The U.S. House of Representatives has passed the Build Back Better Act, which includes the most sweeping nationwide measure to date to limit out-of-pocket co-pays for insulin.

The national co-pay cap, which ADA has aggressively promoted, would apply to Medicare beneficiaries, individuals on commercial insurance, and those covered by other group health plans.

The House-passed legislation creates an out-of-pocket co-pay limit of $35 per month for insulin.

In the days before the House vote, nearly 15,000 American Diabetes Association advocates contacted their representatives through the ADA’s Engagement Platform to urge support for co-pay caps and for allowing the government to negotiate drug prices with manufacturers.

Until now, the diabetes community has felt the impact of the steep rise in the average cost of insulin, the price of which nearly tripled between 2002 and 2013. As a result of high costs, one in four insulin-dependent Americans reports needing to ration their insulin. “This vote is a victory for millions of Americans facing unaffordable insulin and hope for lowering other drug costs. House leaders have taken a bold and urgent step this week,” said Lisa Murdock, Chief Advocacy Officer for the ADA.

New hope

In the run-up to House consideration of the insulin co-pay cap, the ADA led efforts around the country to advocate for co-pay caps that have been enacted in 20 states and the District of Columbia. “These states paved the way for this week’s historic action in the House,” said Murdock. “We thank those members of the House of Representatives who supported a national insulin co-pay cap, building on the efforts of state leaders before them. Together, these leaders are working to ensure that millions of people with diabetes will be able to afford their insulin and will not have to skip doses or ration because they don’t have enough money to pay for this life-saving drug.”

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The bill provides other key benefits for people with diabetes. These include extending 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.

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ACA plans and Medicaid have become especially important to people with diabetes who have been disproportionately affected, economically and through adverse health impacts, by the COVID-19 pandemic. These gap coverage measures are critical for the diabetes community, who relies on these plans to afford their insulin, devices and supplies.

“We now urge the Senate, as it considers the Build Back Better legislation, to move forward with a measure that also adopts these critical provisions that can make insulin more affordable, and health coverage more accessible, to 34 million people living with diabetes today,” Murdock said.

The proposal is expected to be on the floor soon after Easter. According to ABC, “Republicans have largely opposed the measure and refer to the bill as ‘government priced fixing’ that could lead to higher premiums for customers and exorbitant costs for insurers.” However, the Senate is made up of a majority of Democrats, which could pass the Bill.

Source: American Diabetes Association

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