House passes legislation to cap insulin costs

April 1, 2022

Despite concerns and controversy from both sides of the aisle, the House voted to pass the Affordable Insulin Now act into law.

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 insulin products at (1) $35 in 2023 regardless of whether a beneficiary has reached the annual out-of-pocket spending threshold, and (2) $35 beginning in 2024 for those who have not yet reached this threshold.

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. release