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Monetary Relief for Diabetic Americans | The Phia Group

By: Andrew Silverio, Esq.

Last month, Georgia Senator Raphael Warnock introduced legislation that would cap the cost of insulin at $35 per month, easing the heavy financial burden on the tens of millions of Americans living with diabetes.  Similar legislation was included as part of the Build Back Better plan, but Democrats hope to be able to pass the standalone measure, which Chuck Schumer claims has bipartisan support in the Senate.

The bill itself, which can be found at https://www.congress.gov/bill/117th-congress/house-bill/6833/text?r=78&s=1, would cap individuals’ cost-sharing for insulin products at $35 for a 30-day supply under group health and Medicare plans, which are also prohibited from applying any deductible.  This includes at least one of each dosage form including vial, pump, or inhaler, of each type of insulin.

Notably, the bill does not address the actual high cost of insulin products – it merely caps participant cost-sharing, with the remainder falling to the health plan or Medicare.  Still, the measure could do a great deal to help struggling patients, as many as 1 in 4 of whom underuse or skip insulin doses entirely due to the exorbitant costs and difficulty affording the medication.

It’s unclear when the bill is to reach the floor for a vote, but as drafted it would take effect for group health plans for plan years beginning on or after January 1, 2023.