Explainer: Why is insulin so expensive and difficult to cap?
By AMANDA SEITZ, Associated Press
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WASHINGTON (AP) — Reining in the soaring prices of insulin has thus far been elusive in Congress, although Democrats say they’ll try again — as part of their economic package that focuses on health and climate. The price of the 100-year-old drug has more than tripled in the last two decades, forcing the nation’s diabetics to pay thousands of dollars a year for the life-saving medication. Democrats are considering capping the cost of that drug for at least some, although it’s unclear what the final proposal will look like and how many insulin users will get a price break.
Here’s a look at how insulin became so expensive and why it’s so difficult to bring the price of the drug down.
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HOW MANY PEOPLE IN THE U.S. USE INSULIN AND FOR WHAT?
Roughly 8.4 million Americans use insulin, according to the American Diabetes Association. Not everyone who has diabetes needs insulin, but for those who do, it’s an important medication. For more than 1 million of those people with type 1 diabetes, regular access to the medication is a necessity and they will die without it.
“People require insulin, it’s not an option and nobody should have to decide between life-sustaining medication or food and rent,” said Dr. Robert Gabbay, the chief scientific and medical officer for the American Diabetes Association.
Insulin also helps control glucose levels for patients with other forms of diabetes. Some insulin users have rationed the drug because of its expense and risk numerous health complications as a result.
HOW EXPENSIVE IS INSULIN?
The price varies.
Some people on private insurance pay hundreds of dollars monthly for the drug. For most Medicare beneficiaries, the average out-of-pocket cost per insulin prescription was $54 in 2020 — an increase of nearly 40% since 2007, a study released last month by the Kaiser Family Foundation found. Others live in one of 22 states where the copay for a 30-day supply has been capped between $25 to $100.
The cost has led some to use less insulin than their doctor prescribes or postpone paying for other medical care.
WHY IS INSULIN SO EXPENSIVE?
Only three manufacturers — Eli Lilly, Novo Nordisk and Sanofi — produce insulin, allowing those companies to control much of the market.
“They’ve been historically raising their list prices for their respective products in lockstep with one another,” Dr. Jing Luo, a professor of medicine at the University of Pittsburgh, said. “There hasn’t been a lot of pricing pressure.”
And making a generic drug for insulin hasn’t been easy, with new manufacturers having to clear regulatory hurdles and questions over how a generic drug should be categorized, Luo added. A generic insulin is slated to come on the market in 2024 at no more than $30 a vial, which could drive down some of the price.
A biosimilar insulin product the Food and Drug Administration approved last year, however, has been more expensive than advocates had hoped, Gabbay said.
HOW DO DEMOCRATS PLAN TO CAP THE PRICE OF INSULIN?
That remains to be seen.
Senate Majority Leader Chuck Schumer has said some language that limits the price of insulin will be added to the economic bill, but it’s not clear what that price point will be and who all will be protected by that price cap.
Democrats had proposed a $35 monthly cap for those who get the drug through Medicare or private insurers as part of a bigger package that was derailed in the Senate. But it was left out of the scaled down package now headed for a congressional vote.
WHY IS THE COST OF INSULIN SO DIFFICULT TO CAP?
Capping the price of insulin will be very expensive.
Insulin is not only getting more expensive, but the number of people using it is also increasing.
A bipartisan bill proposed earlier this year that would cap insulin prices could cost about $23 billion over the next decade, according to estimates by the Congressional Budget Office. While the bill would reduce insulin costs for many consumers, it would drive up government costs and premiums charged by Medicare and private insurers, according to the office’s analysis.
And that’s one of the reasons why price caps can be controversial.
“If your health insurance company says, voluntarily, nobody who buys insulin in our plan will have to pay more than $25, the question is who is paying the balance of that?” Luo said. “That then means their cost will go up, which means they’ll raise premiums on everyone.”
AP
What started as a $4 trillion effort during President Joe Biden's first months in office to rebuild America's public infrastructure and family support systems has ended up a much slimmer, but not unsubstantial, compromise package of inflation-fighting health care, climate change and deficit reduction strategies that appears headed toward quick votes in Congress.
Lawmakers are poring over the $739 billion proposal struck by two top negotiators, Senate Majority Leader Chuck Schumer and holdout Sen. Joe Manchin, the conservative West Virginia Democrat who rejected Biden's earlier drafts but surprised colleagues late Wednesday with a new one.
What's in, and out, of the Democrats' 725-page "Inflation Reduction Act of 2022" as it stands now:
AP file
Launching a long-sought goal, the bill would allow the Medicare program to negotiate prescription drug prices with pharmaceutical companies, saving the federal government some $288 billion over the 10-year budget window.
Those new revenues would be put back into lower costs for seniors on medications, including a $2,000 out-of-pocket cap for older adults buying prescriptions from pharmacies.
Money would also be used to provide free vaccinations for seniors, who now are among the few not guaranteed free access, according to a summary document.
AP file
The bill would extend the subsidies provided during the COVID-19 pandemic to help some Americans who buy health insurance on their own.
Under earlier pandemic relief, the extra help was set to expire this year. But the bill would allow the assistance to keep going for three more years, lowering insurance premiums for people who are purchasing their own health care policies.
AP file
The bill would invest $369 billion over the decade in climate change-fighting strategies including investments in renewable energy production and tax rebates for consumers to buy new or used electric vehicles.
It's broken down to include $60 billion for a clean energy manufacturing tax credit and $30 billion for a production tax credit for wind and solar, seen as ways to boost and support the industries that can help curb the country's dependence on fossil fuels.
For consumers, there are tax breaks as incentives to go green. One is a 10-year consumer tax credit for renewable energy investments in wind and solar. There are tax breaks for buying electric vehicles, including a $4,000 tax credit for purchase of used electric vehicles and $7,500 for new ones.
In all, Democrats believe the strategy could put the country on a path to cut greenhouse gas emissions 40% by 2030, and "would represent the single biggest climate investment in U.S. history, by far."
AP file
The biggest revenue-raiser in the bill is a new 15% minimum tax on corporations that earn more than $1 billion in annual profits.
It's a way to clamp down on some 200 U.S. companies that avoid paying the standard 21% corporate tax rate, including some that end up paying no taxes at all.
The new corporate minimum tax would kick in after the 2022 tax year and raise some $313 billion over the decade.
Money is also raised by boosting the IRS to go after tax cheats. The bill proposes an $80 billion investment in taxpayer services, enforcement and modernization, which is projected to raise $203 billion in new revenue — a net gain of $124 billion over the decade.
The bill sticks with Biden's original pledge not to raise taxes on families or businesses making less than $400,000 a year.
The lower drug prices for seniors are paid for with savings from Medicare's negotiations with the drug companies.
AP file
With $739 billion in new revenue and some $433 billion in new investments, the bill promises to put the difference toward deficit reduction.
Federal deficits have spiked during the COVID-19 pandemic when federal spending soared and tax revenues fell as the nation's economy churned through shutdowns, closed offices and other massive changes.
The nation has seen deficits rise and fall in recent years. But overall federal budgeting is on an unsustainable path, according to the Congressional Budget Office, which put out a new report this week on long-term projections.
AP file
This latest package after 18 months of start-stop negotiations leaves behind many of Biden's more ambitious goals.
While Congress did pass a $1 trillion bipartisan infrastructure bill of highway, broadband and other investments that Biden signed into law last year, the president's and the party's other priorities have slipped away.
Among them, a continuation of a $300 monthly child tax credit that was sending money directly to families during the pandemic and is believed to have widely reduced child poverty.
Also gone, for now, are plans for free pre-kindergarten and free community college, as well as the nation's first paid family leave program that would have provided up to $4,000 a month for births, deaths and other pivotal needs.
Associated Press writer Matthew Daly contributed to this report.
Rich Pedroncelli
FILE - Insulin is displayed at Pucci's Pharmacy in Sacramento, Calif., July 8, 2022. Senate Majority Leader Chuck Schumer, D-N.Y. said this week that Democrats planned to add language to the economic package focused on climate and health care that will be aimed at reducing patients' costs of insulin, the diabetes drug that can cost hundreds of dollars monthly. (AP Photo/Rich Pedroncelli, File)
