There is a lot of confusion surrounding insulin-related legislation in the media. Conversation has been sparked since the House of Representatives passed the Affordable Insulin Now Act with a vote of 232-193. The Bill must still make its way to the Senate and then the President to become officially enacted.
Context
There are usually upwards of 10,000 bills presented to congress every year and roughly 10% of those become officially enacted. There are many Insulin Bills in the works but Media rarely presents the logistics of these Bills. Some only cap co-pays, some only affect certain individuals, some deal with the cost of insulin at the source. Despite bipartisan teams creating comprehensive Insulin Bills over the past few years, the Affordable Insulin Now Act bypassed many of these and became the predominant legislation to vote on.
In neglecting to tell the whole story, many news articles have created a simplified narrative that 'Republicans voted against lowering insulin costs.' Yet they fail to ask 'why' most Republicans voted 'no.' Representative Tom Cole (R) said,
"While there is bipartisan support for addressing the rising price of insulin, imposing government price controls and passing the cost along from one consumer to another, as this legislation does, is not the answer. Rather, Congress should be working to solve this problem in a comprehensive manner that addresses the main drivers of high prescription drug prices. Bipartisan solutions, like H.R.19, already exist and would lower prescription drug prices while also protecting our nation's biomedical research initiatives that find more cures and at a faster rate than any other country in the world."
This Bill only caps the co-pay. This means that it only helps those on insurance, and it refuses to tackle the high price of Insulin from the manufacturer. Thus, insurance companies are forced to absorb the cost and they will simply raise all of their customer's premiums, or monthly payments, in order to do so.
The real question is not why did Republicans vote 'no,' it is why were comprehensive bipartisan solutions skipped over for the Affordable Insulin Now Act?
Overview
A complex healthcare system has allowed insulin prices to exponentially rise in the last two decades. Insulin in America often costs ten times what it does in other developed countries. This leaves as many as 1/4 of Americans with diabetes needing to dangerously ration their life saving medicine.
There have been many attempts to tackle this problem. The most recent, being the Affordable Insulin Now Act. This has passed the House of Representatives and now must work its way through the rest of Congress. This Bill is a stand alone piece of legislation that stemmed after the Build Back Better plan, which included an insulin provision, faltered. The only issue is that this stand alone measure bypassed a lot of bipartisan work to decrease insulin prices, and these bills were more comprehensive in their logistics.
The Problem
The most troubling issue is that media has failed to report on the intricacies of each bill. Any bill that says it will reduce insulin is viewed collectively as one that is benevolent regardless of its logistics.
This is the predominant issue with the Affordable Insulin Now Act. It fails to actually lower the cost of insulin from the manufacturer, the list price. Furthermore, it only helps those with insurance. The combination of the two means that uninsured individuals are still left to pay exorbitant costs out of pocket.
Insured individuals would have their co-pay, the cost they pay for insulin not covered by insurance, capped to $35 at most. Yet, since the cost of insulin is still inflated at the source, insurance companies still have to pay the difference. They will not let this cut into their profit margins though, and so they will end up raising prices elsewhere to compensate. Probably in the monthly premiums that everyone on insurance pays (or that the tax-payers pay for Medicare).
This bill also skipped over a lot of comprehensive legislation, meant to deal with the list price, that is currently being worked on through bipartisan efforts. Many of these Bills stem from the Insulin Price Reduction Act of 2019 which was a bipartisan effort to tackle prices based on research. This research found that the main reason for inflated costs is due to the shady business practices revolving around Pharmaceutical Benefit Managers (PBM's), the brokers of the pharmaceutical industry.
Why are List Prices so High?
Pharmaceutical Benefit Managers are the middle men between the insurance company and the various manufacturers. Their main job is to choose which drugs the insurance company offers and negotiate lower prices between them and the manufacturer of a drug.
There is a lack of oversight in this industry and incentives created for them to choose the highest costing drug. Since manufacturers are competing to get their product sold, they offer these PBM's rebates. PBM's are supposed to negotiate for the largest rebates and then pass off these savings onto the insurance company. Since there is no oversight, many just choose the drug with the largest rebate, usually the highest costing one since a rebate is percentage based, and then pocket the difference. The savings never get passed onto the consumer. As manufacturers compete to offer the highest rebates, the list price of insulin continues to artificially inflate.
Bills like the Insulin Reduction Act of 2019, would lower insulin at the source. The goal was to force transparency in the market by having PBM's and manufacturers disclose the prices and rebates negotiated. It also would place rebate restrictions that any manufacturer could claim if they lower their prices back to the 2006 market value of Insulin (and only raised it each year according to medical inflation). This means that manufacturers could once again offer their insulin at a lower cost, and stay competitive, by having the freedom to cut out this 'broker fee.'
Conclusion
The unfortunate reality with current media coverage, is that these logistics are often overlooked for a simpler narrative. That narrative is prone to becoming partisan in coverage and both of these unfortunate realities were made apparent with the coverage of the Affordable Insulin Now Act. Much of the coverage oversimplified it and tried to blame one political party for voting 'no' on a so called 'benevolent bill.' This is arguably why the bill was put before the House for a vote and media played into the political games in an otherwise non-partisan issue.
Media has an incentive to opt for the quick story and the unfortunate irony is that this plays into the corruption. This Affordable Insulin Now Act would perpetuate the problem and many representatives even said this as they voted to pass it. It was a political stunt that they knew they could get away with because the media will not hold them accountable.
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