House Passes Insulin Price Cap as Senate Looks for Path Forward

The U.S. House Thursday passed a bill to cap what insured Americans pay for insulin, moving forward a key component of President Joe Biden’s drug pricing agenda.

Lawmakers voted 232-193 in favor of a modified version of the bill (H.R. 6833). Its future remains uncertain for now as a group of senators work to craft a separate insulin proposal that could achieve bipartisan support.

The House bill would limit out-of-pocket costs under private health insurance and Medicare to $35 for a month’s supply of selected insulin products or 25% of a plan’s negotiated price, whichever is less. It would cover products like vials, pumps, inhalers, or other devices that control the dosage.

Biden has for months called on lawmakers to pass his proposals to lower prescription drug costs for consumers, including a price cap on insulin. Approximately 30 million Americans are living with diabetes, but Americans pay as much as five times more for a unit of insulin than people in other high-income countries, according to a 2020 RAND study.

The average annual cost to comply with the measure would be $2 billion and would exceed the private-sector threshold for unfunded mandates, according to Congressional Budget Office estimates. The CBO said it would cost roughly $6.6 billion in total to implement the legislation, which would take effect in 2023.

Democrats have said they would offset the cost by continuing to delay a Trump-era rule aimed at limiting Medicare drug rebates.

Approximately 53% of U.S. adults in a Kaiser Family Foundation study released Thursday identified capping out-of-pocket insulin costs as a top health-care priority for Congress. Roughly 61% said limiting price increases for prescription drugs to the inflation rate was also a high priority.

House Majority Leader Steny Hoyer (D-Md.) told reporters Wednesday that it’s “inexcusable” people are being charged exorbitant prices for “a life-saving and life-sustaining drug.”

Senate Talks

The House previously voted in favor of the insulin cap when it passed the Build Back Better Act (H.R. 5376). That legislation hasn’t moved forward in the Senate due to Republican opposition and complaints of a high price tag from Sen. Joe Manchin (D-W.Va.).

In the Senate, Susan Collins (R-Maine) and Jeanne Shaheen (D-N.H.) are working to develop a bipartisan agreement with Sen. Raphael Warnock (D-Ga.), who has pushed for passage of a bill similar to the one the House passed Thursday. Warnock’s proposal has so far failed to get Republican support.

Collins and other Senate Republicans, including Sen. Chuck Grassley (R-Iowa), say they want broader legislation that would target rising list prices for insulin, in addition to what Americans pay at the pharmacy counter. Collins and Shaheen, who both chair the Senate Diabetes Caucus, also want to ensure that those without insurance aren’t forced to pay high prices for the life-saving treatment.

Shaheen told reporters Tuesday that she and Collins had reached an agreement “in principle” on how to tackle insulin prices. A spokeswoman for Shaheen said the bill they are crafting is not yet finalized.

“Democrats and Republicans are united on the urgent need to lower the skyrocketing cost of insulin—no one should be priced out of a lifesaving medication,” Shaheen said. “Negotiations are ongoing but there is a bipartisan determination to get this done.”