Press Releases

DelBene Highlights Medicare’s New Monthly $35 Insulin Cap

Seniors, Providers, Advocates tout how historic benefit in the Inflation Reduction Act will help Medicare beneficiaries save money, get the care they need

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REDMOND, WA, September 8, 2022 | comments

Today, Congresswoman Suzan DelBene (WA-01) highlighted the new $35 per month out-of-pocket insulin cap for Medicare beneficiaries in the Inflation Reduction Act that President Biden recently signed into law.

During a roundtable at HealthPoint’s pharmacy in Redmond, DelBene was joined by seniors, advocates, and health care providers who discussed how this historic new benefit will help seniors save money and access the care they need.

Over 58,000 Washington seniors on Medicare used insulin in 2020 and spent an average of $675 annually on insulin, higher than the national average.

Nationally, seniors enrolled in Medicare’s Part D prescription drug benefit spent $1 billion out of pocket on insulin in 2020, more than four times the amount spent in 2007. Average out-of-pocket spending per insulin prescription was $54 in 2020 – over 50% more than the new monthly $35 cap.

“Over 58,000 seniors in Washington used insulin in 2020, many of whom are on fixed incomes. They shouldn’t have to worry about choosing between lifesaving medications and paying their bills,” said DelBene. “This new historic benefit in the Inflation Reduction Act will lower costs for Medicare beneficiaries and provide them with certainty going forward. This is just one way that this new law will help our seniors afford the care they need.”

“The insulin cap in the Inflation Reduction Act will be a lifesaver for our country’s Medicare beneficiaries with diabetes. Many of our seniors have been struggling for years with the rising costs of insulin. Now more than ever, finances are a major challenge, and anything we can do to help make insulin more affordable will improve the health and lives of people with diabetes. We are absolutely celebrating the victory that we have for the 3.3 million Medicare recipients who need insulin, but there’s still work to be done here,” said Dana VanBuecken, a nurse practitioner at the Diabetes Clinical Research Program at Benaroya Research Institute at Virginia Mason. “As a provider, I’m happy that Congress has made insulin affordability a priority and I’m celebrating over the cost protections that will be put in place for our seniors with diabetes. We still need national laws that protect access to insulin for all people living with the condition. I’m incredibly thankful to Rep. DelBene for her continued work on behalf of the diabetes community.

“AARP has spent decades calling on Congress to make prescription drugs more affordable, and we finally won the fight for Medicare to negotiate lower drug prices, cap insulin costs, and limit Rx costs to $2,000 for Medicare D recipients,” said Cathy MacCaul, Advocacy Director for the Washington state AARP. “We can't overstate the monumental improvement this prescription drug package will be for older Washingtonians and how grateful we are for strong legislative champions like Congresswoman DelBene.”

“Insulin prices are absolutely astronomical. Even with insurance, it is such a burden,” said Sam Charles, a senior from Carnation who became insulin dependent after undergoing a kidney transplant surgery several years ago. “I’ve volunteered at the Sno-Valley Senior Center since 1988-89, and I’ve see a lot of farmers and seniors like myself who don’t have a pension and worked hard to save. Having this change is so fantastic because I see so many people who just don’t have the money. If it weren’t for children or grandchildren, they would not be walking among us, literally. ”

The insulin cap takes effect in January 2023.

The Inflation Reduction Act also caps seniors’ overall out-of-pocket prescription drug costs at $2,000 annually starting in 2024 and allows Medicare to negotiate for cheaper prescription drugs in 2026.

A recording of the event is available here.

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