The bipartisan bill, the Insulin Price Reduction Act, would hold pharmacy benefit managers (PBMs), big pharmaceutical companies and insurers accountable for the increasing prices by incentivizing reductions in list prices. The legislation was introduced in collaboration with Senators Collins, Carper and Cramer.

Each year, insulin and other drug manufacturers establish list prices for their products. In order to get their insulin covered by insurance, manufacturers then negotiate financial rebates to pay PBMs and insurers. The American Diabetes Association has found that as PBMs have increased rebates as a percentage of the list price, the heightened rebates have helped drive increases in list prices for insulin and resulting in higher out-of-pocket costs for patients using insulin. In Medicare alone, out-of-pocket costs for insulin have more than quadrupled since 2007. Researchers also estimate that the price of a 40-day supply of insulin rose from US$344 in 2012 to US$666 by 2016.

This bill aims to reduce the influence of middlemen, including PBMs, in causing price increases by creating a new insulin pricing model restricting the use of rebates for any insulin product that the manufacturer reduces the price to a level no higher than that in 2006. This, according to Senator Shaheen, could result in more than a 75% decrease in prices (based on estimated 2020 prices).

The rebate restrictions would apply in Medicare# Part D* and private insurance. Private insurance plans would also be required to waive the deductible for insulin products that meet the list price reduction criteria. Future price increases would be limited to no more than medical inflation.

This is not the only initiative in the US aimed at reducing the price of insulin in the country. The US Food and Drug Administration (FDA) held a public meeting on 13 May 2019 to discuss increasing access and facilitating the efficient development of biosimilar and interchangeable insulin products [1]. Part of these plans for increase access to more affordable insulin products include plans for the transition of biologicals, including insulin products, currently approved under the Food, Drug, and Cosmetic Act (FD&C Act) of the Public Health Service Act. This, according to the agency, ‘will open the pathway to market new products that are biosimilar to, or interchangeable with, these transitioned products’ [2].

#Medicare is a national social insurance program, administered by the US federal government since 1966. It provides health insurance for Americans aged 65 and older who have worked and paid into the system. It also provides health insurance to younger people with disabilities.

*Medicare Part D, also called the Medicare prescription drug benefit, is an optional US federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums.

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References
1. GaBI Online - Generics and Biosimilars Initiative. FDA to hold public meeting on access to affordable insulin [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2019 Aug 9]. Available from: www.gabionline.net/Biosimilars/General/FDA-to-hold-public-meeting-on-access-to-affordable-insulin 
2. GaBI Online - Generics and Biosimilars Initiative. Comments on FDA’s plans to transition insulin products [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2019 Aug 9]. Available from: www.gabionline.net/Guidelines/Comments-on-FDA-s-plans-to-transition-insulin-products 

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