The chances of passing election-year legislation to help people afford insulin – which weeks ago seemed mired in political fighting – are looking brighter as a bipartisan effort to tackle the issue takes root in the Senate.
Although the effort is still in its early stages, it is moving forward with Senate Majority Leader Chuck Schumer’s support. He tapped Sens. Susan Collins, R-Maine and Jeanne Shaheen, D-N.H., to craft a compromise that members of both parties could accept. Adding pressure to the Senate’s efforts was a vote by the House on March 31 to pass a different bill that caps out-of-pocket insulin costs for many patients with insurance at $35 a month.
Collins stated in an interview March 30, that the outline was based on a bill that Collins had worked on three years back. It goes beyond the cap on diabetes patients’ costs and aims to lower the prices drug companies charge.
“It tackles the broader issue of the high list price for insulin, and the conflicts of interests that occur in the chain from manufacturer to the consumer buying it at the pharmacy counter,” Collins said.
The idea of reducing patients’ out-of-pocket insulin costs is immensely popular, and More than half the population is aware of it.It is seen as a “top priority”According to a Kaiser Family Foundation poll, Congress is the most important.
It had been a key selling point of President Joe Biden’s Build Back Better plan, but when that legislation stalled, Biden and Schumer gave Sen. Raphael Warnock, D-Ga., an open lane to promote a stand-alone measure identical to the House bill that caps insulin costs at $35 a month for people with private insurance and Medicare coverage.
However, the political climate presented obstacles. The chances that a bill sponsored and supported by a Democrat, who is facing a tough reelection campaign in the fall, could be passed by enough Republicans in the Senate seemed slim. Even some Democrats were nervousConsider removing insulin provisions from any possible revised Build Back better bill. So Schumer adopted a different option offered by Collins and Shaheen. It would have a cap on out of pocket costs and potentially draw more votes.
Insulin prices have skyrocketed since the early 2000s. Americans are paying more for insulin. 10 timesWhat people in developed countries pay.
Although Collins said details are still being worked out, her legislation would be based on the pair’s earlier bill, the Insulin Price Reduction Act of 2019It aimed to return insulin costs to 2006 levels. It would have done that by barring rebate payments for insulin to pharmacy benefit managers – those intermediaries who negotiate price breaks for insurance companies and determine which drugs the insurance plans cover.
Collins and other pharmacy benefit managers critics believe they inflate drug prices because they prefer higher-priced drugs, from which they can obtain a larger rebate and thus more profit. This gives drug manufacturers an additional incentive to raise their list prices.
According to the 2019 plan, drug companies that agreed to return to 2006 prices could then raise their prices each year only at the Rate of medical inflation. According to senators, the plan would result in a 75 percent reduction in prices compared to those in 2020.
“There’s a very complex system which essentially encourages high list prices, because the pharmacy benefit managers frequently receive a percentage of the list price,” Collins said. “So their incentive is to choose one that is higher-cost. And so we are trying to address that broader issue, as well as looking at the out-of-pocket costs.”
Warnock’s proposal to cap the cost of insulin is silent on list prices and benefit managers, an omission some Democrats complained about even as they voted for the similar bill in the House. They also noted that the insurance companies would likely increase premiums because they would be required to absorb the costs that are not being paid by patients.
“This bill does not lower the price of insulin by one penny,” said Rep. Lloyd Doggett, D-Texas. “It just shifts the burden of paying for the insulin off of the shoulders of insured insulin users, and shifts it on to the rest of all of us who are paying insurance premiums.”
Collins also noted that the uninsured would not benefit from the House cap, which applies to Medicare and insurance companies but doesn’t affect drug makers’ prices.
“It doesn’t help someone who’s uninsured,” Collins said. “When you address the high list price, then it’s going to help more people.”
Collins said that there could be many changes as lawmakers continue to work with different stakeholders on a final bill. These include diabetes advocacy groups, the Centers for Medicare & Medicaid Services and the Congressional Budget Office. Things get more complicated when list-price changes and caps on out-of pocket expenses start to interact.
“We’re talking to CBO, which says it’s so complex that they need a new model,” Collins said.
Politics remain a challenge. Collins and Shaheen didn’t get their measure to the Senate floor in 2019 or 2020, when Senate Minority Leader Mitch McConnell had been majority leader. They did receive praise from both sides and Senator Kevin Cramer (conservative North Dakota Republican) was a cosponsor.
Collins stated that while this opens the door to Republican support she is still only at the stage she called a “discussion draft” and was still circulating it among her colleagues.
Republicans in the House who voted down the $35-cap bill were smugglers. They said it was a political stunt and that Democrats should have presented ideas that had been discussed with Republicans.
These objections could not be used to block the bill in the House. However, the Senate has only 50 Democrats and the legislation would need 60 votes to pass.
Although Republican senators might also be opposed to Warnock’s bill, one of the House sponsors argued that having the House advance a dramatic cut in insulin costs – with the support of only a dozen Republicans – would raise the stakes for the Senate.
“If 10 Republicans stand between Americans being able to get access to insulin or not, that’s a good question for 10 Republican (senators) to have to answer when they go back home,”Before the House vote, Dan Kildee (D-Mich.) made these remarks. “So we’re gonna pass this bill, and this will put the pressure on the Senate to act.”
He and his Democratic cosponsors also indicated their willingness to accept a measure including the Collins and Shaheen additions.
“Any train that’s leaving the station that gets folks affordable insulin – I’m open to any vehicle,”Kildee stated. “We think this is a solution that would work. How it gets to the president’s desk, I’m agnostic on that question. Any way we can get it there.”
KHN(Kaiser Health News), a national newsroom, produces in-depth journalism on health issues. KHN, together with Policy Analysis and Polling is one of three major operating programs. KFF(Kaiser Family Foundation). KFF is an endowed, nonprofit organization that provides information on health issues for the nation.
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