House passes bill to cap insulin copays at $35 a month for Medicare, private plans

The House passed a bill Thursday that caps the out-of-pocket cost of insulin at $35 a month for beneficiaries in Medicare Part D and for certain group and individual plans.

The Affordable Insulin Now Act, which passed the House via a 232-193 vote, comes as work in the Senate continues on a bipartisan alternative that could bring additional changes. 

Under the bill, a Part D beneficiary’s cost-sharing would be no more than $35 for a 30-day supply of insulin.

The cap also would apply to either $35 or 25% of the plan’s negotiated price for a 30-day supply.

Private plans would be required to offer first-dollar coverage of insulin without any deductible, according to an analysis from the Congressional Budget Office. 

The cap on cost-sharing for private insurance plans would take effect in 2023.

The legislation could face changes in the Senate, where a similar version has been proposed by Sen. Raphael Warnock, D-Georgia. 

However, Sens. Jeanne Shaheen, D-New Hampshire, and Susan Collins, R-Maine, are working on a bipartisan bill to address the issue and could go beyond a cap. 

“Negotiations are ongoing, but there is a bipartisan determination to present policy proposals that both cap out-of-pocket costs and address soaring insulin prices that for too long have forced Americans to ration their supplies,” the senators said in a joint statement. “That’s unacceptable and it’s time we put an end to it.”

It also remains unclear whether Democrats will pursue other drug price reform legislation. Similar provisions to implement an inflationary cap on Part D drug prices and to give Medicare narrow powers to negotiate drug prices have floundered.