Inflation Reduction Act only caps insulin prices for Medicare patients, not for people with private insurance

UPDATE (03/16/2023): Drug manufacturer Sanofi announced it is cutting the list price of Lantus, its most-prescribed insulin in the U.S., by 78%. It's also capping out-of-pocket costs for Lantus at $35 for patients with insurance. These changes will go into effect on Jan. 1, 2024.

Earlier this week, Novo Nordisk said it is also lowering the prices of several of its U.S. insulin products in 2024.

On March 1, drug company Eli Lilly said it was immediately capping monthly out-of-pocket costs for its insulin at $35 per month for people with commercial insurance coverage at participating retail pharmacies.

The original story remains as published below:

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Over 37 million Americans have diabetes, a chronic disease that affects how your body turns food into energy. Many of those living with diabetes need insulin to survive, but the price of the medication in the United States is often expensive.

The Inflation Reduction Act of 2022, a bill recently passed by Congress and signed into law by President Joe Biden, includes the largest-ever federal effort on climate change and aims to lower rising costs of goods while paying down the nation's debt. It also includes provisions to increase access to affordable healthcare.

On social media, some people are claiming that a provision in the bill to cap insulin prices at $35 a month for all Americans was removed by Senate Republicans.

THE QUESTION

Does the Inflation Reduction Act cap insulin prices? 

THE SOURCES

• Inflation Reduction Act of 2022
• Centers for Medicare & Medicaid Services (CMS)
• Xavier Becerra, secretary of the Department of Health and Human Services

THE ANSWER

The Inflation Reduction Act only caps insulin prices for Medicare patients, not for people with private insurance. 

The original text of the bill included a provision that extended the $35 insulin cap to Americans covered by private insurance. But it was stripped from the bill by the Senate Parliamentarian, forcing a separate vote on the provision that failed to get enough GOP support to pass.

WHAT WE FOUND

The Inflation Reduction Act of 2022 does cap insulin prices at $35 per month for some Americans, but not all. 

The bill package included a proposal to put a $35 monthly cap on the cost of insulin for Medicare patients. More than 63 million Americans are enrolled in Medicare, and 1 out of every 3 Medicare patients has diabetes, according to the Centers for Medicare & Medicaid Services (CMS).

The original bill also included a provision that extended the $35 insulin cap to Americans covered by private insurance. However, Senate Parliamentarian Elizabeth MacDonough ruled that the private insurance part of the cap failed to comply with strict budgetary rules. 

This required the Senate to vote to include the cap for people with private insurance. They needed 60 votes to pass it and avoid a filibuster. Only 57 senators voted for it, and 43 Republicans voted against it, so it was stripped from the bill. As a result, the version of the Inflation Reduction Act passed by the Senate caps insulin prices at $35 a month for Medicare patients only.

Along with the insulin cap, the bill will also extend enhanced federal tax credits to save millions of people an average of $800 a year on health insurance premiums on Affordable Care Act Marketplaces and limit the amount of money people with Medicare Part D pay out-of-pocket for prescription drugs to $2,000 a year, according to CMS Administrator Chiquita Brooks-LaSure. 

"With this bill, millions of Americans will see lower health care costs,” Department of Health and Human Secretary Xavier Becerra said in an Aug. 7 statement. “In addition, it will do something that we have tried – and failed – to do in Washington for decades – allow Medicare to negotiate a better deal on prescription drugs. No one should have to go without health care or a prescription they need because they can't afford it.” 

President Joe Biden is urging a swift passage of the bill in the House when it returns briefly from summer recess on Aug. 12. 

The Associated Press contributed to this report.