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Insulin cap for Medicare patients signals hope for others – NBC10 Philadelphia

In the years before he came to the Senate, Raphael Warnock spent time at the bedside with Georgia residents suffering from the long-term effects of diabetes, a condition made worse by limited access to life-saving drugs like insulin.

“As a pastor, I saw the human face of this up close. I’ve been there and witnessed what happens when diabetes goes untreated,” Warnock said in an interview with the Associated Press. “I was there with the families when they got the news that a loved one was going to have to have an amputation.”

That work as a pastor helped the freshman senator push Congress to take the first step in curbing the high cost of insulin for millions of Americans.

The passage of a sweeping climate change and health care bill this month put key Democratic priorities in front of voters in the months leading up to the midterm elections, including provisions to reduce health care costs.

As a result, Medicare will be able to negotiate drug costs until 2026, and beneficiaries’ out-of-pocket prescription costs will be capped at $2,000 starting in 2025.

But the most immediate relief will take effect in January, when the cost of insulin for Medicare patients will be capped at $35 a month.

The provision, a longtime priority for Democrats, would bring relief to the roughly 2 million people nationwide who currently pay an average of $572 a year out of pocket for insulin, according to a recent analysis by the Kaiser Family Foundation.

For people who need insulin and have insurance, a bill that just passed the House would be a big help by capping co-pays for life-sustaining prescriptions at $35 a month. But the bill doesn’t help the uninsured, says Kaiser Health News reporter Bram Sable-Smith. He explains the legislation and talks about his own diagnosis of type 1 diabetes.

In Warnock, the annual average is higher at $591 for the more than 50,000 Georgia residents whose lives depend on drugs.

About 7 million Americans require insulin daily, and 14% of them spend nearly half of their income after food and housing on medication, according to a Yale study.

“It’s devastating for a family to have to make that choice,” Lisa Murdoch, chief executive officer of the American Diabetes Association, told the AP. “This is a life-saving drug. You can’t live without it, and we shouldn’t have people in this country forced to do it.”

The problem of insulin pricing is more pronounced in the US than in other countries, and has worsened over the past two decades. According to a 2016 study published in the Journal of the American Medical Association, the price of insulin tripled from 2002 to 2013. And between 2012 and 2016, prices continued to rise, nearly doubling, a congressional report released in March showed.

The problem has been perennial in Congress, with a broad bipartisan consensus recognizing the problem but little agreement on a solution. That’s why organizations like the American Diabetes Association have been trying to fight for affordable insulin in states since 2019, when Colorado became the first state to impose a cap on insulin copays.

“We just ran from there,” Murdoch said. “We currently have 22 states and the District of Columbia with caps on monthly co-payments, and we’ll continue to work on that as long as we need to raise the conversation.”

While several states have passed legislation to cap the price of Medicare and private insurance, the new federal law doesn’t go that far. Legislation introduced by Warnock originally included a monthly cap for both Medicare recipients and private insurers.

But during an hours-long series of votes, Republicans eliminated a part that would have included private insurance, which is used by most people who need insulin. Some of the GOP senators who voted to remove it represent states with the highest death rates from diabetes, according to the Centers for Disease Control and Prevention.

At the time, Republicans who voted against the provision said it violated Senate budget rules, but Democrats deliberately did not drop it, forcing their colleagues on passage to vote in the Senate to repeal it.

“Democrats actually wanted to break Senate rules to pass the insulin price cap instead of going through the normal process,” Sen. Ron Johnson, R-Wis., tweeted after the vote. Johnson added that he previously “voted for an amendment that Democrats blocked to provide insulin at cost to low-income Americans.”

But Warnock said the row over procedural rules meant a failure of substance.

“Blocking a provision that would have imposed the same restriction on people with private insurance is another example of why people hate politics and what’s wrong with Washington,” he said.

However, the provision resulted in the participation of seven Republicans. And while that wasn’t enough to pass a broader cap, it proved to be more support than any previous attempt to cap insulin prices in Congress. Majority Leader Chuck Schumer has indicated that expanding affordable access to insulin will be a priority for the House in September.

Advocates say a potential legislative response to closing coverage gaps could come in the form of the Insulin Act, a bipartisan proposal introduced last month by Sen. Jeanne Shaheen, D-New Hampshire, and Sen. Susan Collins, R-Maine, that would include limiting in the private market. The legislation also provides mechanisms to lower the list price of insulin, providing relief to uninsured diabetics.

“We are grateful for the step forward in the Inflation Reduction Act, but now we are focused and calling on Congress to pass the Insulin Act as soon as possible,” said Campbell Hutton, vice president of regulatory and health affairs at JDRF, a New York-based nonprofit. which funds type 1 diabetes research.

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