In Tuesday’s presidential debate, President Donald Trump claimed he helped lower the price of insulin to be as cheap as water.
In reality, many Americans still pay hundreds of dollars a month for insulin depending on their insurance coverage, health experts said.
Trump may have been referring to when the Centers for Medicare and Medicaid Services announced a $35 cap on copays for insulin in May for some Medicare and Medicare Advantage plans. The Trump administration estimated the cap would save seniors $446 on average, and that the manufacturers would endure an added $250 million in costs.
But Anne Swerlick, a senior policy analyst at the Florida Policy Institute, said the insulin cap was mostly just “political theatre,” and barely scratched the surface of the much larger, systemic issue of inflated drug pricing.
The companies that provide insulin to Medicare users at the $35 price point are still making more from other patients who use the drug. Each of the three drug companies - Eli Lilly, Novo Nordisk and Sanofi - make billions in revenue every year, according to the news source Axios. And the capped copay is still a voluntary plan for manufacturers.
“The system is extraordinarily fragmented and people are going to fall through the cracks,” Swerlick said.
The problem of inflated drug costs affects a state like Florida especially, Swerlick said. Gov. Rick Scott chose not to expand Medicaid, even though the state’s uninsured population is among the highest in the country at three million people.
The least expensive form of insulin a diabetic patient could get may cost between $25 to $75 at a place like Walmart, said Dr. Henry Rodriguez, the clinical director of the University of South Florida Diabetes Center. The kind of insulin they can get there, which isn’t modified to either act rapidly or be long-acting through the day, means patients would have to follow strictly regimented eating schedules to make sure they don’t face low blood sugar, Rodriguez said.
The more expensive modified insulins that afford diabetic patients more freedom in their lives and are often preferred by physicians, can be more difficult to access, he said. For an uninsured patient, it could cost between $500 to $1,000 a vial, and patients may need anywhere from one to three vials a month.
Private insurance companies notify their beneficiaries when one type or brand of insulin is no longer covered. But that forces patients to shift to another. As a prescribing physician this lack of control can be frustrating, Rodriguez said. Even for the most educated patients, the process can be confusing and burdensome, he added.
“You have to have a business degree or be an insurance adjuster to figure out how to navigate all of this,” Rodriguez said.
Depending on the details of an individual health plan, someone could still pay anywhere from $150 to $200 a month out of pocket for insulin, said Kevin Sneed, the dean of the Taneja College of Pharmacy at USF.
Compared to when he became a pharmacist in the 1990s, Sneed said the price of insulin has spiked tenfold. While Sneed said he agrees with the spirit of Trump’s decision to stabilize the insulin market, it isn’t true that the drug is cheap for everyone who needs it.
Medicaid patients, for example, face varying prices based on what state they live in. There’s hardly any transparency about how companies arrive at their end price, Sneed said.
Insulin is a common drug that’s been on the market for years. It’s a lifesaving therapy for millions of diabetics who rely on it, Sneed said. He described the hike in price for the medication as “disgraceful.”
“It’s just criminal to me,” Sneed said. “You have water and you have insulin on this earth to live.”