Sen. Josh Hawley (R-Mo.) renews D.C. push to cap insulin costs

WASHINGTON (Gray DC) - New attempts to cap rising insulin costs are making a comeback on Capitol Hill. This comes nearly a year after President Joe Biden called for a price cap in his first State of the Union address, and months after Republicans blocked part of Senator Raphael Warnock’s (D-Ga.) legislation which would’ve capped costs for people on private insurance.

“Let’s cap the cost of insulin at $35 a month,” President Biden said during the 2022 State of the Union address, “So everyone can afford it.”

For Lacy Mason, a type 1 diabetic from Georgia, that was the beginning of feeling like the discussion on insulin prices was moving to the forefront.

Mason said, “Last year at this time it was really exciting.”

Through multiple proposals, and months of negotiations, Congress only managed to pass a $35 per month cap for seniors on Medicare Part D.

Legislation proposed by Senator Raphael Warnock (D-Ga.) was met the chopping block late in the year, and with it, many others were left without relief.

Mason said, “It’s definitely a sense of frustration, but also not just for myself. It’s a deep sense of worry for other people in my position.”

While in graduate school, Mason says she struggled affording insulin and was forced to take less than she needed to try and make it last longer.

“I had some friends that were nurses who were able to take the insulin vials from the hospital that weren’t all the way used and give those to me,” she said. “I would do what I had to do.”

Analysis from the Kaiser Family Foundation shows that a cap for people with private insurance would help at least 1 out of 5 insulin users save money.

This week Senator Josh Hawley (R-Mo.) introduced a bill to cap out-of-pocket costs at $25 a month for people with private insurance and on Medicare. It nearly mirrors a bill introduced by Senator Warnock last year but would save people an additional $10 per month.

Hawley said, “I think it’s pretty hard for senators to explain to their constituents who need insulin, need it for their life, that they ought to be paying these outrageous prices and that there’s just nothing that we can do.”

We also spoke with Senator Warnock who says he’s hoping to see a bipartisan effort this Congress to extend a cap to those with private insurance.

Warnock said, “Some 50,000 Georgians right now are already benefiting from the cap that I was able to pass last Congress. And I’m hoping that with Senator Hawley, and others, who clearly have demonstrated some interest. In fact, last summer I had another one of my colleagues express some interest in working with me on this, and the closer we got to the election, he went a little radio silent. And I’m hoping that we can get this done now.”

Ed Haislmaier, from the conservative Heritage Foundation, points to a 2021 study that shows pharmaceutical company profit margins are falling and insulin prices are going up.

“Big Pharma is not the problem,” Haislmaier said. “The real target is the middlemen, and between the pharmacy benefit managers who are making up that difference.”

Haislmaier says he’d rather see Congress focus on telling pharmacy benefit managers they need to act in the best interest of patients rather than pass a hard price cap.

It’s still unknown whether a separate bipartisan bill will make a comeback during this Congress. That would cap insulin prices even for people who don’t have private insurance.

Charles “Chuck” Henderson, CEO of the American Diabetes Association, said in a statement, “The American Diabetes Association has been the leading organization advocating for copay caps for insulin, resulting in the enactment of these cost-sharing limits in 22 states and the District of Columbia. Insulin costs continue to be unaffordable for too many of the 8.4 million Americans who require it to stay alive. The average price of insulin tripled in the decade leading up to 2013, and today insulin costs 10 times more than it does anywhere else in the world. While the Medicare copay cap was a significant step in the right direction and a potentially life-saving policy change for seniors, the ADA will continue to fight to expand this benefit to all people with diabetes who rely on insulin to survive.”

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