New York — Payne has two-year-old Brandon Type 1 diabetes He needs insulin to live. But even with health insurance, the price isn’t cheap.
A one-month supply of insulin vials and a three-month supply of spare pens for the Mississippi toddler cost his parents $194 last week, according to his mother, 29-year-old Marlee Brandon. They can afford it now – but she’s worried about the future.
“One day, Payne will be an adult and won’t be able to sign up for our insurance anymore,” she said. “I feel like a lot of people don’t realize how expensive and complicated it is.”
A A bipartisan group of senators Aiming to reduce the cost burden through Insulin lawa bill to cap the cost of life-saving medication at $35 per month for Americans with private insurance plans. The bill, introduced last week by Sens. Jeanne Shaheen, D-Maine, Raphael Warnock, D-Georgia, Susan Collins, R-Maine, and John Kennedy, R-Los Angeles, would also start a pilot program to provide affordable insulin to uninsured Americans in 10 states. A somewhat similar bill passed in 2022, as part of the Biden-era Inflation Reduction Act, a sweeping package from Democrats that has had more success. The medication is capped at $35 per month For seniors on Medicare.
The legislation is the latest in a long effort by some lawmakers from both parties Controlling insulin pricesIt faces many hurdles, including concerns about cost and other competing congressional priorities. However, with Trump in the White House and his Republican Party in control of Congress, it creates an opportunity for a rare bipartisan victory on health care affordability in a year when the rising cost of health care is a concern for the United States. Voters from both parties.
About 8.1 million people in the United States use insulin, according to the U.S. Centers for Disease Control and Prevention. This includes more than two million people with type 1 diabetes who will die without regular access to insulin. The medication also helps control glucose levels in people with other types of diabetes.
But the price of insulin can vary greatly. While some people with private insurance pay zero or very little, Others pay hundreds of dollars each month Plus other diabetes costs, such as pumps, blood glucose sensors, and other supplies.
In addition to the 2022 law that lowers out-of-pocket costs for insulin for Medicare beneficiaries, More than half of the states In recent years, copayment caps for insulin, which range from $25 to $100 per month for patients with state-regulated insurance plans, have exceeded.
Major insulin makers Eli Lilly, Sanofi, and Novo Nordisk also moved there Reducing the cost of insulinwith various combinations of lowering list prices, capping out-of-pocket costs, and expanding affordability.
However, not all patients are covered. About 57% of Americans with private health insurance have self-insurance plans that states cannot regulate, according to Matthew Fiedler, a senior fellow at the Center for Health Policy at the Brookings Institution. This means they are excluded from the state’s cost cap bills. Some patients are also uninsured, or have difficulty accessing manufacturers’ cost-savings programs.
“I think it puts the onus on the patient to try to navigate and keep the cost down,” said Dr. Leslie Eiland, an adult endocrinologist at the University of Nebraska Medical Center, who with the Endocrine Society is advocating for the latest bill.
“No one should struggle to afford insulin,” Olivier Bougelot, Sanofi’s North America generics president, said in a statement and praised the company’s savings program that includes people without health insurance. Flavia Brackling, a Novo Nordisk spokeswoman, said expanding access to affordable medications is a priority, and noted that the company has not raised menu prices for its insulin products for 2026.
Pharmacy benefit managers and insurers are creating access and affordability barriers for patients even as manufacturers try to expand access, said Chance Jones, spokesman for the leading trade association for pharmaceutical companies, PhRMA.
“We look forward to working with policymakers to ensure that middlemen do not stand between patients and their medications,” he said.
While the new insulin law has bipartisan support, this would not be the first time such legislation appeared to have momentum, but failed.
In 2022, the House passed an insulin cap of $35 per month that would have applied to Americans with private insurance, but the resolution did not pass the Senate.
A similar attempt to include it in an inflation-reducing bill introduced by Democrats that year ultimately failed after Republicans opposed it, saying it was done in a way that violated Senate rules.
Brenna Glover, 23, a restaurant worker in Houston, moved to Texas from California because she needed cheaper living expenses to cover the high health costs associated with type 1 diabetes.
Paying for insulin and other supplies is a balancing act. To be able to afford the $50 copay for four vials of insulin, she limits her carbohydrate intake. This way, she can use less insulin each day and make it last longer.
Glover said the $35 per month cap would be a “small step toward everything becoming easier,” as well as helping her cover things like groceries and gas.
Advocates expect young people to particularly benefit from the bill, as many struggle to get quality health insurance plans or any insurance at all if they can’t access plans through parents, said Manny Hernandez, CEO of The Diabetes Link, a national nonprofit for young people with diabetes.
Hernandez said he was encouraged by recent meetings with Republican members of Congress from his home state of Florida, but he worries that other priorities will overshadow the bill, as has happened in the past.
“There are a lot of distractions and there are a lot of important things going on,” he said. “But I don’t lose hope.”