Insulin Cost Cap Splits Democrats Seeking Broad Drug-Price Curbs

Senate Democrats are testing whether a cap on what many Americans pay for insulin medication can muster bipartisan support, even as advocates for reining in drug prices differ over strategy.

Some vocal advocates for Democrats’ sweeping changes to drug pricing say they’re worried action on one measure could mean leaving the rest of the agenda behind. Broad measures were included in the Build Back Better domestic spending package (H.R. 5376) that’s stalled in the Senate.

Senate Majority Leader Chuck Schumer (D-N.Y.) recently announced that a bill to cap what people with insurance pay for insulin from Sen. Raphael Warnock (D-Ga.) “will be a priority for Democrats in the weeks ahead.”

“In Washington if we create a partial solution, we take away from the mission to create a complete solution,” Rep. Susan Wild (D-Pa.) told reporters Wednesday, referring to the insulin legislation.

Kerem Yucel/AFP via Getty Images

Nicole Smith-Holt stores insulin in her refrigerator in St. Paul, Minn. With costs high, Congress has yet to resolve how to drive down prices for the medicine.

Others say the insulin bill simply isn’t enough to lower Americans’ drug costs in a meaningful way. The bill would cap consumers’ out-of-pocket insulin costs at $35 per month without changing the price drugmakers charge for insulin.

“Advancing copay caps individually will simply shift costs and lead to higher premiums and taxes for consumers,” said Lucy Westerfield, deputy executive director of Patients For Affordable Drugs Now, a group that’s supported Democrats’ larger drug pricing package.

Westerfield’s group wants Democrats to empower the government to negotiate with drugmakers to reduce consumers’ prices, limit year-to-year increases in the cost of medicines, and cap out-of-pocket costs.

Push for Bigger

Insurers also share Westerfield’s view that capping out of pocket costs for insulin might increase insurance premiums.

“Rather than paying for their expensive drugs at the pharmacy counter, patients would pay for them through their insurance premiums and copays,” said David Allen, a spokesman for AHIP, which represents insurers.

Rep. Lloyd Doggett (D-Texas), who has pushed his party to go further with their drug pricing legislation, also said broader federal action is needed to curb the cost of medicine.

“The problem with the cap is that it does nothing to restrain manufacturer price gouging; it simply shifts costs and ultimately increases premiums,” Doggett said about the insulin legislation.

Lawmakers on both sides of the aisle have railed against the high cost of insulin and supported ways to limit what Americans pay. Sen. John Kennedy (R-La.) introduced legislation (S. 1132) last year that would’ve capped what Americans pay for insulin at $50 per month.

Warnock’s insulin bill mimics a key and popular part of the House-passed Build Back Better Act, which bogged down after Sen. Joe Manchin (D-W.Va.) opposed the package.

Bipartisan Test

Pulling the insulin cost cap from the stalled package is meant to test whether it can get bipartisan support in coming weeks, rather than splitting up the larger legislation, according to two Democratic aides familiar with the discussions.

The provision might not have even passed as part of the larger package, the aides said, as Democrats expected Republicans to challenge whether it could be included in a budget reconciliation bill. Such bills, which need a simple majority for passage, can only include provisions with budgetary effects.

The Warnock bill would need 60 votes to pass in the Senate, meaning Democrats will have to garner at least 10 Republican supporters. A Kennedy spokesman declined to say whether the senator supports the measure.

Americans pay as much as five times for a unit of insulin as people in most developed countries, according to a 2020 RAND study.

Wild, who’s seeking re-election this year in a district Democrats consider competitive, said getting a comprehensive drug pricing package signed into law should be a top objective for her party.

“Lowering the costs of prescription drugs needs to be our number one priority in Congress,” she said.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Robin Meszoly at rmeszoly@bgov.com; Sarah Babbage at sbabbage@bgov.com