More than 13 million people with Medicare have diabetes. And, more than three million of them use insulin. A new study, published in JAMA, out of USC Schaeffer Center for Health Policy & Economics finds that the $35 Medicare monthly limit on insulin costs helps reduce financial barriers to taking insulin for people with high insulin costs.
With enactment of the Inflation Reduction Act (IRA), Medicare limited the cost of insulin for people with diabetes to $35 a month beginning in January 2023. The cost reduction was relatively small for most people. The cost for a month’s supply of insulin fell from $22.95 to $18.16.
The goal was not to hurt the pharmaceutical industry–which profits grossly from insulin sales–but to make the drug more easily accessible to people who needed it. Unfortunately, the law did nothing to bring down the price of insulin, which is far higher in the US than in other wealthy nations. And, the law only appears to have helped the 13 percent of people with Medicare with high out-of-pocket insulin costs.
Until passage of the IRA, people with Medicare spent more than one billion dollars on insulin out of pocket. And, many people who needed insulin went without it, notwithstanding the enormous health risks. The $35 monthly cap made costs predictable and reduced monthly costs by about $5 a month.
People with high monthly insulin costs of as much as $58 benefited more than others, saving nearly $30 a month. About eight percent more people filled prescriptions, suggesting that a significant number of people had been skipping doses.
Still, collectively, people’s insulin use did not change much after the $35 insulin cap took effect. The vast majority of people who use insulin already qualify for lower costs under Medicare’s low-income subsidy program or the pilot Senior Savings Model program.
Before implementation of the IRA, only about one in eight people who filled an insulin prescription paid more than the $35 monthly cap.
Here’s more from Just Care:
- Medicare covers diabetes prevention program
- Beginning July 2026, Medicare will cover GLP-1s for people who want to lose weight
- Diabetes is common among older adults: Know the symptoms
- Taking statins may increase risk of diabetes for some
- Insurers drive up costs for people with diabetes
