Democrats dramatically narrow their ambitions for lowering insulin costs

WASHINGTON — Democrats’ high hopes to lower insulin costs for patients with insurance got downsized on Sunday, and now only Medicare patients will see relief at the pharmacy counter.

Back in November, the party had grand ambitions of capping insulin costs at $35 per month for all patients with insurance. But when they tried to insert the policy into the sweeping climate, tax, and health care package they’re advancing this month, it conflicted with Senate rules. Now, the plan only caps out-of-pocket costs for Medicare patients who use insulin, around a quarter of whom pay more than $35 per month right now.

Democrats and a surprising handful of Republicans tried to overcome the conflict with Senate rules Sunday, but they didn’t garner quite enough support to do so.


Addressing the sky-high price of insulin has much broader support than nearly any other piece of Democrats’ package of reforms, and the procedural defeat comes after months of efforts — some of which were even bipartisan — to find some way to do something. It comes, too, after Democrats abandoned a separate, more aggressive policy that would have allowed Medicare to directly negotiate insulin prices, not just what patients pay.

Senate Majority Leader Chuck Schumer saw the rules conflicts coming in February, and several members of his caucus pursued other ways to lower the price of insulin.


When those were unsuccessful, Democrats decided to try, anyway, to use the fast-track process known as reconciliation to address the issue. That process lets the party pass legislation without Republican support, but it comes with far more complicated rules.

Ultimately, the Senate rules referee decided that Democrats couldn’t apply an out-of-pocket cap to the commercial insurance market. Instead of removing the policy because it violated the rules, Democrats instead forced Republicans to vote to remove the policy.

The provision would have needed the votes of 60 senators to pass, but only 57 lawmakers supported it. The Republicans that voted for the policy were Sens. Bill Cassidy (La.), Susan Collins (Maine), Josh Hawley (Mo.), Cindy Hyde-Smith (Miss.), John Kennedy (La.), Lisa Murkowski (Alaska), and Dan Sullivan (Alaska).

The move was disappointing to some patients who use insulin and were hoping for relief.

“Diabetic Americans are being used as political props to play partisan politics while 1 in 4 of us must ration the insulin we need to survive [because] both parties in Congress refuse to regulate insulin’s price,” tweeted Laura Marston, an intellectual property attorney and a patient advocate for affordable insulin.

Predictably, Democrats took the opportunity to blast most Republicans for not voting to overrule the parliamentarian.

“After years of tough talk about taking on insulin makers, Republicans have once again wilted in the face of heat from Big Pharma,” Senate Finance Chair Ron Wyden (D-Ore.) said in a written statement.

It’s unclear exactly why insulin-specific instructions were slashed from the Medicare negotiation provision. Some consumer advocates including Public Citizen are concerned that insulin products may not be chosen through the regular negotiation process.

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