Congress Won’t Act on Insulin Prices for Commercial Market

by Peter Johnson   Although Congress last week passed a landmark prescription drug price reform bill as part of the Inflation Reduction Act (IRA), the legislation will not include any provisions that impose price controls on insulin sold to patients with commercial insurance. D.C. insiders tell AIS Health that they do not expect separate, standalone legislation to make it through Congress any time soon, which shines a spotlight on new insulin benefits announced by major carriers like UnitedHealth Group.   Will standalone legislation move forward? The IRA caps out-of-pocket insulin costs to Medicare members at $35 per month — and leaves the commercial market untouched. That’s because the Senate parliamentarian, Elizabeth MacDonough, found in her review of the IRA that commercial market insulin caps didn’t meet the requirements of the budget reconciliation process, the arcane Senate procedure that Democrats used to push through the IRA.   Ann Marie Breheny, senior legislative and regulatory adviser at WTW, recently told AIS Health that the prospects for a standalone insulin law are low.  “The proposal that’s being put out there in the Senate [on insulin] is not the same as the proposal that’s already passed the House,” Breheny explained. “It’s now just facing this big-time crunch.”  That said, insulin legislation could be a small part of a larger bill during the lame-duck session of Congress in December. During that month, Congress will sometimes push through significant niche legislation as part of end-of-year budget bills — a habit D.C. wags have long compared to decorating a Christmas tree. That’s how the No Surprises Act passed at the end of 2020.   UnitedHealth will offer cheap insulin to uninsured customers Health insurers and other commercial payers are moving to make up some of the void. UnitedHealth Group announced on July 15 that it would eliminate out-of-pocket costs for insulin — a move that some health care experts expect will set a trend amongst commercial carriers. In addition, UnitedHealth’s Optum subsidiary now sells Sanofi S.A. insulins “for $35 to people with diabetes who do not have insurance, through its online health services and products retailer Optum Store,” per a press release. The service will work as a coupon program with retail pharmacies and will soon include a home delivery option filled by Optum’s mail order pharmacy. “People can access Optum Store to determine whether their insulin is part of the affordability program, get qualified and download an insulin savings card, and then fill their prescription at the $35 price point at any retail pharmacy. A mail-service option will soon be available for people who prefer home delivery through the Optum Store,” said the press release.

From Radar on Drug Benefits   Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.