Get the Facts on Insulin Pricing + The Presidential Transition


 

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.

Update October 1, 2021: the US Department of Health and Human Services (HHS) announced that they will be rescinding the 2020 rule—originally put on pause for review in January 2021, as outlined below—effective November 1, 2021. The reversal of the previous administration’s Executive Order will not prevent individuals from accessing insulin at 340B participating community clinics.


A flurry of misinformation has been making its way around the internet, stoking fears that the Biden Administration paused or reversed a previous Trump Administration Executive Order that lowered the price of insulin. Below, we clarify what actually happened:

In December 2020, the former administration issued a policy ruling stating that health centers that participate in the 340B program must pass on drug cost savings to the patients they serve. 

The 340B program is a section of the Public Health Service Act. This program requires drug manufacturers to sell their products at cost to participating hospitals and clinics that serve uninsured and low-income patients. Through this program, these patients are able to get low or at-cost drugs like insulin.  

The 340B program is already written to operate in this way, and the December 2020 policy ruling was essentially a reiteration that centers participating in the 340B program must abide by its rules or would no longer receive federal funding to operate.

And here’s where it gets a bit tricky: the health centers participating in this program claim they already were and had never stopped passing on savings to patients. 

But the December 2020 ruling allowed drug manufacturers to then withdraw from the 340B program, under the claims that the health centers were hiking up drug prices to make a profit off of the medications they had received at cost from manufacturers. Several manufacturers pulled out, potentially interrupting the supply of insulin to these centers. 

The former policy ruling was slated to take effect Friday, January 22 but has been delayed, pending a review by the Biden administration, until March 22. In the meantime, the Health and Human Services team will examine what is happening in health centers that participate in the 340B program – the intent is to determine what is actually happening with cost while minimizing interruption in patient care. 

To clarify:

  • This IS NOT a reversal of any policy or legislation related to the list price of insulin, nor is it related to copay caps and other active legislation at the state level. It is also not related to federal efforts like the Insulin Price Reduction Act, which may be reintroduced during this administration.
  • This IS a pause on the December 2020 ruling to ensure the existing 340B program is working as designed for all entities, ultimately ensuring that uninsured and low-income patients receive the insulin they need, as some patients who receive their insulin through 340B clinics have reported an alleged sharp increase in their cost of insulin since the ruling went into place.

One insulin pricing change put in place during the Trump Administration does remain active – some insulin under some Medicare plans became $35 per month. This is still in place, having started January 1, 2021.

WRITTEN BY Lala Jackson, POSTED 01/25/21, UPDATED 10/01/21

Lala is a communications strategist who has lived with Type 1 diabetes since 1997. She worked across med-tech, business incubation, library tech, and wellness before landing in the T1D non-profit space in 2016. A bit of a nomad, she grew up primarily bouncing between Hawaii and Washington state and graduated from the University of Miami. You can usually find her reading, preferably on a beach.