The Facts About the $35 Insulin Copay Cap in Medicare

“In a recent post on his social media platform, Donald Trump claimed credit for lowering insulin copayments to $35 for “millions of Americans,” stating – inaccurately – that President Biden had “nothing to do with it.” This brief walks through the facts about actions taken under both the Trump and Biden Administrations related to capping insulin copayments for people with Medicare and explains the differences between their approaches.

What did the Trump Administration do?

In 2020, the Trump Administration established a voluntary, time-limited model under the Center for Medicare and Medicaid Innovation known as the Part D Senior Savings Model. Under this model, participating Medicare Part D prescription drug plans covered at least one of each dosage form and type of insulin product at no more than $35 per month. The model was in effect from 2021 through 2023, and less than half of all Part D plans chose to participate in each year.

What did the Biden Administration do?

In 2022, President Biden signed into law the Inflation Reduction Act, which included a provision that requires all Part D plans to charge no more than $35 per month for all covered insulin products, and also limits cost sharing for insulin covered under Part B to $35 per month. Deductibles no longer apply to insulins under Part D or Part B. These provisions took effect in 2023 (January 1 for Part D; July 1 for Part B).”

“What the November election could mean for people who need insulin

President Biden has proposed to extend the $35 monthly cap on insulin out-of-pocket costs to people with commercial insurance. The Biden Administration and Senate Democrats included a similar provision in the Inflation Reduction Act, but that provision was stripped from the final legislation after the vast majority of Republicans voted to remove it. According to KFF analysis, more than 1 in 4 insulin users in the individual and small group markets and about 1 in 5 insulin users with large employer coverage paid, on average, more than $35 per month out-of-pocket for insulin in 2018.

The House Republican Study Committee proposed a full repeal of the Inflation Reduction Act in its FY2025 budget proposal. While it is unclear whether Trump supports repealing this law in its entirety, doing so would eliminate the $35 insulin copay cap for millions of insulin users with Medicare and leave in its place only voluntary efforts offered by the three major insulin manufacturers, which apply to many people irrespective of their health coverage.”

Lower insulin prices were the work of the Trump administration, not “Crooked Joe Biden. He had NOTHING to do with it.”

“Trump wrong in claiming full credit for lowering insulin prices

If Your Time is short

  • President Donald Trump continues to claim that he alone deserves credit for lowering insulin prices for seniors.
  • Though the Trump administration established a voluntary, temporary program lowering insulin costs for some older Americans on Medicare, the mandatory price caps implemented through Biden’s Inflation Reduction Act go significantly further.
  • Trump deserves some credit for lowering seniors’ drug costs, but his claim that Biden deserves none cannot be justified.”

Fact check: Trump falsely claims Biden didn’t lower Americans’ insulin costs

Fact check: Trump falsely accuses Harris and Biden of lying about $35 insulin

Medicare announces lower prices on 10 common, high-cost drugs

“The negotiations with drugmakers are projected to save older adults $1.5 billion in out-of-pocket costs when the new prices go into effect in 2026.”

“Here are the negotiated prices for the drugs, based on a 30-day supply:

  • Eliquis, a blood thinner from Bristol Myers Squibb and Pfizer: $231 negotiated price, down from $521 list price.
  • Xarelto, a blood thinner from Johnson & Johnson: $197 negotiated price, down from $517 list price.
  • Januvia, a diabetes drug from Merck: $113 negotiated price, down from $527 list price.
  • Jardiance, a diabetes drug from Boehringer Ingelheim and Eli Lilly: $197 negotiated price, down from $573 list price.
  • Enbrel, a rheumatoid arthritis drug from Amgen: $2,355 negotiated price, down from $7,106 list price.
  • Imbruvica, a drug for blood cancers from AbbVie and Johnson & Johnson: $9,319 negotiated price, down from $14,934 list price.
  • Farxiga, a drug for diabetes, heart failure and chronic kidney disease from AstraZeneca: $178 negotiated price, down from $556 list price.
  • Entresto, a heart failure drug from Novartis: $295 negotiated price, down from $628 list price.
  • Stelara, a drug for psoriasis and Crohn’s disease from J&J: $4,695 negotiated price, down from $13,836 list price.
  • Fiasp and NovoLog, diabetes drugs from Novo Nordisk: $119 negotiated price, down from $495 list price.”

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