The American Diabetes Association applauds Representatives DeGette and Reed for their leadership in addressing this urgent issue. ( The Insulin Price Reduction Act would hold pharmacy benefit managers (PBMs), big pharmaceutical companies and insurers accountable for these surging prices by incentivizing reductions in list prices. endobj The ADA thanks Congressional Diabetes Caucus Co-Chairs Representative Diana DeGette (D-CO) and Representative Tom Reed (R-NY) for their leadership in introducing the House version of this legislation, which will lower the cost of insulin for many Americans who rely on it to stay alive. Importantly, these lower-priced products would not be subject to health plan deductibles and would not be placed on less favorable formulary tiers.

(PDF provides a complete and accurate display of this text. Titled the Insulin Price Reduction Act, otherwise known as S.2199, the proposed legislation sponsored by Senators Tom Carper, D-Delaware; Jeanne Shaheen, D-New Hampshire; Susan Collins, R-Maine; and Kevin Cramer, R-North Dakota, seeks to hold payers, manufacturers, and pharmacy benefit managers accountable for insulin price increases. Each year, insulin and other drug manufacturers establish list prices for their products. Sponsor: Rep. DeGette, Diana [D-CO-1] (Introduced 10/29/2019) Committees: House - Energy and Commerce; Ways and Means: Latest Action: House - 10/30/2019 Referred to the Subcommittee on Health. He is a regulatory attorney and government affairs professional who frequently consults Wall Street firms on financial issues related to the healthcare sector. 1395w–104) is amended—.

(1) by redesignating the subsection (m) as added by section 6063 (c) of the SUPPORT for Patients and Communities Act … American Diabetes Association®. If approved, the legislation would roll back over a decade of increasing insulin prices, many who say is years of price gouging by the pharmaceutical industry.

The Insulin Price Reduction Act was first introduced in the United States Senate on July 22, 2019.For more than 7.4 million Americans, including all individuals with type 1 diabetes, insulin is a life-sustaining medication for which there is no substitute. Many individuals with diabetes ration or forego insulin doses to reduce costs.“Insulin is a matter of life and death,” said LaShawn McIver, MD, MPH, Senior Vice President of Government Affairs and Advocacy. “For the many Americans who cannot afford their insulin, the consequences can be dire, including serious complications, such as cardiovascular disease, blindness, kidney disease, amputation, and  even death. All Rights Reserved. ) To provide patient protections with respect to the cost of insulin.To provide patient protections with respect to the cost of insulin.This Act may be cited as the “Insulin Price Reduction Act”.“(i) any such reduction in price that is reflected at the point of sale to the enrollee; or“(ii) any remuneration that is a flat fee-based service fee that a manufacturer of such insulin pays to a pharmacy benefit manager for services rendered to the manufacturer that relate to arrangements by the pharmacy benefit manager to provide pharmacy benefit management services to a health plan or health insurance issuer, if certain conditions established by the Secretary are met, including requirements that the fees are transparent to the health plan or health insurance issuer.“(A) any plan year in which the list price for insulin is certified under section 5(b)(2)(A) of the Insulin Price Reduction Act; and“(B) each subsequent plan year during which the manufacturer limits any increase in the list price to the price that gave rise to the restriction under paragraph (1), adjusted by not more than the price change in the medical care component of the consumer price index for all urban consumers (U.S. city average), as certified under section 5(b)(2)(B) of the Insulin Price Reduction Act.“(1) remove such insulin from the formulary applicable to the plan or coverage;“(2) impose higher cost-sharing with respect to such insulin than the cost-sharing that applied with respect to the insulin in the year in which the list price reduction certification was provided under section 5(b)(2)(A) of the Insulin Price Reduction Act;“(3) impose any prior authorization requirements for coverage of such insulin that were not applied during the year in which the list price reduction certification was provided under such section 5(b)(2)(A); or“(4) establish a step therapy requirement for such insulin that was not applied during the year in which the list price reduction certification was provided under such section 5(b)(2)(A).“(1) the term ‘certified insulin’ means, with respect to a year, insulin that has been certified under section 5(b) of the Insulin Price Reduction Act for the year;“(2) the term ‘insulin’ means any insulin product approved by the Food and Drug Administration to improve glycemic control in patients with diabetes mellitus;“(3) the term ‘list price’ has the meaning given the term ‘wholesale acquisition cost’ in section 1847A(c)(6)(B) of the Social Security Act; and“(4) the term ‘rebate’ means any discount, price concession, or fee, other than the fee described in section (a)(1)(B), the terms of which are fixed at the time of the sale and disclosed, but which is not received at the time of the sale.”.
(1) in paragraph (1)(A), in the matter preceding clause (i), by inserting “and paragraph (5)” after “paragraph (2)”;(2) in paragraph (3)(A), in the matter preceding clause (i), by inserting “and paragraph (5)” after “subparagraph (C)”; and(3) by adding at the end the following new paragraph:“(i) the pre-reduction average manufacturer price (as defined in subparagraph (C)) for the dosage form and strength of the drug for the rebate period; for“(ii) the average manufacturer price for the dosage form and strength of the drug for the rebate period.“(i) the average manufacturer price for such drug for the calendar quarter beginning July 1, 2019; increased by“(ii) the percentage by which the consumer price index for all urban consumers (United States city average) for the month before the month in which the rebate period begins exceeds such index for September 2019.”. A 2018 ADA survey showed that individuals with diabetes who face high out-of-pocket costs are forced to make decisions about their insulin regimen that can have damaging consequences on their health. According to The American Diabetes Association (ADA), the average price of insulin nearly tripled between […]


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