Bay Area Edition | June 2022

LEGISLATION Insulin legislation aims to cap uctuating prices nationwide

A rising disease The percentage of people with diabetes in Harris and Galveston counties has continued to rise over at least the past 10 years.



Harris County Galveston County



plans such as Medicaid; however, the new bills would provide a price cap on copays for those with private health insurance or Medicare, U.S. Rep. Al Green, DHouston, said. None of these legislations cover the uninsured. Stephen Habbe, vice president of state government aairs for the ADA, said that rising costs of insulin has become more of a problem. “Accessibility to insulin due to aordability has been a major prob- lem for millions of Americans, and the pandemic has exacerbated that One of the three bills being debated in Congress is House Resolution 6833, better known as the Aordable Insulin Now Act, which would cap insulin prices at either $35 a month or 25% of a private insurance plan’s price—which- ever is cheaper—and $35 for those who have Medicare. The House of Representatives passed the resolution in a 220-193 vote March 31, and it was problem,” he said. Proposed changes received by the Senate on April 4. Additionally, U.S. Sen. Raphael Warnock, DGeorgia, introduced companion legislation in the Senate on Feb. 17, Green said. However, U.S. Rep. Troy Nehls, RRichmond, was one representative who voted against the measure. “This bill institutes a price control agenda that will cost the federal government an additional $11 billion ... while not addressing the cost of insulin for uninsured Americans,” Nehls said.


Congress members have proposed three bills in 2022 that aim to reduce the cost of insulin to consumers. Insulin is used to treat diabetes, a health condition that changes how the body turns food into energy. In 2018, 12% of Texans age 18 and older had diabetes, according to the most recent data from the Centers for Disease Control and Prevention. About 11% of those age 20 and older in Brazoria and Galveston counties had diabetes in 2019. This increased from about 9%-10% in 2018. Meanwhile, how much it costs distributors to buy a product in bulk from manufacturers has uctuated in recent years. The average wholesale cost for a dose of insulin in 2022 is $363 compared to $239 in 2020—the earliest data available from the Texas Depart- ment of State Health Services. Wholesale cost does not reect how much a person pays, as that cost is dependent on factors such as insurance plans, dosage amount and frequency, DSHS Press Ocer Douglas Loveday said. If any of the three bills pass, they would dier from legislation Gov. Greg Abbott signed in June 2021 that limits copays for a 30-day supply of insulin at $25 for Texans on state-regulated health plans, according to a June 2021 news release from the nonprot American Diabetes Association. Texas’ existing legislation—Senate Bill 837—does not oer the cap to individuals who are uninsured or those not on state-regulated health






2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Caps across the country Sixteen states, including Texas, have introduced out-of-pocket cost caps on insulin since 2019. COST CAPS $0-$25 $26-$50 $51-$75 $76-$100

16 out of 50 states (32%) cap costs on insulin


Deborah Kilroe, director of com- munications with the Congressional Budget Oce, a federal nonpartisan agency, said the bill would increase federal spending annually by about $6.6 billion and decrease revenue by about $4.8 billion. In an eort to compromise on the issue, U.S. Sen. Susan Collins, RMaine, and U.S. Sen. Jeanne Sha- heen, DNew Hampshire, introduced a bipartisan policy, according to an April 11 news release by Collins’ oce. The

policy, which is still receiving input in the Senate, would include encourag- ing insulin manufacturers to reduce the suggested retail price by ensuring insurance plans cannot collect rebates, which drive up drug costs. “People with diabetes should be able to get the medication they need without having to choose between lling their prescription, paying rent or putting food on the table,” Habbe said. Kelly Schaer contributed to this report.

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