by Dhishithaa Kumarandurai

Diabetes and the Critical Role of Insulin

Diabetes impacts the body’s ability to convert food into energy. During digestion, food is broken down into sugar, which enters the bloodstream. The pancreas then releases insulin to help this sugar enter cells and be used for energy. However, individuals with diabetes either do not produce insulin or cannot use it effectively, necessitating daily insulin injections to manage their blood glucose levels. Without these injections, elevated blood sugar levels can lead to severe health problems. For many people with diabetes, insulin is as vital as water. Of the over 30 million Americans with diabetes, around 7.4 million rely on insulin to manage their condition.

The High Cost of Insulin and Legislative Efforts

Insulin is one of the most expensive drugs on the market, with the COVID-19 pandemic exacerbating the issues of insulin hoarding and rationing for several reasons. The severe economic impact of the pandemic led to many people losing their jobs and, consequently, their employer-sponsored health insurance. This led to no insurance coverance and decreased income, making it nearly impossible to afford Insulin. The pandemic caused significant disruptions in global supply chains, affecting the production and distribution of insulin. These disruptions often led to shortages and increased prices.COVID-19 can cause severe complications in people with diabetes, leading to higher demand for insulin and other diabetes-related supplies. This increased demand further strained the supply chain

Researchers at Yale University found that 14% of insulin users spend at least 40% of their post-subsistence income on the drug. The average list price for a vial of insulin in the U.S. is $98.70, compared to $12 in Canada. This price disparity results from extended monopolies on this life-saving product, allowing manufacturers to raise prices at will.

The Trump administration established a voluntary, temporary program to lower insulin costs for some older Americans on Medicare, but the mandatory price caps implemented through Biden’s Inflation Reduction Act (IRA) go significantly further. In July 2020, Trump signed an executive order establishing the “Part D Senior Savings Model,” which capped monthly out-of-pocket insulin copay costs at $35 or less for some Medicare Part D plans. This program ran through December 2023 and benefited over 800,000 Medicare beneficiaries in 2022.

The IRA, signed into law by Biden in August 2022, capped out-of-pocket insulin costs for all Medicare drug programs at $35 per month, including Medicare Part B, which covers insulin pumps. This mandatory cap took effect in January 2023 for Part D plans and July 2023 for Part B, making insulin more affordable for millions.

Project 2025 and the Potential Repeal of the IRA

Project 2025, a policy proposal from conservative authorities, aims to reshape various aspects of the U.S. government, potentially including the repeal of the IRA. While Trump has stated he would strive to keep insulin prices low, the repeal of the IRA could lead to increased costs for diabetic patients. Project 2025’s drug pricing agenda calls for completely repealing the IRA, reversing critical legislation that has helped lower the cost of prescription drugs.

Repealing the IRA could have devastating consequences, leaving millions unable to afford their necessary insulin. This could force many to ration their medication, leading to severe health risks, including hospitalization and death. More than 1.5 million Medicare Part D enrollees would see their 2025 out-of-pocket costs increase, and as many as 18.5 million could lose much-needed cost savings. Some seniors could see an average of nearly $400 in lost drug savings in 2025 alone, with total out-of-pocket savings potentially dropping by $7.4 billion.

What Can We Do?

• Advocacy– advocate for policies that ensure affordable access to insulin. Public awareness campaigns, support for legislative measures aimed at reducing drug prices, and community support programs can all contribute to making insulin affordable for everyone.
• Support Endocrine Society–  They are a leading voice advocating for US legislation to lower the cost and price of insulin. Their efforts have influenced both the Biden Administration and the US Congress to prioritize this critical issue. They have engaged in congressional meetings and briefings, educating policymakers about insulin affordability and its impact on racial and ethnic minorities.They also advocate for legislation that would broaden the $35/month cap on insulin to private insurance plans
•  Stay informed– By staying informed and active in policy discussions, we can work towards a future where no diabetic patient has to worry about affording their life-saving medication.

Sources Cited:

Center for American Progress. “Project 2025’s Prescription Drug Plan Would Increase Costs for as Many as 18.5 Million Seniors and Others with Medicare.” American Progress, 17 July 2023, www.americanprogress.org/press/release-project-2025s-prescription-drug-plan-would-increase-costs-for-as-many-as-18-5-million-seniors-and-others-with-medicare/.

University of South Carolina. “A Conversation about Insulin.” University of South Carolina, 11 Nov. 2021, www.sc.edu/uofsc/posts/2021/11/11_conversation_insulin.php.

HealthNews. “IRA Is Significant Step in Reducing Insulin Costs but Not Panacea for Diabetes Patients.” HealthNews, 21 July 2023, www.healthnews.com/health-conditions/diabetes/ira-is-significant-step-in-reducing-insulin-costs-but-not-panacea-for-diabetes-patients/.

Al Jazeera. “What Is Behind the Insulin Shortage in the US?” Al Jazeera, 2 May 2024, www.aljazeera.com/economy/2024/5/2/what-is-behind-the-insulin-shortage-in-the-us.

PolitiFact. “Trump Wrong in Claiming Full Credit for Lowering Insulin Costs.” PolitiFact, 12 July 2024, www.politifact.com/factchecks/2024/jul/12/donald-trump/trump-wrong-in-claiming-full-credit-for-lowering-i/.

Lipska, Kasia J., and Silvio E. Inzucchi. “Mayo Clinic Proceedings.” Mayo Clinic Proceedings, vol. 94, no. 10, Oct. 2019, pp. 2181-2193, www.mayoclinicproceedings.org/article/S0025-6196(19)31008-0/fulltext.

“The Impacts of COVID-19 on Diabetes and Insulin.” Johns Hopkins Bloomberg School of Public Health, 2021, https://publichealth.jhu.edu/2021/the-impacts-of-covid-19-on-diabetes-and-insulin. Accessed 17 Aug. 2024.
“Lowering the Cost of Insulin.” Endocrine Society, https://www.endocrine.org/advocacy/accomplishments-and-champions/lowering-cost-of-insulin. Accessed 17 Aug. 2024.