$35 insulin price cap: 'Little’ cost savings for insured patients, only HSA users benefit
The $35 insulin cap reduces out-of-pocket costs for those with health savings accounts but new policies are needed to improve access to affordable insulin among commercially insured patients, says a new study.
Although state price caps on insulin have reduced out-of-pocket costs for insured patients, they have done little to increase insulin use, a new study found.
Insulin users under age 65 experienced a 17.4% (or $11.46 monthly) cost reduction in eight states where prices are capped, in an Annals of Internal Medicine study. However, there was minimal difference in mean 30-day insulin equivalent fills per month after implementation when compared with control states.
The drop in costs in states with insulin caps was driven largely by reductions for enrollees with health savings accounts (HSAs) that require high insulin out-of-pocket payments. This group had a 43.4% relative drop in monthly costs, with an average monthly savings of $61.58. However, patients without an HSA or health reimbursement arrangement didn’t experience significant out-of-pocket savings.
“Our findings suggest that the proposed national $35 insulin cap for commercially insured persons would reduce out-of-pocket costs by a large degree for HSA plan members but have little effect on out-of-pocket costs for non-account plan members, who comprise the vast majority of the commercial market,” researchers said. “Even a national policy that successfully reduces patient-facing insulin out-of-pocket costs might be unlikely to contain long-term insulin price inflation, which is ultimately passed on to health plan members through premium increases.”
As expected, people in the three states with the most generous caps had greater average savings in monthly costs ($27.82). Those with HSA plans in these states had an average $64.11 monthly cost savings. For those in states with $100 caps, there was an average $8.81 in savings, with HSA plan members in these states saving an average $58.66 a month.
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The lack of change in average 30-day insulin fills per month held true regardless of plan type and when looking separately at states with $25 to $30 out-of-pocket caps and states with a $100 cap. Because of this, researchers said “other policies might be needed to improve access to affordable insulin among commercially insured patients with diabetes who have cost-related underuse.”
At least 25 states in recent years have limited monthly insulin costs in the commercial market, and leading insulin manufacturers have followed suit as the Biden administration pushes a national cap for privately insured patients.