Policy Impact Analysis - 117/S/3700

Bill Overview

Title: Affordable Insulin Now Act

Description: This bill limits cost-sharing for insulin under private health insurance and the Medicare prescription drug benefit. Specifically, the bill caps cost-sharing under private health insurance for a month's supply of selected insulin products at $35 or 25% of a plan's negotiated price (after any price concessions), whichever is less, beginning in 2023. The bill caps cost-sharing under the Medicare prescription drug benefit for a month's supply of covered insulin products at (1) $35 between October 1, 2022, and January 1, 2024; and (2) $35 or 25% of a plan's negotiated price, whichever is less, beginning in 2024. The bill provides funds for FY2022 for the Centers for Medicare & Medicaid Services (CMS) to implement the bill. Currently, the CMS is testing a voluntary model under the Medicare prescription drug benefit (the Part D Senior Savings Model) in which the copayment for a month's supply of insulin is capped at $35 through participating plans. The model is set to expire on December 31, 2025.

Sponsors: Sen. Warnock, Raphael G. [D-GA]

Target Audience

Population: People with diabetes requiring insulin

Estimated Size: 10700000

• The World Health Organization estimates that 422 million people globally have diabetes, a condition that commonly requires insulin for management.
• Type 1 diabetes patients typically require lifelong insulin therapy for survival.
• Patients with type 2 diabetes may also require insulin therapy if their condition is not well controlled by oral medications or other means.
• The cost of insulin is a significant burden, particularly for those paying high out-of-pocket costs due to inadequate insurance coverage or living in countries without price regulations on pharmaceuticals.

Reasoning

• The policy primarily targets individuals requiring insulin in the U.S., aiming to reduce their out-of-pocket costs through private insurance and Medicare. Given the estimated 10.7 million people in this demographic, the policy must be designed to effectively allocate resources within its budget while considering the expected growth in diabetes prevalence.
• Current data suggests that insulin costs pose a significant financial burden to those without adequate coverage. By capping costs, this policy can potentially alleviate some of that strain, but its real-world effectiveness will vary based on plan specifics and individual circumstances.
• A wide range of people will be affected differently due to factors such as type of diabetes, existing insurance coverage, income levels, and access to alternative treatments. Thus, the policy's impact is expected to be varied, with some individuals experiencing substantial improvements in financial and emotional well-being, while others may see little change if they are not directly impacted due to already having had sufficient coverage.

Simulated Interviews

Cost Estimates

Key Considerations

• The interaction with existing voluntary models like the Part D Senior Savings Model may complicate cost evaluations and future adjustments.
• Affordable insulin could significantly improve health outcomes for insulin-dependent diabetics, potentially reducing other healthcare costs over time.