DALLAS — U.S. Health and Human Services Secretary Xavier Becerra’s visit to Dallas on Wednesday was as much about the people who fall through the cracks of a new federal cap on insulin costs as it was about the patients who can now get the life-saving diabetes treatment for only $35.
“Here’s the most important part of this new prescription drug pricing: You have to be a Medicare recipient for you to benefit. You have to be 65 years or older or you have to be an American who’s disabled and qualifies for Medicare,” Becerra said. “All those other Americans still are strapped with the unfair negotiation, the unfair pricing that occurs.”
Becerra touted the Inflation Reduction Act, a 2022 law that caps a month’s supply of Medicare-covered insulin at $35 and allows the federal health insurance program for seniors to negotiate prices with drug manufacturers, while on a panel about drug costs at the Baylor Scott & White Health and Wellness Center in South Dallas.
That cap is a win for some Americans who rely on insulin. In 2020, Medicare enrollees without low-income subsidies paid an average of $54 out-of-pocket for insulin, a 39% increase since 2007, according to Medicare data analysis from the Kaiser Family Foundation.
People under 65 are left somewhere in between. Some private health insurance plans cover most or all of the cost of insulin, while other private plans still require patients to pay hundreds or thousands of dollars each year. Senate Republicans blocked a $35 cap on out-of-pocket insulin costs for patients with private insurance that was originally included in the Inflation Reduction Act.
For the uninsured, the cost is even higher, which makes insulin affordability a particular issue in Texas, the state with the highest uninsurance rate in the nation, according to the U.S. Census Bureau. It’s an issue that will likely get worse in the coming months as Medicaid protections from the COVID-19 public health emergency declarations end.
A January survey of Medicare recipients found that out-of-pocket insulin costs of $35 or more per month was associated with a more-than 61% lower likelihood of sticking to the prescribed medication. The effects of splitting or missing insulin doses can be detrimental to diabetes patients and eventually lead to kidney, eye and nerve damage.
“I write the prescription and I look it up and I’m hoping and praying that it’s covered and affordable,” said Dr. Lydia Best, medical director at the Health and Wellness Center. “They call from the pharmacy or, worse yet, they wait until their next visit and say they couldn’t afford it.”
Estella Savage, 74, found out she had diabetes when she was just 35 years old. For nearly four decades, Savage has had to navigate treating and managing the condition, which has cost her between $2,000 and $3,000 per year. At one point, the price of Savage’s medication prevented her from taking it.
Savage’s diabetes is now well controlled, thanks in large part to education and exercise programs organized through the Health and Wellness Center, located at the Juanita J. Craft Recreation Center. She joined Becerra’s panel Wednesday to share her own experience with accessing care for a chronic disease like diabetes.
“I want people to know that they can be helped, too,” she said.
The panel featured other big names in the drug-pricing world, including representatives from AARP, the Texas Pharmacy Association and the American Diabetes Association as well as Dr. Alex Oshmyansky, CEO and founder of Mark Cuban Cost Plus Drug Co.
Becerra emphasized a renewed call to expand affordable drug prices to all Americans, referencing President Joe Biden’s recent State of the Union address.
“As the president said last night in the State of the Union, it’s so important to let other Americans know that the law doesn’t yet reach you, it doesn’t protect you,” Becerra said. “We’ve got to get the members of Congress to recognize the importance of making sure everyone in America has access to a reasonably priced drug like insulin.”
As part of his visit to Dallas, Becerra also made a stop at Friendship-West Baptist Church to partake in a roundtable discussion about investments in mental and behavioral health.
The secretary said he will be traveling to other parts of the country to discuss drug affordability, but that “we want to come to Texas often” because of the state’s high number of uninsured people.
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