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The new legislative package signed by President Joe Biden on Tuesday is a big win for Medicare patients who are struggling to cover the cost of insulin to treat their diabetes.
But the bill, called the Inflation Reduction Act, does not ensure that these cost controls apply to the broader population of patients who rely on insulin.
The bill limits the co-pay for insulin to $35 per month for Medicare Part D recipients starting in 2023. Notably, Medicare-covered seniors also have a $2,000 annual limit on $2,000 a year Part D prescription drug payments starting in 2025. Medicare will also now be able to negotiate the cost of certain prescription drugs.
“We are thrilled that seniors will see these cost savings,” said Dr. Robert Gabbay, chief scientist and medical officer for the American Diabetes Association.
But the changes are not consistent with broader applicability to diabetic patients who are insured with private insurance.
“We are pleased with our victory, but there is still a lot to be done,” Gabbay said.
Why Insulin Relief Was Limited to Medicare Patients
The Democrats pushed for the Inflation Reduction Act through a process called budget reconciliation, or simple party majority.
In this process, a member of the Senate MP ruled that broader insulin reform for non-Medicare patients could not be included in legislation. Senate lawmakers then requested 60 votes to keep it in the bill. But they did not get only 57 votes, as 43 deputies opposed.
The result was a disappointment, Gabbay said. Legislation limiting the cost of insulin or the cost of treating people with diabetes has already been passed in 23 states and Washington, DC.
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“We were hoping now is the time to go national and really pass a comprehensive law that will protect all people with diabetes in the US,” Gabbay said.
The American Diabetes Association plans to continue advocating for helping more patients, including INSULIN Lawwhich requires limiting monthly insulin costs for a wider patient population.
“We hope that Congress will be able to discuss this this fall,” Gabbay said.
Senate Majority Leader Chuck Schumer, DN.Y., also expressed his intention put the proposal back to the vote in the coming months.
For patients aged 65 and older who rely on insulin, the Inflation Reduction Act “is a game changer,” Gabbai said.
More than 8 million people in the US rely on insulin to control their blood glucose levels, and if they stop taking the medication for a few days, they could die. “This is deadly serious,” Gabbay said.
However, as the year progresses, some Medicare patients become nervous about coverage gap known as a “donut hole” and may try to ration his insulin, he said.
According to a recent Yale study, the high cost of insulin results in 14% of patients experiencing “catastrophic” treatment costs. The study found that for Medicare patients on insulin, catastrophic costs affect one in five patients.
Beginning in 2023, the Inflation Reduction Act will cap the cost of insulin for Medicare recipients at $35 per month and will apply to those who use insulin pumps.
Medicare beneficiaries who pay more than $35 a month after the law was originally passed will be reimbursed, according to American Diabetes Association.
For patients struggling to cover their insulin costs, the American Diabetes Association provides resources to help cut these costs at the lowest possible cost. Insulinhelp.org.