Congressman Introduces “Insulin Access For All Act” for Medicaid and Medicare Beneficiaries
Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, you can build custom plans based on your personal circumstances through our tool, GetInsulin.org.
On Wednesday January 9, Representative Bobby Rush (D-Ill) introduced the Insulin Access For All Act in the U.S. House of Representatives. The bill aims to eliminate the cost-sharing requirement for patients on Medicare and Medicaid so more people living with diabetes have access to this life-saving medication. Cost sharing refers to the share of costs covered by insurance that must be paid out-of-pocket, often including deductibles, coinsurance, and copayments. If this bill were to become law, insulin could be covered by Medicare and Medicaid in full, eliminating costly monthly pharmacy expenses.
“This bill, introduced with significant  cosponsors, addresses the appalling issue plaguing Americans who have one of the most devastating and debilitating diseases of modern times — diabetes. There are many who simply cannot afford the insulin they need to live longer, active, and productive lives. This legislation tackles that issue head on and ensures that those suffering from diabetes no longer have to pay out-of-pocket costs for insulin. No American should go without life-sustaining medication,” Rush said.
The high cost of insulin can have fatal consequences, as was the case with Alec Raeshawn Smith in 2017. When Smith turned 26, he was kicked off his mom’s health insurance plan and could no longer afford his insulin. The costs for his medication and supplies without insurance were $1300 a month, and Alec was left trying to ration his insulin. Alec’s mother, Nicole Smith-Holt, has become a powerful advocate for change in the pricing of medication, and the Attorney General of Minnesota (Smith’s home-state) is currently pursuing legal action against three insulin manufacturers. Nicole Smith-Holt’s advocacy and the voices of many patient advocates like her have played a key role in mounting pressure for change, though notably Alec did not qualify for Medicaid in his state, so this specific bill would not have addressed his circumstances.
Just last month, United States FDA Commissioner Scott Gottlieb, M.D. released a statement detailing a handful of new guidances designed to increase competition and bring down prices across the insulin market. The changes are slated to take effect in 2020.
The bill introduced by Rush does not address the high cost of insulin for people without health insurance, or those with private health insurance plans. Many people living with diabetes have high deductible health plans — plans with high out-of-pocket costs that typically don’t cover the cost of insulin until a certain threshold is met. Earlier this week Eli Lilly CEO Dave Ricks wrote on the company’s blog that “High-deductible plans should also exempt from their deductibles preventive medicines needed for chronic diseases. Lilly and many pharmaceutical companies have joined a coalition of health insurers, physician groups and others to urge the federal government to explicitly allow high-deductible health plans to do this.”
Rising insulin prices and the growing popularity of high deductible health plans have brought the issue of insulin pricing and access to a fever pitch. Eliminating cost-sharing for insulin via legislation is an approach with the ability to make real change, at least for Medicare and Medicaid-insured Americans who rely on insulin to live. This legislation may represent a first step toward increased action from lawmakers on the issue of insulin pricing.