The Trump administration’s outreach to insulin manufacturers and health insurers to reduce the price of insulin for more than 3.3 million Medicare recipients is a terrific first step in addressing the rising cost of prescription drugs.
If insurers and manufacturers agree, the administration’s proposed pilot program would cut the cost of insulin to $35 for a 30-day prescription, saving Medicare recipients an average of $446 a year beginning in January 2021, Medicare officials said.
It’s a good approach — avoiding the red tape of legislation and a federal regulatory process that’s plodding in the best cases and riddled with delays when an industry puts up a fight — but it would help fewer than half of the nation’s 7 million insulin-dependent diabetics.
Recent studies show insulin prices — which roughly doubled to about $450 a month in 2016 from around $234 a month in 2012 — are a serious problem for many.
Yale researchers reported in 2018 that a quarter of patients with Type 1 or 2 diabetes were rationing their insulin in response to high costs. They were using less insulin than their doctors prescribed, and a third of them were not even telling their health care providers they were doing this. And those who were rationing were much more likely to be suffering high glycemic levels — meaning their blood-sugar readings were out of control, which can lead to complications such as kidney failure, heart disease, stroke, blindness and lower-limb amputations.
A study released in February, which, like the Yale study, was published in the Journal of the American Medical Association, found insulin being sold online on Craigslist. It was being peddled at a fraction of its list price. The buyer needed no prescription and had no idea whether the cut-rate vials were being stored at temperatures to ensure the drug’s effectiveness.
Congress has been so slow to address this problem that several states, including New Mexico, Virginia and Colorado, have passed laws forcing insurers to cap the cost of insulin.
It is surprising that the insurance and pharmaceutical industries have not found a way to cooperate on a solution to the price problem. By failing to do so, they invite government intervention — and could soon face measures far less agreeable to them than the Trump administration’s Medicare pilot program.
Drug-price regulation is a fight the two industries could lose if Congress decides to get involved.
The drug industry’s lobbying arm, the Pharmaceutical Research and Manufacturers of America or PhRMA, has clearly lost power on Capitol Hill, a reality on display when protection against competition for certain top-selling prescription drugs was dropped from the new trade deal with Canada and Mexico.
It’s time for Congress to stop merely holding hearings on the price of insulin and other lifesaving drugs and pass legislation. That might be the only way to get the pharmaceutical and insurance industries to agree to a solution that helps all Americans who need such drugs to survive. The Trump administration’s Medicare pilot program for insulin could serve as the model for such reform.