Report: Insulin cap to generate millions in savings for Medicare beneficiaries 

WASHINGTON – If the Inflation Reduction Act’s provision capping the cost of insulin at $35 for a month’s supply had been in place in 2020, 1.5 million Medicare beneficiaries across the country would have saved an average of $500, according to a new report from the U.S. Department of Health and Human Services. 

Starting July 1, under Medicare Part B, beneficiary cost sharing will be limited to $35 for a month’s supply of insulin, which will result in an estimated $27 million in total savings, says the report. 

“The Biden-Harris Administration is committed to lowering health care costs and increasing access to high-quality, affordable health care, and the Inflation Reduction Act is helping us do just that,” said HHS Secretary Xavier Becerra. “Thanks to this historic law, people who get their insulin through Medicare won’t have to pay more than $35 for a month’s supply. No one should have to skip or ration their insulin because they can’t afford it.” 

The provision already went into effect on Jan. 1 for Medicare Part D, kicking off an estimated $734 million in total savings. 

Produced by the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE), the report includes selected findings from a recent report to Congress that examined the critical role that insulin plays in the treatment of diabetes, reviewed evidence on how insulin affordability affects adherence to insulin treatment and downstream health consequences, and described policy efforts to improve the affordability of insulin. 

The report also provides information on savings by state and by demographic characteristics, including gender, race and ethnicity, and age. The states with the most beneficiaries projected to benefit from the insulin cost savings are Texas (114,000 beneficiaries), California (108,000) and Florida (90,000).  

Prior to the provision, about 37% of insulin fills for beneficiaries required cost-sharing that exceeded $35 per fill, including 24% that exceeded $70 per fill. Nationally, the average out-of-pocket cost was $58 per insulin fill, typically for a 30-day supply. Patients with private insurance or Medicare paid about $63 per fill on average. 

The full HHS report, “Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings by State and Demographics”, is available at https://aspe.hhs.gov/reports/insulin-affordability-data-point and the report to Congress is available at: https://aspe.hhs.gov/reports/insulin-affordability-rtc.