Insulin price cap for private insurers pulled from reconciliation bill

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Senate Republicans blocked the $35 cap on out-of-pocket spending on insulin for patients enrolled in private insurance.

Why it matters: The drug costs eight times more in the U.S. than 32 other high-income nations, according to a 2020 study commissioned by the Health and Human Services Department.

What we’re watching: The change to the climate, tax and healthcare package came during the amendment process that allows any senator to force a vote on proposed tweaks to the measure.

  • Seven Republicans voted with Democrats to keep the insulin cap in the bill, but that was not enough to overcome the 60-vote threshold.
  • The Republicans argued that the provision violated the rules of reconciliation after the Senate parliamentarian ruled that it is not primarily related to the federal budget.

Between the lines: Even though the $35 cap for the private insurers has been stripped from the package, Democrats are hoping to preserve the $35 insulin cap for patients on Medicare

  • One in every three Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more of the common forms of insulin, according to the Department of Health and Human Services.

The big picture: Capping out-of-pocket insulin costs — a narrow sliver of President Biden’s stalled Build Back Better package — has been a priority for Democrats, particularly ahead of this year’s midterms.

  • It’s also captured the attention of a few Republicans, leading to some bipartisan efforts to craft legislation.

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