(CNS News) – Senate Republicans prevented a cap on the price of insulin for private insurers from being added to the text of the Inflation Reduction Act, Democrats’ climate, tax, and spending bill, which the Senate passed on Sunday. Although seven Republicans voted (along with 50 Democrats) in favor of the price cap, which would have stopped the price of insulin from exceeding $35 per month, the measure failed to garner the 60 votes necessary to pass.
However, the $35 cap still applies to people who obtain insulin through Medicare and some private plans.
The motion to keep the cap on private insurers ended with 57 votes in favor and 43 votes against, but 60 votes were need to keep it in place. Seven Republicans joined all 50 Democrats in voting “yea,” to impose the price cap. Those Republicans are Senators Cassidy (R-La.), Collins (R-Me.), Hawley (R-Mo.), Hyde-Smith (R-Miss.), Kennedy (R-La.), Murkowski (R-Ak.), and Sullivan (R-Ak.).
Hyde-Smith said about the amendment: “We must find a sensible solution to lower drug prices for the American people, especially now that everyone is struggling from the pressures of high inflation. I strongly opposed the Democrats’ tax-and-spend plan, but liked the chance of capping insulin costs, even if that plan may not have been a perfect fix. I will continue to work toward improving access to affordable insulin for Mississippians and others across the nation with diabetes.”
Senator Ron Johnson (R-Wisc.), who opposed the cap, tweeted that it was a “Democrat ‘gotcha’ vote.”
"In reality, the Dems wanted to break Senate rules to pass insulin pricing cap instead of going through regular order,” he wrote. “They put this in a bill it wasn't allowed in, all for show.”
The Inflation Reduction Act was passed using a special process known as “reconciliation,” which allows the Senate to pass fiscal policy legislation with only a simple majority, at least 51 votes, as opposed to normal bills, which require a 60-vote supermajority to pass.
Senate rules surrounding reconciliation bills also allow senators to object to provisions that do not change the level of spending or revenues, “or one for which the change in spending or revenues is ‘merely incidental.’”
The Senate Parliamentarian decides which provisions may be objected to in this manner before debate begins on the bill. If 60 senators vote to overturn the objection, then the measure may be included regardless. The insulin price cap is one such provision in the Inflation Reduction Act that the Parliamentarian ruled is not strictly a fiscal measure.
Under this process, laid out by the “Byrd Rule,” the price cap was objected to by a Republican senator and the Senate voted on whether or not to overturn the objection. That vote failed with 57 senators voting to overturn the point of order, falling short of the 60 senators the vote needed to succeed, and the provision was struck from the final text of the bill.
According to an analysis from RAND, the United States pays the highest price for insulin in the world at $98.70 per unit. The closest price is $21.48 per unit in Chile, and Canada pays an average of $12.00 per unit.
RAND writes that in an American Diabetes Association survey nearly one-third of respondents “said they had postponed doctors’ appointments or put off paying bills to afford their insulin. A quarter had skipped a rent or mortgage payment.”
RAND also notes that companies have started to negotiate discounts, rebates, and other policies that reduce the cost of insulin, but “even if those discounts cut 50 percent from the price, RAND’s study noted, Americans would still be paying several times more for insulin than what people in other countries pay.”
The University of South Carolina found in 2021 that approximately 7.4 million Americans use insulin to manage the symptoms of diabetes. Insulin is necessary for people living with diabetes. Without it, patients are unable to absorb the sugars from food and cannot maintain normal glucose levels. Diabetics who stop taking insulin will die.
According to the bipartisan House Diabetes Caucus, “The price of insulin has doubled since 2012, after nearly tripling in the previous 10 years. A patient’s out-of-pocket insulin cost can exceed $300 per vial; some regularly use two or more vials per month. Patients have resorted to skipping doses, which can have dangerous, even fatal consequences.”
“The insulin market involves drug makers, wholesalers, pharmacies, PBMs and insurers,” said the Caucus. “The drug’s list price is based on factors including manufacturers’ operational expenses, research and development costs, and marketing expenses. From there, the cost is affected by intermediaries in the supply chain and incentives that drive up the price further.
“At the same time, relatively few downward market forces exist to keep the price under control,” reported the Caucus. “In the United States, insulin is manufactured by only three companies, while three large wholesalers control about 85 percent of the distribution market.”
Senate Majority Leader Chuck Schumer (D-N.Y.) has already promised to bring legislation capping the price of insulin for private purchasers to the floor again in September. That vote may come by itself or as part of the larger, bipartisan bill proposed by Senators Collins (R-Maine) and Shaheen (D-N.H.), who are the co-chairs of the Senate Diabetes Caucus.