As news about insulin comes out, it's important to remember the COST of insulin has never been capped for anyone in the US. The COPAY has been capped for some people. Here's why that is an important distinction.
First of all, I'm not making this post to promote or denounce any specific party or person. I'm going to keep things as cut and dry as possible, and you can make up your own mind.
So, people have been talking about the "$35 insulin price caps" and if they're going to continue, if the new administration is going to strike them down, etc.
First things first- price cap vs copay cap. Copay caps just limit what qualifying patients pay in a given period of time. Price caps, on the other hand, limit what the insulin manufacturers can charge for the product. Both are good, of course, but copay caps are much more of a band-aid solution, whereas list price caps would virtually end the US insulin price crisis.
The difference matters because copay caps only cover qualifying patients. This usually left out patients on private insurance and uninsured patients. Additionally, the pharma companies still got their full price at the end of the day.
So, the price of insulin has never been capped in the US. The closest thing we've gotten is the insulin manufacturers' voluntary price reductions, which can end at any time, have no guarantees, and in some cases, didn't really pan out exactly like we all thought. This was clearly a move by the insulin manufacturers to avoid further legal action- basically they wanted to keep a hand on the wheel.
Second, no US politician has made serious progress toward a genuine price cap. This includes Trump and Biden and state-wide efforts. When politicians say, "We capped the price of insulin" or something similar, they're not telling the truth exactly. Whether that's out of malice or not is up to you, but what they should be saying is, "We capped the copay for some people". The media also tends to get this wrong, so if you see an article about "price caps," I encourage you to actually read the bill or whatever and not take their word for it.
Trump's (first term) executive order created a temporary program where some prescription drug plans could choose whether to cover some insulin products at no more than $35 a month. About half of medicare part D plans participated. This EO was pharma-backed and terrible for 340b programs. The Biden administration froze the EO
Biden's Inflation Reduction Act barred ALL medicare part D plans from charging more than $35 out-of-pocket for insulin products. Similar to the Trump action, but different in some subtle ways. Removing it is a terrible idea, but the Biden administration consistently and vastly overstated the effects of this. The layman would think the insulin price crisis is over, but that is very untrue.
At the end of the day, neither of those actions are as far-reaching as they try to appear. If you want to learn more about the two presidential actions, here's a pretty decent article about it.
So, if Trump stripped away the Inflation Reduction Act, that would be extremely bad, of course. However, please don't make the mistake that things are great already. It would take things from "bad" to "worse". These protections should be stronger and cover more people, not stripped away.
It seems I need to clarify. Losing the copay cap would be devastating. Many actions on the table for this administration would be devastating. We must defend the protections available and seek additional protections. POTUS cannot unilaterally lower the list price, but Congress can regulate it.
My only qualifications are that I'm an advocate who pays attention and has a lot of smart advocate friends who pay even more attention. But if you have any questions about this stuff, please feel free to ask and I'll do my best to answer.
