What to Know in Washington: Cheaper Insulin Still Out of Reach

Senate leaders have signaled that they want to address insulin costs this year, but the path is complicated.

More than 37 million Americans have diabetes and paying for it is eating up a greater share of their household income than ever before.

For 17 years, Kristen Whitney Daniels has been a Type 1 diabetic, needing regular doses of insulin to stay healthy. She usually reaches her insurance’s annual $3,000 out-of-pocket maximum in about two months. So when drugmaker Eli Lilly cut the list price this spring of its generic insulin—Lispro—to $25 a vial, she set out to find it at area pharmacies.

One told Whitney Daniels it had no Lispro in stock. Another was selling it for $70 a vial, she said. A third refused to sell it to her without a prescription, even though she had one for Humalog, the branded and more expensive insulin from Eli Lilly. Eight other diabetics described in interviews the same experience: None was able to find Lispro at the discounted price after it went into effect in May.

These stories showcase the complex bureaucracy diabetics face to buy insulin and the market pressures that keep prices high and low-cost alternatives and generics out of reach.

Senate leaders said they hope to get to the issue when the chamber returns from its August recess. There’s broad support to extend to private insurers Medicare’s $35-per-month cap on insulin costs; the proposal was three votes shy of becoming law last year.

Some lawmakers say more needs to be done to protect the uninsured and fix long-standing flaws in the insulin market. Doing so could mean addressing the role pharmaceutical middlemen play in the price of insulin or simply demanding that drugmakers lower their prices.

President Joe Biden has repeatedly called on Congress to extend Medicare’s $35-per-month cap on insulin costs to the private sector. Republicans supporting an insulin cap say they want any new federal spending offset with cuts elsewhere. Senate Democratic leaders have signaled they may pair insulin with other drug-pricing bills to offset the cost. Supporters of the cap say they’re trying to figure out what bill or combination of bills can garner 60 votes in the Senate. Read the full story from Alex Ruoff.

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To contact the reporter on this story: Brandon Lee in Washington at blee@bgov.com

To contact the editor responsible for this story: Kayla Sharpe at ksharpe@bloombergindustry.com