apply the cap to individual plans sold through the Affordable Care Act marketplaces and to commercial health plans used by most Americans.
The measure also sets up a pilot programme aimed at offering insulin at the same capped price for uninsured patients.
If the INSULIN Act becomes law, it would mark the first nationwide out-of-pocket cap imposed on private insurers for treatment of a disease outside the preventive drug category, according to Cynthia Cox, senior vice president and director of the ACA programme at KFF.
Shaheen said the proposal would broaden access to lower-cost insulin across coverage types. She described the legislation as a broad and practical plan aimed at cutting insulin costs for diabetic patients regardless of insurance status.
More co-sponsors are expected in the coming days, according to a Senate Democratic aide who spoke on condition of anonymity to discuss the legislation more freely.
Backers are trying to build enough momentum to attach the measure to other must-pass legislation, including a package extending programmes due to expire at the end of the year.
Lawmakers introduced the same legislation in 2023 with 13 co-sponsors, including seven Republicans, though it did not make it out of committee.
If enacted, the bill would narrow a long-running gap in access to lower-cost insulin. A $35 monthly out-of-pocket cap already applies to Medicare beneficiaries. The Inflation Reduction Act of 2022 created that limit.
The new bill would extend similar protection to people in group and individual health plans.
Under the proposal, insurers would need to waive deductibles and limit cost-sharing to no more than $35 a month or 25% of the list price for at least one type of insulin and dosage.
Monthly insulin costs still vary widely depending on insurance coverage. One government report found the average monthly insulin cost in 2019 was $123, while patients with private insurance paid $63 on average.
The federal government has more direct control over public programmes such as Medicaid and Medicare. It does not have the same authority to force commercial insurers to cap costs for specific drugs without new legislation.
The Affordable Care Act already requires insurers to cover vaccines, drugs tied to preventive care, and birth control without patient cost-sharing.
Cox said the INSULIN Act cap would likely help people with diabetes, though it could also push insurers to raise out-of-pocket costs for other drugs. Plans, she said, would still need to cover the same overall share.
Insulin has been on the market for decades, though it still does not have a true generic version. Lower-cost biosimilar options do exist, though.
The first group of drugs selected for Medicare price negotiations under the Inflation Reduction Act included several insulin products.
Major insulin manufacturers have also voluntarily introduced a $35 cap for people in commercial plans.
29 states and the District of Columbia have capped monthly insulin costs at levels ranging from $25 to $100 for commercial plans or state-regulated coverage sold on the individual market.
