Medicare caps insulin costs at $35 a month. Can Biden get that price for all Americans?

Ken Alltucker, USA TODAY
·3 min read
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President Biden on Tuesday night called on Congress to extend a monthly cost limit on insulin to all Americans.

Insulin costs are now capped at $35 a month for people on Medicare, but that out-of-pocket cap does not extend to younger Americans who directly purchase their own health insurance or get coverage through an employer.

All people with Type 1 and some with Type 2 diabetes need the drug, but a study last year found more than 1.3 million American adults skipped, delayed buying or rationed doses of insulin due to cost of the life-saving medication.

During his State of the Union speech, Biden was also expected to call on Congress to expand Medicaid for low-income residents in 11 states that have refused to do so under the Affordable Care Act.

Here's what we know.

Why do Americans struggle to afford insulin?

The price of the life-saving medication nearly tripled from 2002 to 2013 and costs 10 times more in the United States than it does anywhere else in the world, according to the American Diabetes Association.

A 2022 study found 11% of Medicare-age adults 65 and older rationed insulin compared to more than 20% of younger adults.

How has Congress addressed insulin costs?

Following last year's climate and health bill called the Inflation Reduction Act, Medicare recipients now have insulin costs capped at $35 per month. That cap does not extend to Americans covered by private insurance plans after Republicans stripped that provision from the final bill.

White House officials did not immediately say how Biden's proposed insulin out-of-pocket cap would extend to the uninsured, veterans or those covered by military health insurance.

Some analysts doubt Biden's proposal to extend the cap to working-age adults will gain traction in the Republican-controlled House of Representatives.

Still, patient advocacy groups vowed to push for more affordable insulin prices.

Chuck Henderson, CEO of the American Diabetes Association, said insulin costs are unaffordable for too many of the over 8 million U.S. residents who depend on the medication.

"While the Medicare copay cap was a significant step in the right direction and a potentially life-saving policy change for seniors, the ADA will continue to fight to expand this benefit to all people with diabetes who rely on insulin to survive," Henderson said.

Who invented insulin?

Biden on Tuesday mentioned how the person who discovered insulin didn't patent so that it would be available to everyone.

Canadian scientist Frederick Banting discovered insulin in 1921. Scientists treated the first diabetic patient in 1922 and sold the patent to the University of Toronto for 3 Canadian dollars. The university administered the patent and received royalty payments from drug companies that sold human insulin.

Southern states resist Medicaid expansion

The Affordable Care Act, passed in 2010 when Biden served as vice president, pays the bulk of costs for states that choose to expand Medicaid eligibility. Last November, South Dakota voters approved expanding Medicaid through a constitutional amendment.

States that have resisted Medicaid expansion include Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.

Biden on Tuesday also touted the Inflation Reduction Act's provision that negotiates some Medicare drug prices, and celebrated the record Affordable Care Act enrollment this year and an uninsured rate that dipped to 8%, in part, due to pandemic policies. Millions of Americans could lose Medicaid coverage this year when states resume Medicaid eligibility checks that were halted during the COVID-19 public health emergency.

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Ken Alltucker is on Twitter at @kalltucker, or can be emailed at alltuck@usatoday.com

This article originally appeared on USA TODAY: Biden wants insulin cost cap of $35 a month for all Americans