Major drug-pricing legislation aimed at capping the cost of insulin is at risk of being delayed until the fall. This delay could potentially hinder its progress as it may become overshadowed by other legislative battles, such as appropriations bills, abortion, and the threat of a government shutdown.
The Democrats consider this legislation a top priority. Senate Majority Leader Chuck Schumer has expressed his hope to combine the insulin bill with a reform of the pharmacy benefit manager (PBM) industry in order to create a package that could garner bipartisan support and be voted on before the end of the summer.
However, with just one week remaining before lawmakers depart for August recess, time is limited and there is a lengthy agenda to address. The Senate has recently started discussing its version of the annual defense policy bill, with the intention to negotiate with the House by the end of the month. Additionally, there is the pressing matter of appropriations bills, which are being loaded with GOP provisions related to abortion and funding for LGBTQ projects.
Despite these challenges, there is optimism that there will be enough momentum to enact PBM reform when Congress reconvenes in September. Multiple committees in both the House and Senate have proposed different ideas for PBM reform, albeit with some overlapping subjects, which could complicate matters.
While the Health Committee cleared PBM legislation in May, other bills from various committees, such as the one co-sponsored by Senators Chuck Grassley and Maria Cantwell cleared the Commerce Committee earlier in the year. Grassley has also introduced another bill with Senator Tom Carper in the Finance Committee, with a markup scheduled for July 26. These legislative actions mean that the bills may not be able to be merged until September, as the Finance Committee’s approval is necessary to proceed.
Despite the complexities of merging PBMs and insulin pricing legislation, Schumer is determined to address the issue of drug pricing and considers PBMs as a key component. However, it remains uncertain whether there is enough Republican support for the insulin measure, which adds another layer of complexity to the situation.
Since last year, Democrats have been striving to pass legislation that caps the cost of insulin at $35 for individuals with private health insurance. The Inflation Reduction Act initially included such a cap for commercial insurance but was removed due to budgetary constraints. It did, however, receive support from seven Senate Republicans, indicating potential for a deal in the closely divided Senate.
In the meantime, the three leading insulin manufacturers have announced plans to lower the prices of some of their products. Nevertheless, lawmakers aim to establish legislation that ensures these companies remain committed to reducing prices. There are currently two bipartisan proposals under consideration, with no final decision made by Schumer or Health Committee Chairman Senator Bernie Sanders regarding which one will be chosen.
The first plan is presented by Senators Raphael Warnock and John Kennedy, while the other is proposed by Senators Susan Collins and Jeanne Shaheen. Both plans propose capping insulin at $35 per month for privately insured individuals, but they differ in other aspects. Shaheen and Collins’ bill includes provisions related to PBM discounts and biosimilars, while Warnock and Kennedy’s bill applies the $35 cap to all types of insulin and extends the discount to uninsured individuals.
Although there is no sense of competition between these proposals, as per the senators involved, it is worth noting that even if an insulin cap is passed in the Senate, it is unlikely to gain support in the Republican-controlled House. Republican representatives have expressed concerns about potential shortages if insulin caps are implemented, and some view it as a socialist and federally mandated policy that hinders competition.
In conclusion, the drug-pricing legislation targeting insulin costs is at risk of being delayed until the fall due to an extensive legislative agenda and other contentious issues. While there is optimism about achieving PBM reform when Congress returns in September, merging the PBMs and insulin pricing bills poses challenges. Democrats remain committed to capping insulin costs, but the level of Republican support remains uncertain. Ultimately, the fate of the legislation remains uncertain and highly dependent on forthcoming discussions and negotiations.
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