Dear Honorable Representative Darin LaHood,
Today I am writing to you about a bill to lower the price of insulin that has recently been introduced in the United States: I am referring to the Insulin Price Reduction Act. (H.R. 4906, introduced this past October by Rep. Diana DeGette of Colorado). You serve on the Ways and Means Committee, and back in October this bill was referred to the Subcommittee on Health, where it has not yet been passed. This is a bill that will help many Americans, myself included. I have been a Type One Diabetic for going on sixteen years. I have been around diabetics and insulin my whole life as my mother is also diabetic. I have seen insulin prices sky rocket in the past sixteen years, and it still to this day does not make sense to me. Why should a life saving drug be so hard to afford? I know I am not the only one that feels this way, but I want to make sure that I make an effort to have my voice heard.
Do you know how much it costs per day, on average, to take insulin to make up for the fact that we persons with Diabetes Type 1 don’t have a functioning pancreas? In India it costs about 150 Rupees per day, or about $2; or about $60 per month. In America the average cost of $6,000 per year to treat a person with Type 1 Diabetes works out to about $500 per month, or $16 per day. That’s the average, not the lowest, nor the highest. The cheapest brands of insulin, such as Novocain R and Novocain N cost over $90 per vial (about 9¢ per unit), and a person who weighs about 140 pounds must use 30 to 50 units per day ($2.85 to $4.55 per day), if they are using those least expensive vials of insulin. But today most people are using rapid-acting insulins such as insulin lisper (18¢ to 24¢ per unit, or $5.70 to $12 per day, $175 to $350 per month for a person weighing about 140 pounds). The least expensive pens for injecting quick acting insulin (like the Humalog KwikPen) cost about 33¢ per unit, so that’s more like something between $312 and $500 per month for that. These are the very cheapest on the market, but there are other insulins; one that you can inhale called Afrezza costs a little over $1 per unit. Can you imagine working full-time at a wage of $15 per hour, earning about $2,000 per month, and having to spend $400 to $500 to stay alive with insulin, plus $800 for housing, $200 for food, $400 for maintaining and driving a car with insurance, and so forth? It doesn’t leave much for living expenses. People with diabetes who live in places where housing is more expensive, or who live in places where you can still be paid $8 or $9 per hour for working, are really not able to afford insulin on top of their other expenses.
Senators Jeanne Shaheen, Tom Carper, Kevin Cramer, and Susan Collins have all proposed a legislation to help keep new insulin prices more affordable. This is an effort to lower the price of insulin back to a price no higher than the 2006 price (adjusted for the inflation in the consumer price index). This bill has also been endorsed by JDRF and the American Diabetes Association. The ADA has stated that pharmacy benefit managers (PBMs) have increased rebates (PBMs get a cut of the rebate) as a percentage of the list price. These increasing rebates increase the list price for the insulin, thus resulting in higher out-of-pocket price for individuals needing insulin. Just with Medicare alone, these out-of-pocket prices have more than quadrupled since 2007.
The goal of the Insulin Price Reduction Act is plain and simple: lower the price of insulin to become more affordable to those who depend on it. The bill is an attempt to reduce the use of middlemen (PBMs) to reduce the use of rebates for any insulin product to make the price no higher that in 2006. This could result in more than a 75% decrease in price for the drug. Future price increases would only be related to medical inflation. This bill also aims to cut the list prices by restricting rebates that go to the PBMs. The competition within the insulin market has led to higher list prices because higher prices mean higher rebates which mean more of a cut for the PBMs. What this bill is attempting to achieve is to make the price an insurer pays for a drug closer to what an uninsured individual may pay. This more or so means that the patients with high deductible health plans would be able to obtain insulin at a standard copay rather than paying the full price until they meet their deductible. JDRF has stated “This bill would take several significant steps to make insulin affordable. Prescription drug rebates currently make up about 70 percent of the list price of insulin.” Insulin is a large money maker for PBMs because these companies know that people need this drug to stay alive, therefore people will pay what they have to in order to obtain the drug.
As I was doing research on the Insulin Price Reduction Act, I came across some statistics that should affect any individual, diabetic or not. There have been an immense amount of cases resulting in death related to insulin rationing. In July of 2019, a 21-year-old died as a result of rationing insulin. In June of 2019, a 24-year-old died after a week-long hospital visit to treat DKA because of her skipping insulin doses. In 2017 three individuals died after they could no longer afford insulin and had to begin rationing their insulin. These individuals should not have had to ration their life saving drug because they could not afford to take care of themselves. The rising price of insulin has to stop otherwise who knows how many deaths are going to occur in 2020 because of rationing.
I believe that a large portion of the United States could benefit from the Insulin Price Reduction Act. This population could benefit from this Act because I am sure that almost everyone knows someone who’s life depends on insulin. There are about 1.25 million Americans with Type One Diabetes, but each of us has several family members and many friends, so Diabetes touches the lives of many tens of millions of Americans. There are so many Type One Diabetics and even some Type Two Diabetics who can not afford to take care of themselves because of the price of insulin. Therefore individuals with diabetes live shorter lives or are slowly killing themselves because they may have to make the decision between paying rent or their medication. Many times I personally have had to ration my insulin so that I could wait until the next paycheck to get my month’s supply of insulin. There are so many other prescriptions and necessities that diabetics need as well. The price of insulin is just another burden that these individuals face. I think that this Act should draw more attention to this problem, as it may help save the lives of many individuals who unfortunately live with this disease. All I am asking is that you encourage that health subcommittee of the your Ways and Means committee to get working on passing this bill, and I hope that you will vote for it the it comes up for a vote in your committee, and then vote for it on the House floor vote. I am beginning to fear for my own health as well as the health of those who suffer from diabetes along with me. If this doesn’t get passed, I’m afraid the suffering and grief for many of us who have Type One Diabetes will be impossible to measure.
Links to Articles Containing Information I used:
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