A bipartisan group of lawmakers wants a bipartisan bill to lower insulin prices to also outlaw drug rebates for the key diabetes treatment.
The collection of bipartisan House and Senate lawmakers released a list of top policy priorities for limiting insulin costs, a major policy priority for Congress.
“Our proposal holds all parties accountable by encouraging them to reduce list prices, and critically, it limits out-of-pocket costs for patients with diabetes,” said Sens. Jeanne Shaheen, D-New Hampshire, and Susan Collins, R-Maine, in a joint statement. Reps. Diana Degette, D-Colorado and Tom Reed, R-New York, also joined the announcement.
Chief among the priorities is to cap insulin out-of-pocket costs at $35 a month for all Americans. Another key priority is to support patient access to insulin by ensuring prior authorization or other formulary management tools “cannot be imposed to limit beneficiary use,” according to a release on the priorities.
But Shaheen and Collins appear willing to go beyond other legislation that installs just an out-of-pocket cap on insulin costs.
The two senators are hoping to take on pharmacy benefit manager (PBM) and insurer drug rebates for insulin.
A major priority is to ensure that plans and PBMs “cannot collect rebates, which drive up drug costs at the point of sale, on insulins that roll prices back to 2006 or equivalent levels,” the release said.
There has been some competing legislation. Sen. Raphael Warnock, D-Georgia, introduced legislation in February that would also cap costs at $35 a month starting in 2023.
But some lawmakers say there isn’t any reason to not combine efforts on the legislation.
Sen. Ron Wyden, D-Oregon, told reporters last week that he liked the idea of merging Warnock’s bill with the longer-term efforts being considered by Shaheen and Collins.
“I think both of these approaches have a lot to recommend,” he said.
The provision to target rebates drew pushback from the Pharmaceutical Care Management Association, which represents the PBM industry.
The priorities would "provide drug manufacturers additional opportunities to maximize revenues by gaming which products to roll back to 2006 prices to avoid discounting, and which products to keep at 2022 pricing," the group said in a statement to Fierce Healthcare. "It would do little to reduce costs for patients.
The $1.75 trillion Build Back Better Act included a $35 insulin cost cap in addition to other reforms such as an inflationary cap for Part D drugs and giving Medicare the narrow authority to negotiate prices on a small subset of drugs.
But the legislation ran aground in the Senate late last year after Sen. Joe Manchin, D-West Virginia, announced his opposition.
Now, Democrats are hoping to resurrect key parts of the legislation that may garner more support.
Previous efforts to clamp down on rebates, though, have faced fierce opposition from the PBM and insurance industries.
The Trump administration proposed a rule that eliminated the safe harbor for Part D drug rebates that grants protection from prosecution under federal anti-kickback laws. The rule was pulled in 2019 after concerns from the White House that it would raise premiums on seniors.
The Department of Health and Human Services resurrected the rule at the tail end of the Trump administration, but Congress has delayed its implementation date until 2023.