Biden’s proposal to cap all insulin costs at $35 a month has little probability of passing Congress

President Joe Biden delivers the State of the Union address before a joint session of Congress on February 7, 2023

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President Joe Biden used the pulpit during his State of the Union address this week to call for a universal price cap on insulin for all diabetes patients, but the proposal is highly unlikely to pass the current Congress.

Biden’s signature legislative achievement, the Inflation Reduction Act, capped insulin prices for Medicare beneficiaries at $35 a month, but the law doesn’t protect younger diabetic patients with private insurance or no insurance from higher prices.

“Let’s finish the work this time. Let’s cap insulin costs to $35 for everyone,” Biden told Congress Tuesday night.

As the President spoke, Sen. Jeanne Shaheen, DN.H., called on Congress to pass the Insulin Act that would extend the $35 price cap to those with private insurance. Shaheen co-sponsored the bipartisan legislation with Sen. Susan Collins, R-Maine, last July.

According to a report by Rand Corp. from 2021, the average price of insulin in the US in 2018 was 10 times higher than the average price in other wealthy countries.

While there is some bipartisan support for a universal price cap on insulin, the proposal will face an uphill battle and is unlikely to pass in a tightly divided Congress, where Democrats hold a slim majority in the Senate and Republicans weakly hold the House of Representatives represent.

Even when Democrats controlled both houses last summer, Senate Republicans managed to stop a measure that would have capped insulin prices for people with private insurance at $35 a month. Should the Senate pass the insulin bill, it would still face a House that is now in the hands of the GOP.

Rep. Cathy Rodgers of Washington, the Republican chair of the House Energy and Commerce Committee, wasted no time in real-time rejecting Biden’s proposal and sweepingly condemning state insulin price caps as “socialist” and a “federal mandate” that encourages competition harms .

“It’s time for the president to abandon his socialist pricing schemes and work to make insulin products more affordable without jeopardizing insulin competition and innovation,” Rodgers said in a statement released during the president’s address Tuesday night.

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Lisa Murdock, chief policy officer at the American Diabetes Association, acknowledged that extending the insulin price cap to those with private insurance will be an uphill battle in the ongoing Congress. However, Murdock noted that in the previous Senate, seven Republicans had voted for the cap.

“We’ve seen Republicans come forward and champion this measure, so I don’t want to say we think it’s out of reach — we’re still very committed to working with members on both sides of the aisle to do so.” that,” Murdock said.

The insulin market is dominated by Eli Lilli, Novo Nordisk And Sanofi. Industry reaction to Biden’s proposal was mixed.

Lilly supports expanding the $35 price cap to all Americans, spokeswoman Kristiane Bello said. The company has a program to provide insulin to patients regardless of their insurance status for $35 or less a month, Bello said.

Sanofi also supports a universal price cap of $35 for insulin and is already offering the drug at that price to the uninsured through a savings program, a company spokesman said.

Novo Nordisk fears that government drug price fixing will eventually limit patient access to new therapies, spokeswoman Nicole Araujo said.

Stephen Ubl, CEO of Pharmaceutical Research and Manufacturers of America, called insulin cost caps “a patch on a broken system that’s forcing people to pay more for drugs than health insurers and pharmacy benefit managers are paying.”

Last month, California sued insulin manufacturers and pharmacy service administrators CVS Caremark, Cigna’s Express scripts And Optum by United Health They claim they are using their market power to overcharge patients.

CNBC has reached out to pharmacy performance managers for comment on the president’s remarks.

According to the American Diabetes Association, about 40% of people with diabetes have private insurance and 5% have no insurance. One in five privately insured diabetes patients pays more than $35 a month for insulin, according to a survey by the Kaiser Family Foundation.

Although insulin prices vary depending on a patient’s insurance policy, in some cases, Murdock says, people pay hundreds of dollars a month for drugs they need to survive.

According to an analysis by the Health Care Cost Institute, about 9% of people taking insulin with insurance through their employer paid more than $200 out of pocket in 2019. According to the analysis, these people spent an average of $403 per month.

According to a Harvard study published in the Annals of Internal Medicine, an estimated 1.3 million US adults will have to ration their insulin in 2021 due to price. Patients rationed by skipping doses, taking less insulin, or delaying the purchase of injections to save money.

States have taken matters into their own hands in the absence of a federal price cap for insulin in all forms of insurance. So far, 22 states and Washington, DC have capped the price of insulin. The cap ranges from $25 in Connecticut for a month’s supply to $100 in other states.