Since Jan. 1, older adult Medicare users have seen major cuts in insulin prices.
The Inflation Reduction Act, signed into law in August 2022, promised older adults with diabetes on Medicare they would pay no more than $35 a month for insulin. This change has since gained public support, considering previous reports that four out of five Americans have gone into debt in the past to pay for insulin.
“No one should have to choose between taking their medication as prescribed and putting food on the table or a roof over their head,” Rep. Dan Kildee, a Democratic lawmaker who sponsored the legislation, said in a statement.
A new Navigator poll showed that a majority of Americans, regardless of political affiliation, race, or age group, support the lower insulin prices.
However, not everyone is benefitting from the price reduction. In August, members of the Senate blocked a provision in the Inflation Reduction Act that would have included private insurance users in the $35 insulin price cap.
“State caps leave out many residents,” Pew Charitable Trusts author Michael Ollove wrote. “They cover patients enrolled in state-regulated health insurance plans, which generally are individual health insurance policies sold on Affordable Care Act marketplaces as well as state employee health plans. … The state laws can’t include most large employer and union health plans; those fall under federal government regulation.”
The limitations on the price cap could keep caregivers and older adults who don’t use Medicare or the Affordable Care Act marketplace from getting affordable insulin.
The limitations on the price cap could keep caregivers and older adults who don’t use Medicare or the Affordable Care Act marketplace from getting affordable insulin.
Although the insulin cap mainly applies to Medicare, 22 states currently have legislation that caps co-pays for people with private insurance and/or limits the price of diabetes products.
“There’s a whole menu of ideas on how to address the issue of insulin affordability,” Niels Knutson, director of government relations for the type 1 diabetes advocacy organization JDRF, told Medscape Medical News. “Most pathways to solving this on the federal level will require 60 votes in the Senate. There is universal recognition that this is a problem. The challenge becomes everybody on the same page for how to fix it.”
Insulin will become affordable for more older adults as additional parts of the Inflation Reduction Act go into effect. On July 1, 2023, the $35 insulin cap will also apply to those who use a pump, which Medicare considers durable medical equipment.