Insulin Price Freeze - What Does it Mean for Me?

The largest manufacturer of insulin recently announced it will cap out-of-pocket co-pays on insulin at $35 for those with commercial insurance and lower the price of some insulin products by 70 percent. This comes on the heels of a $35 co-pay cap for seniors on Medicare that took effect in January as part of the Inflation Reduction Act.

“This is great news and will make a difference for patients,’ said Erika Brutsaert, MD, MPH, an endocrinologist at Westchester Medical Center. “The cost of insulin has been increasing steadily for the past decade and a lot of patients have high co-pays.’’

Endocrinologist Erika Brutsaert, MD

Dr. Brutsaert said the manufacturer has reduced the price of two insulins by 70 percent and more recently, other insulin manufacturers announced they will take similar, cost-lowering steps.

“This is particularly important because the list price is what drives the costs for everyone. This especially affects those who are paying out-of-pocket,” Dr. Brutsaert said.

According to the Centers for Disease Control and Prevention (CDC), diabetes is the most expensive chronic condition in the United States. The CDC estimates 37 million Americans – about 11 percent of the population – have diabetes.

“Rationing is Extremely Dangerous”

The price of insulin has been skyrocketing partly because pharmacy benefit managers can negotiate lower prices for their groups, Dr. Brutsaert said. Drug manufacturers, in turn, respond by raising the list price and the general consumer makes up for those price reductions by paying more.

Dr. Brutsaert explained this has been particularly difficult for her patients who are underinsured and has forced some to ration their insulin.

“Rationing is extremely dangerous. Patients unable to pay for the correct dose of insulin are suffering. Long term, the high blood sugars from undertreating diabetes can result in blindness, renal failure and amputation,” Dr. Brutsaert said.

About 17 percent of patients using insulin reported rationing their insulin, with the highest rate of rationing occurring among people who are uninsured (29 percent), followed by people with private insurance (18.8 percent), according to a 2021 survey conducted by US Department of Health and Human Services.

Many of these patients, even if they are fortunate enough to get insulin, are forced to use older types of insulin which are less effective.

“Capping co-pays is not enough," said Dr. Brutsaert. “It is critical that people who need insulin are able to access it.’’