Many Privately Insured People with
Diabetes Could Save Money if Congress Caps Insulin Costs
Several legislative proposals in Congress propose a $35 per month cap on
what people with health insurance would have to pay out of pocket for
insulin, a life-saving hormone taken regularly by many people with
diabetes to maintain their health.
Such a cap could provide
financial relief to at least 1 out of 5 insulin users with different
types of private health insurance, a new KFF
analysis of insurance claims data finds.
In the large employer
market, 19% of people who take insulin spend an average of more than $35
per month ($420 annually) for insulin, the analysis shows. The shares are
even higher for insulin users covered through the small group market
(31%) and individual market (26%).
People in small group plans may face higher out-of-pocket costs for
insulin because such coverage is generally less comprehensive than in
large employer plans, and there is no reduced cost-sharing for low-income
people as there is for individual market plans purchased through the
Affordable Care Act’s marketplaces.
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