Trump to Announce $35 Maximum Copay for Insulin Users on Medicare

Getty Alexis Stanley shows her insulin kit on January 17, 2020 in St.Paul, Minnesota. - It's the wealthiest country on the planet but the sometimes staggering cost of health care means that Americans in need of everyday items such as insulin to treat diabetes resort to the black market or pharmacies across the border to source cheaper drugs.

President Trump is expected to announce Tuesday a cap on the price of insulin for diabetics on Medicare to a maximum copay of $35 for a monthly supply. That’s according to a tweet by Senior White House Correspondent Christian Datoc.

According to Endocrine News, they have been anticipating this announcement but would like it to go further, saying, “We note that this plan will not solve the problem of insulin affordability. The administration’s plan will have no impact on some of the people most vulnerable to rising insulin costs, such as those covered by high deductible insurance plans or those who have no insurance at all and are forced to pay full price for their medicine.”

However, for the 2.3% of people with type 1 diabetes who are on Medicare, the savings are likely to be welcome. According to a paper published by the Centers for Medicaid and Medicare Services in 2017, “Beneficiaries with diabetes reported worse general health, more inpatient admissions, and higher out-of-pocket health care costs than those without diabetes.”

The paper reported that 18.9% of Medicare patients have type 2 diabetes, but not all people with type 2 diabetes need insulin.

According to the Diabetes Research Institute, “34.2 million people, or 10.5% of the U.S. population, have diabetes. An estimated 26.8 million people – or 10.2% of the population – had diagnosed diabetes. Approximately 7.3 million people have diabetes but have not yet been diagnosed.”


The Rising Cost of Life-Saving Insulin Has Been an Ongoing Issue & Lowering Costs Were Part of Trump’s Campaign Promises

GettyRepublican president-elect Donald Trump gives a thumbs up to the crowd during his acceptance speech at his election night event at the New York Hilton Midtown in the early morning hours of November 9, 2016 in New York City.

The American Journal of Managed Care reported, “In his run for the presidency, President Donald Trump campaigned on the promise to lower the cost of overpriced prescription drugs.”

One such overpriced prescription drug is insulin. The cost of insulin has climbed substantially over the last couple of decades.

In 1996 the cost for a one-month supply of Insulin was $21, according to the AJMC. By 2001 the price had gone up to $35, and as of 2019 a month supply of insulin was up to $275, making the cost too steep for many.

“For millions of people living with diabetes, including all individuals with type 1 diabetes, access to insulin is literally a matter of life and death,” The American Diabetes Association wrote.

The ADA says the continually rising costs have to do with “the complexity of drug pricing in general and of insulin pricing in particular,” but the financial part of the equation trickles down to consumers, who are then sometimes forced to choose between buying the insulin they need to live and buying other necessities, which can lead to negative health outcomes. In some cases diabetics have been known to try to ration their insulin, which ultimately led to their deaths.


The High Cost of Insulin Has Led to Some Paying the Ultimate Price

GettyA photo Alec Smith, who died after trying to ration his insulin because he couldn’t afford it.

For people with type 1 diabetes, not having insulin leads to Diabetic Ketoacidosis (DKA), which can mean death within hours according to the International Diabetes Federation. They describe what happens when a type 1 diabetic does not have insulin.

When blood glucose (BG) is too high for too long, the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, and causes the blood to become acidic, which is toxic. BGs are harder to normalize with routine insulin injections during DKA. Hospitalization becomes essential for survival. Symptoms include sunken eyes, rapid breathing, headache, muscle aches, severe dehydration, weak peripheral pulses, nausea, stomach pain and cramping, vomiting, semi or unconsciousness, cerebral edema, coma and death. DKA is a horrendously painful way to die.

In the case of Alec Smith, a 26-year-old restaurant manager who aged out of his mother’s health insurance — he died less than a month after losing insurance. His family believes he was rationing his insulin, according to NPR.

“He died alone in his apartment three days before payday. The insulin pen he used to give himself shots was empty,” they wrote.

The president’s announcement on capping the cost of insulin for Medicare users could help some in lower-socioeconomic brackets. However it only applies to those who are 65 or older and eligible for Medicare.

According to the IDF, “It has been well documented that lack of health insurance and lower incomes are associated with higher rates of DKA.”

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