What is Biden's proposal on the price of insulin?
The Build Back Better bill contains provisions that would cap the amount those with diabetes pay for insulin to $35 a month. How does the plan work?
In the United States, around 1.5 million people have Type 1 diabetes, a genetic disease wherein the body attacks and destroy cells meant to produce insulin. Insulin is used by the body to regulate blood sugar levels, of which both high and low levels can have severe and even fatal consequences. Type 2 diabetes is a condition wherein the body is unable to produce enough insulin or does not recognize that insulin has been created. Around 32.5 million have Type 2 diabetes and combined with those with Type 1 this equals around one in ten Americans.
Those with diabetes in the US pay some of the highest prices in the world for insulin, which can sometimes range between $375 and $1000 a month. For those who receive their healthcare through the government as a part of Medicare or Medicaid, the steep increases in prices have been very difficult to cope with. Medicaid members have seen a forty percent increase in the prices of insulin since the Medicaid expansion under the Affordable Care Act began. These increases have occurred across the market, and when those who need insulin to survive do not receive their daily shot, they can enter diabetic ketoacidosis. This condition lands many diabetics in the hospital, accounting for around half a million hospitalization days each year.
In 2020 the US Census Bureau found that around 28 million people were insured, a number that has increased since the pandemic began as many workers lost their jobs or saw their hours and benefits cut. This led many diabetics to take risks with their health by not filling prescriptions on time, an extremely dangerous move for a population extremely vulnerable to the virus.
Often those without insurance see the highest price tags associated with insulin. Should Congress move forward with the current version of the bill, this population could see even higher prices, pharmaceutical companies lose profits from other patients.
The proposal included in the Build Back Better bill caps the amount people with diabetes spend on insulin at $35 a month if they receive healthcare through the government or a private insurance company.
The American Diabetes Association commended the move by the House noting that the bill will also "increased health insurance premium tax credits—which were created through the Affordable Care Act and increased through more recent COVID-19 relief legislation— as well as increased funding for states to offset the cost of running Medicaid programs." For many on Medicare, these funds will be used to lower costs associated with not only insulin but devices and other supplies to treat the disease.
While these caps would help many, the US would continue to pay much higher prices than other high-income countries. Germany caps the amount a person with a chronic illness is able to spend on prescriptions and treatments at one percent of their income and in New Zealand treatment for diabetes is available free of cost.
The cost of diabetes in the United States
A study conducted by Type1 International found that a quarter of people in the US with Type 1 Diabetes had rationed their insulin at some point in the last year.
The rate seen in surveys in the US was almost four times as high as in other high-income countries, and three percent higher than the rates in low and middle-income countries. No person should have to ration life-saving medication. But, the fact the United States could take action to lower the cost today and does not perfectly illustrates the power pharmaceutical companies have over the federal government and lawmakers. According to Forbes, the United States represents around fifteen percent of diabetes patients globally, but over fifty percent of the revenue seen by pharmaceutical companies
Five people in the United States died in 2019 because they were forced to ration their insulin. Four were in their twenties, and one was in their thirties. These deaths represent a catastrophic failure of the medical system because the treatment existed for these people to live a normal life and they died because they were unable to access a mediation taken by ten percent of the population.