February 03, 2023

Insulin price cap provides relief

Not being able to afford insulin is a fear Anthony Fienhage of Creston said a lot of people with diabetes live with.

“I still worry about it now,” he said. “Seeing that $400 price tag, I don’t know how I would have done it. People get so desperate they ration their insulin.”

Jan. 1 a bill capping insulin pen prices for Medicare recipients and giving Medicare the ability to negotiate drug pricing went into effect. The cost of insulin is now capped at $35 per month for many with Medicare coverage. The policy will expand July 1 for those who take insulin through a pump (which is covered under Medicare Part B).

Last year, Fienhage was diagnosed with Type I diabetes at 23 years old.

“I lost about 50 pounds in four months,” he recalled. “I started to notice that none of my pants fit anymore, and I wasn’t doing anything to lose weight. I was extremely thirsty. I was fatigued constantly.”

As the father of a 2-year-old daughter, Fienhage assumed he was experiencing the exhaustion parents go through with a young child.

“After meals, I would almost falling asleep standing up. My body was eating itself to sustain,” he said. “I just thought I’m going to the doctor to be told you have a kid, it’s hard. By the end of the day, she hit me with the diagnosis.”

It took several weeks of insulin for him to feel like himself again.

Through his work’s insurance, Fienhage pays $70 every time he needs to refill his prescription — approximately once a month or once every two months. While this cost is manageable, his cost would be $400 without the insurance.

It doesn’t make sense for him to switch to Medicare for the discounted insulin; however, knowing he has an option should he lose his insurance provides a sense of relief and security.

“I love seeing anything like this where they say we’re going to do something to lower these costs,” Fienhage said. “I know there’s options out there if I were to lose my job or if anything were to happen.”

On Capitol Hill, some key lawmakers are already planning to attempt to tackle the issue again, though it’ll be an uphill battle to pass legislation in a divided Congress. And across the country, more state legislatures are expected to consider bills aimed at limiting how much patients pay for the drug.

At least three states have approved legislation so far.

  • Connecticut passed a $100 monthly cap for a 30-day supply of diabetes devices and supplies.
  • Delaware has approved a $35 per month limit on charges for diabetes equipment and supplies.
  • D.C. requires a 30-day supply of covered diabetic devices not cost more than $100.

Since diabetes is genetic, Fienhage constantly worries about having passed the disease onto his daughter or his expected son. “My daughter’s always thirsty,” he said. “I think it’s just because she’s a kid, but I had a panic about it.”

With a sense of bipartisan unity on the topic of insulin prices, the world may be a different place for people with diabetes in the future.

Cheyenne Roche

CHEYENNE ROCHE

Originally from Wisconsin, Cheyenne has a journalism and political science degree from UW-Eau Claire and a passion for reading and learning. She lives in Creston with her husband and their two little dogs.