The Inflation Reduction Act – the sweeping healthcare, climate and tax legislation President Joe Biden signed into law on Tuesday – includes a provision capping the out-of-pocket cost for insulin at $35 dollars a month, but only for Medicare beneficiaries.

While officials with the American Diabetes Association consider the insulin provision a win, they lamented the missed opportunity to help all diabetics in the United States. 

What You Need To Know

  • The recently signed The Inflation Reduction Act includes a provision capping the out-of-pocket cost for insulin at $35 dollars a month, but only for Medicare beneficiaries

  • But the legislation does not extend the price cap to the millions of Americans with diabetes who either have private insurance or no insurance at all, which officials with the American Diabetes Association consider a missed opportunity

  • A Republican-led motion to strip a provision from the bill which would have extended the insulin cap to Americans on private insurance was successful, despite the support of all 50 Senate Democrats and 7 Republicans; The measure needed 60 votes to remain in the bill

  • But advocates don't believe the effort to get the benefit extended to all Americans with diabetics is a lost cause; The American Diabetes Association told Spectrum News that it will be sending representatives to Capitol Hill next month to continue their advocacy work to get the $35 cap extended to all Americans

"We're pretty excited about this," Dr. Francisco Prieto, a member of the American Diabetes Association's National Advocacy Committee, told Spectrum News. Dr. Prieto said that he recently spoke to a patient who would benefit from the plan that currently spends roughly $100 per month on insulin. 

But the legislation does not extend the price cap to the millions of Americans with diabetes who either have private insurance or no insurance at all. A Republican-led motion to strip a provision from the bill which would have extended the insulin cap to Americans on private insurance was successful, despite the support of all 50 Senate Democrats and 7 Republicans. The measure needed 60 votes.

“As a physician, I would like everyone to make health as much of a priority as as it is for me, but obviously that's not the same on everyone's agenda," said Prieto in an exclusive interview with Spectrum News on Wednesday. 

Republicans who opposed the amendment complained the provision wouldn’t address the sky high cost of insulin. Between 1999 and 2019, the price of insulin has increased about 1,000%. The cost of insulin in the U.S. is as much as 10 times the cost in other countries. They also said the broader price cap would deny drug companies revenue to develop new medications. 

“Allowing the federal government to set limits on drug pricing will limit competition and drastically reduce innovation within the pharmaceutical industry," said Rep. Mariannette Jane Miller-Meeks, M.D., a Republican who represents Iowa in the House of Representatives.

Democrats disagreed.

“It just demonstrates that Senate Republicans and House Republicans are siding with big health insurance companies, as opposed to with patients who need access to these drugs," said Rep. Jake Auchincloss, a Democrat representing Massachusetts.

But advocates don't believe the effort to get the benefit extended to all Americans with diabetics is a lost cause. The American Diabetes Association told Spectrum News that it will be sending representatives to Capitol Hill next month to continue their advocacy work to get the $35 cap extended to all Americans.