WASHINGTON, D.C. – Recently, U.S. Senator Shelley Moore Capito (R-W.Va.) announced her co-sponsorship of the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, legislation that would cap the monthly out-of-pocket cost of insulin at $35 for Americans on private and employer-sponsored insurance and create a pilot program to provide insulin at the same cost to Americans without insurance. The legislation is led by U.S. Senators Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine).

“For years, West Virginia has been deeply impacted by diabetes and the rising cost of insulin,” Senator Capito said. “By limiting out-of-pocket insulin costs for individuals with private or employer-sponsored insurance, we can bring immediate financial relief to millions of Americans—including many West Virginians.”

BACKGROUND:

The INSULIN Act would directly address issues in the insulin market causing high list prices, while simultaneously extending vital patient protections, fostering competition and broadening access to needed insulin products. Specifically, the INSULIN Act:

  • Limits out-of-pocket costs for patients with diabetes by ensuring that group and individual market health plans must waive any deductible and limit cost-sharing to no more than $35 per month for at least one insulin of each type and dosage form.
  • Mandates pharmacy benefit managers (PBMs) pass through 100% of insulin rebates and other discounts received from manufacturers to plan sponsors, reducing perverse incentives in the insulin market that encourage high list prices and help patients in the form of reduced premiums.
  • Promotes generic and biosimilar competition to lower costs for patients.
  • Creates a pilot grant program for 10 states to implement programs to identify uninsured diabetes patients and provide them with insulin at $35 a month.
  • Establishes an insulin resource center and hotline for uninsured diabetes patients to connect them with resources about diabetes and programs to help them secure insulin.

Full text of the legislation can be found here.

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