Politics & Government
$35 Cap On Insulin? Only 1 NJ House Member Votes Against Bill
"No New Jerseyan should have to drive to Canada – as my constituents report doing – to get affordable insulin," a congresswoman urged.
NEW JERSEY — A proposed federal law that would force insurers to cap out-of-pocket costs for insulin at $35 per month got a thumbs-up from every New Jersey congress member, except one: U.S. Rep. Jeff Van Drew.
The U.S. House of Representatives passed the Affordable Insulin Now Act by a vote of 232-193 on March 31. The bill was relaunched as separate legislation after originally being included as part of President Joe Biden’s Build Back Better Act, which has stalled in the U.S. Senate.
Here’s what the Affordable Insulin Now Act would do if it becomes law:
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“This bill limits cost-sharing for insulin under private health insurance and the Medicare prescription drug benefit. Specifically, the bill caps cost-sharing under private health insurance for a month's supply of selected insulin products at $35 or 25% of a plan's negotiated price (after any price concessions), whichever is less, beginning in 2023. The bill caps cost-sharing under the Medicare prescription drug benefit for a month's supply of covered insulin products at $35 beginning in 2023. Currently, the Centers for Medicare & Medicaid Services is testing a voluntary model under the Medicare prescription drug benefit (the Part D Senior Savings Model) in which the copayment for a month's supply of insulin is capped at $35 through participating plans. The model is set to expire on December 31, 2025. The bill also (1) further delays implementation of regulations relating to the treatment of certain Medicare prescription drug benefit rebates from drug manufacturers for purposes of federal anti-kickback laws, and (2) increases funding for the Medicare Improvement Fund.”
The nonpartisan Congressional Budget Office (CBO) released the following analysis of the bill:
“H.R. 6833 would impose a private-sector mandate as defined in the Unfunded Mandates Reform Act (UMRA) by capping the amount that certain group and individual health insurance plans may require enrollees to pay out of pocket for insulin products. The CBO estimates that the average annual cost to comply with the mandate would be $2 billion and would exceed the private-sector threshold established in the UMRA ($170 million in 2021, adjusted annually for inflation).”
The Affordable Insulin Now Act now heads to the Senate for further consideration.
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Every Democratic New Jersey member of the House voted yes on the bill: Donald Norcross, Andy Kim, Josh Gottheimer, Frank Pallone, Tom Malinowski, Albio Sires, Bill Pascrell Jr., Donald Payne Jr., Mikie Sherrill and Bonnie Watson Coleman.
The state’s two Republican congressmen split their votes; Rep. Chris Smith voted yes, and Rep. Jeff Van Drew voted no.
A spokesperson for Van Drew offered Patch an explanation about his vote:
"As written, it will only benefit them, and not the American people. The bill does not restrict Big Pharma from charging high prices for insulin to insurance companies who will then just shift those costs to patients by increasing their monthly premiums. So, while someone may pay less for the insulin itself (their copay), their monthly premiums will skyrocket in order to offset the government price control on insulin. Also, this bill completely leaves out any language for the uninsured, whom are the most vulnerable. The Congressman supports H.R. 6757, the Insulin Savings for Patients Act, which would offer patients rebates for insulin rather than artificially setting a price cap on the copay. In short, this bill had a nice-sounding name that would end up helping nobody because once again, it does not fix the root of the problem."
AFFORDABLE INSULIN: ‘IT WILL SAVE LIVES’
Following last week’s vote, several Democratic U.S. House members from New Jersey spoke about their reasons for supporting the bill. They included Rep. Payne (District 10), a diabetic who has personal experience with insulin costs.
Payne pointed out that many other nations don’t see the exorbitant prices for insulin that the United States experiences. For example, the cost of a single unit of insulin costs almost $100 in the U.S. compared to $12 for the same unit in Canada.
“American prices for insulin are outrageous and need to be lowered to match prices in other countries,” Payne said. “We have diabetics in America who ration insulin, or stop using it for days in order to save money for food and rent. These are life-threatening financial decisions.”
Rep. Watson Coleman (District 12) said the cost of insulin skyrocketed by 54 percent between 2014 and 2019.
“Health care is a fundamental human right, and in the richest country in the world, no one should struggle to afford life-saving medication,” Watson Coleman said.
Rep. Sherrill (District 11) said the soaring cost of insulin is “unacceptable.”
“No New Jerseyan should have to drive to Canada – as my constituents report doing – to get affordable insulin,” Sherrill said.
Rep. Gottheimer (District 5) said the bill would save some New Jersey residents thousands of dollars per year.
“Those dollars saved will go directly back into the pockets of middle-class families, helping make life more affordable,” Gottheimer said.
Rep. Kim (District 3) said one of the top worries of Burlington and Ocean County families is the cost of health care.
“Too many families in our community are being forced to choose between buying the life-saving medicine they need or a week’s worth of groceries,” Kim said. “This legislation would significantly drive down the cost of healthcare for millions of Americans, including working families right here in New Jersey.”
Rep. Pascrell (District 9) called the bill is a “watershed” moment for more than seven million Americans who rely on insulin to stay alive.
“For a drug discovered over 100 years ago, a $1,000 price tag for a single vial of insulin is a national disgrace,” Pascrell said. “This bill will lower costs. It will save lives. If we can’t improve the lives of millions, why the hell are we here?”
It isn't just Democrats who want change when it comes to high drug prices. Two years before President Joe Biden blasted the cost of insulin in his state of the union address, his Republican predecessor, Donald Trump, took aim at the problem by supporting legislation that cut out-of-pocket costs for seniors on Medicare.
The American Diabetes Association (ADA) pushed the Senate to follow the House’s lead and approve the bill, adding that “it’s time to pass a national co-pay cap.”
“We've seen exactly how much Americans with diabetes who rely on insulin stand to benefit from reducing the cost to patients of this live-saving drug,” the group said.
Separate efforts to combat the high price of insulin are taking place on the state level, where a proposed New Jersey law would cap out-of-pocket costs for insulin, EpiPens and asthma inhalers for those covered by state-regulated health plans, the State Health Benefits plan or the School Employee Health Benefits plan. Insulin costs would be capped at $35 for a 30-day supply, EpiPens at $25, and asthma inhalers capped at $50.
- See related article: NJ Lawmakers Aim To Cap Costs Of Lifesaving Medications
PAYING FOR INSULIN
Nearly 10 percent of New Jerseyans live with diabetes. For most of them, the monthly insulin costs can range between $200 and $600. Some pay much more. And it can be heartbreaking for a family when they can't afford the medicine it takes to keep their loved one alive.
Lisa Clarke, the mother of a 10-year-old diagnosed with Type 1 diabetes, was among several New Jersey residents who testified about how the bill would change their lives at a March news conference held in Newark.
“No one should suffer because they cannot afford the medication that keeps them alive,” Clarke urged.
U.S. Sen. Robert Menendez, who will get a chance to vote on the Senate version of the bill along with his peer, Cory Booker, spoke in ardent support of it alongside Clarke and other advocates.
“Despite the historic progress we made with the Affordable Care Act, everyone recognizes that health care costs in America are still far too high,” Menendez said. “Perhaps no one understands that more than families and individuals living with diabetes who struggle to afford their monthly insulin and diabetic supplies.”
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