Insulin Costs May Be Capped in a Medicare Program


If drug companies and insurers agree to participate, the Trump administration proposes limiting insulin costs to $35 a month for some older Americans.

A new Medicare pilot program would lower the cost of insulin to $35 a prescription for older Americans who need the lifesaving drugs, the Trump administration announced Wednesday.

If insulin manufacturers and insurers agree to offer the plans — which are voluntary — then people 65 and older who need insulin could save an average of $446 a year beginning in January 2021, according to Medicare officials.

More than 3.3 million Medicare beneficiaries take at least one of the common forms of insulin.

The average list price of insulin roughly doubled to about $450 a month in 2016 from around $234 a month in 2012.

And the cost has risen even higher since then, driving much of the outrage over high drug prices with Congress and the public pressuring drug makers and insurers to reduce the burden on consumers.

Many people who are diabetic need insulin and cannot live without it. Some have gone so far as to ration their doses, unable to afford to spend the money for their prescriptions.

“We’ve seen a lot of increases in the cost of insulin, and we hear a lot about it from our beneficiaries,” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said in an interview Tuesday.

Several states, including Virginia, New Mexico and Colorado, have moved to force insurers to cap out-of-pocket insulin costs, as proposals in Congress that might address the issue have stalled.

The proposal could also give a political boost to President Trump in an election year. If insurers agree to offer the capped program, people could begin signing up Oct. 15, at the height of his campaign. Mr. Trump has made lowering drug prices a centerpiece of his health care agenda, although some of his biggest proposals have failed to materialize.

“We’re hoping that manufacturers and the plans will do the right thing here and come together with a plan that will lower out-of-pocket costs for insulin,” Ms. Verma said. “I think this is pretty significant.”

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