\n\tSamantha Putterman, PolitiFact<\/span><\/p>\n

Insulin for Medicare beneficiaries \u201cwas costing 400 bucks a month on average. It now costs $35 a month.\u201d<\/p>\n

President Joe Biden, in a March 22 speech<\/p>\n

The cost of insulin in the United States has risen considerably in recent years, with some estimates finding that Americans have paid around 10 times<\/a> as much for the drug as people in other developed countries.<\/p>\n

But recent changes by the federal government and drug manufacturers have started to drive insulin prices down, something President Joe Biden often mentions at campaign events.<\/p>\n

Biden told the crowd at a March 19 campaign reception<\/a> in Reno, Nevada, that he\u2019s fought for years to allow Medicare to negotiate with drug companies.<\/p>\n

\u201cHow many of you know someone who needs insulin?\u201d Biden asked. \u201cOK, well, guess what? It was costing 400 bucks a month on average. It now costs $35 a month.\u201d<\/p>\n

We\u2019ve heard Biden make this point several times on the campaign trail \u2014 in other instances<\/a>, he has said beneficiaries were paying \u201cas much as\u201d $400 a month \u2014 so we wanted to look into it.<\/p>\n

The Inflation Reduction Act, which Biden signed in 2022, caps out-of-pocket insulin costs at $35 a month for Medicare enrollees. The cap took effect in 2023. In response, three drug manufacturers said they planned<\/a> to reduce the price of insulin to $35 through price caps or savings programs.<\/p>\n

The legislation also helped patients by clarifying how much they would have to pay for insulin and other drugs.<\/p>\n

But Biden overstated the average monthly cost that Medicare beneficiaries were paying before the law.<\/p>\n

One government estimate for out-of-pocket insulin costs found that people with diabetes enrolled in Medicare or private insurance paid an average of $452 a year \u2014 not a month, as Biden said. That\u2019s according to a December 2022 report<\/a> by the Department of Health and Human Services using 2019 data. Uninsured users, however, paid more than twice as much on average for the drug, or about $996 annually.<\/p>\n

About Half of US Insulin Users Are on Medicare<\/strong><\/p>\n

More than 37 million Americans have diabetes, and more than 7 million of them need insulin to control their blood sugar levels and prevent dangerous complications. Of the Americans who take the drug, about 52% are on Medicare<\/a>.<\/p>\n

It\u2019s unlikely that many Medicare enrollees were paying the $400 out-of-pocket monthly average Biden referred to, though it could be on target for some people, especially if they\u2019re uninsured, drug pricing experts told us.<\/p>\n

\u201cIt would be more accurate to say that it could cost people on Medicare over $400 for a month of insulin, but the average cost would have been quite a bit lower than $400 on Medicare,\u201d said Stacie Dusetzina, a health policy professor at Vanderbilt University School of Medicine.<\/p>\n

Medicare Part D<\/a>, also called the Medicare prescription drug benefit, helps beneficiaries pay for self-administered prescriptions. The benefit has several phases, including a deductible, an initial coverage phase, a coverage gap phase, and catastrophic coverage. What Medicare beneficiaries pay for their prescriptions often depends on which phase they\u2019re in.<\/p>\n

\u201cIt is confusing, because the amount that a person was supposed to pay jumps around a lot in the Part D benefit,\u201d Dusetzina said. For example, she said, Medicare beneficiaries would be more likely to pay $400 a month for insulin during months when they hadn\u2019t yet met their deductible.<\/p>\n

Mariana Socal, an associate scientist at Johns Hopkins Bloomberg School of Public Health, said it\u2019s also difficult to estimate insulin\u2019s precise cost under Medicare because individual prices hinge on other factors, such as how many other prescription medications patients take.<\/p>\n

\u201cBecause the Medicare program has multiple instances where the patient is required to pay a coinsurance (percentage of the drug\u2019s cost) to get their drug, it is very likely that patients were paying much more than $35 per month, on average, before the cap established by the Inflation Reduction Act went into effect,\u201d Socal wrote in an email.<\/p>\n

There are different ways to administer insulin<\/a>, including through a pump, inhaler, or pen injector filled with the medicine.<\/p>\n

In a 2023 report<\/a>, HHS researchers estimated that about 37% of insulin fills for Medicare enrollees cost patients more than $35, and 24% of fills exceeded $70. Nationally, the average out-of-pocket cost for insulin was $58 per fill, typically for a 30-day supply, the report found. Patients with private insurance or Medicare paid about $63 per fill, on average.<\/p>\n

For people with employer-sponsored insurance, the average monthly out-of-pocket spending on insulin in 2019 was $82, according to a report published in October 2021<\/a> by the Health Care Cost Institute, a nonprofit that studies health care prices. The study found that the majority of patients were spending an average of $35 a month, or lower, on the drug. But among the \u201c8.7% of individuals in the highest spending category,\u201d the median monthly out-of-pocket spending on insulin was about $315, the study said.<\/p>\n

Our Ruling<\/strong><\/p>\n

Biden said Medicare beneficiaries used to pay an average of $400 per month for insulin and are now paying $35 per month.<\/p>\n

The Inflation Reduction Act capped the monthly price of insulin at $35 for Medicare enrollees, starting in 2023. The change built in price predictability and helped insulin users save hundreds of dollars a year.<\/p>\n

However, most Medicare enrollees were not paying a monthly average of $400 before these changes, according to experts and government data. Costs vary, so it is possible some people paid that much in a given month, depending on their coverage phase and dosage.<\/p>\n

Research has shown that patients with private insurance or Medicare often paid more than $35 a month for their insulin, sometimes much more, but not as high as the $400 average Biden cited.<\/p>\n

We rate Biden\u2019s statement Half True.<\/p>\n

PolitiFact copy chief Matthew Crowley contributed to this report.<\/em><\/p>\n

our sources<\/h4>\nWhiteHouse.gov, \u201c Remarks by President Biden at a Campaign Event | Reno, NV<\/a>,\u201d video<\/a>, March 19, 2024<\/p>\n
U.S. Department of Health and Human Services, \u201c New HHS Report Finds Major Savings for Americans Who Use Insulin Thanks to President Biden\u2019s Inflation Reduction Act<\/a>,\u201d Jan. 24, 2023<\/p>\n
U.S. Department of Health and Human Services, \u201c Insulin Affordability and the Inflation Reduction Act: Medicare Beneficiary Savings by State and Demographics<\/a>,\u201d revised Oct. 26, 2023<\/p>\n
Bloomberg Law, \u201c Insulin Costs Remain Top Target Beyond Biden\u2019s Drug Price Cuts<\/a>,\u201d Oct. 26, 2023<\/p>\n
The American Diabetes Association, \u201c State Insulin Copay Caps<\/a>,\u201d accessed March 28, 2024<\/p>\n
NPR, \u201c Eli Lilly Cuts the Price of Insulin, Capping Drug at $35 per Month Out-of-Pocket<\/a>,\u201d March 1, 2023<\/p>\n
WhiteHouse.gov, \u201c FACT SHEET: President Biden\u2019s Cap on the Cost of Insulin Could Benefit Millions of Americans in All 50 States<\/a>,\u201d March 2, 2023<\/p>\n
Health Care Cost Institute, \u201c Capping Out-of-Pocket Spending on Insulin Would Lower Costs for a Substantial Proportion of Commercially Insured Individuals<\/a>,\u201d Oct. 15, 2021<\/p>\n
Centers for Disease Control and Prevention, \u201c National Diabetes Statistics Report<\/a>,\u201d updated November 2023<\/p>\n
KFF, \u201c Insulin Out-of-Pocket Costs in Medicare Part D<\/a>,\u201d July 28, 2022<\/p>\n
KFF Health News, \u201c America Worries About Health Costs \u2014 And Voters Want to Hear From Biden and Republicans<\/a>,\u201d March 8, 2024<\/p>\n
USA Facts, \u201c A Cap on Insulin Costs Benefits Millions of Americans With Diabetes<\/a>,\u201d April 15, 2023<\/p>\n
The Associated Press, \u201c Insider Q&A: What\u2019s Behind Rising Insulin Prices?<\/a>\u201d Aug. 5, 2018<\/p>\n
USA Today, \u201c Insulin $35 Cap Price Now in Effect, Lowering Costs for Many Americans With Diabetes<\/a>,\u201d Jan. 3, 2024<\/p>\n
Email interview with Mariana Socal, associate scientist at Johns Hopkins Bloomberg School of Public Health, March 28, 2024<\/p>\n
Email interview with Stacie Dusetzina, professor of health policy at Vanderbilt University, March 29, 2024<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
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