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Early this year, Illinois Representative Bobby Rush introduced a bill to eliminate cost-sharing for insulin covered under Medicare Part D or Medicaid. 

The legislation, H.R. 366 – Insulin Access for All Act of 2019, proposes to get rid of deductibles, copayments, and coinsurance for insulin and any medical supplies needed to inject insulin.

If the bill becomes law, individuals on Medicare or Medicaid will pay nothing for insulin and injection supplies. Medicaid covers certain low-income individuals, families and children, pregnant women, the elderly, and people with disabilities. Medicare covers people age 65 and older, and people under 65 with end-stage renal disease. To our understanding, individuals on Medicare who are using a tubed insulin pump would still participate in cost-sharing, as this is covered under Part B rather than Part D.

Passage of the bill would clearly benefit people on Medicaid and Medicare Part D, whose financial burden would be reduced. The measure could also allow patients to actually take the insulin they need, which would improve their health and possibly decrease complications like DKA. That, in turn, would decrease costs to the health care system.

Individuals on private or commercial insurance as well as the uninsured would not be affected directly.

The bill was referred to the House Subcommittee on Health in late January, and we will be following the progress of the legislation closely. It currently has 48 co-sponsors, though no bipartisan support – all are registered Democrats. As of yet, the co-chairs of the Congressional Diabetes Caucus, Diana DeGette (D-CO) and Tom Reed (R-NY), have not signed on. If passed, the changes would be implemented beginning January 1, 2020.

This bill comes amidst a number of congressional efforts to address drug pricing. In particular, we have our eye on a newly-introduced bill from Senators Tina Smith (D-MN) and Bill Cassidy (R-LA), which would ensure that currently-available insulin products do not benefit from the 12-year market exclusivity given to new biologic drugs. Representatives DeGette and Reed have introduced a companion bill in the House.