Insulin Prices Fell for Medicare Patients Under Biden-Era Caps

A JAMA study using Medicare claims from 2019–2023 found that 75% of Medicare prescription beneficiaries paid $35 or less per month for insulin after the Inflation Reduction Act’s 2023 cap, and average out-of-pocket monthly costs fell from just over $50 in 2019 to about $22 in 2023.

Researchers report declines in insulin out-of-pocket costs for Medicare beneficiaries after federal price caps took effect. The study, published in the Journal of the American Medical Association, analyzed Medicare prescription claims from 2019 through 2023. The Inflation Reduction Act of 2022 established a $35 out-of-pocket cap for a 30-day insulin supply under Medicare Part D beginning in January 2023. Researchers said the policy was intended to improve insulin access and affordability for people on Medicare. Key findings: - About 75% of Medicare prescription beneficiaries were paying $35 or less per month for insulin within a year of the cap taking effect, up from 48% in 2019. - Average out-of-pocket monthly costs for insulin fell from just over $50 in 2019 to about $22 in 2023. - The analysis covered nearly 3.8 million Medicare patients who had at least one insulin prescription between 2019 and 2023. - Researchers found 25% of Medicare patients were still paying more than $35 for a month’s supply when prescriptions were not prorated to the 30-day cap; plans may treat a 45-day supply as a 60-day supply and charge up to $70 in that example. - State-level out-of-pocket costs declined everywhere but varied by state, ranging from a little over $10 in Washington, D.C., to more than $31 in Minnesota in 2023. Summary: The study indicates that the Medicare insulin cap enacted under the Inflation Reduction Act coincided with lower out-of-pocket insulin costs nationwide. Some patients continued to face higher charges when prescriptions did not align with full 30-day multiples. Undetermined at this time.