Medicare’s $35 per month insulin cap excludes many Michigan diabetics

February 21, 2023 | Bridge Magazine, In The Media

CHRT Senior Policy Analyst Emma Golub was quoted in a Bridge Michigan article commenting on Medicare’s $35 per month insulin cap that went into effect on Jan. 1 and the broader issue of medication affordability. 

The cap on insulin prices is a win for the estimated 122,000 diabetics in Michigan on Medicare, as without it this medication can cost up to $2,000 per month. However, the shift in Medicare coverage excludes more than 900,000 diabetics who don’t qualify for Medicare, and therefore won’t benefit from the insulin cap.

Additionally, some diabetics who are covered by Medicare still find themselves straddled with high costs for other medications. 

Kent County resident Pam Bloink, who was interviewed for the Bridge Michigan article, is on Medicare and said she takes nine other medications in addition to insulin, for ailments including high blood pressure, cholesterol, depression, and heart issues. She spent more than $7,000 on medications last year, as Medicare left her without coverage for many of her prescriptions. 

“Prescription drug affordability continues to be a major hole in our healthcare system,” says Golub. “Lifesaving drugs are only lifesaving if people can afford them.” 

The American Association of Retired People (AARP) estimates that 32 percent of Michigan adults skip taking medications due to cost. Insulin prices have soared in the U.S. over the past decade—in 2020, they were more than eight times as high as prices in 32 other high-income nations, according to a RAND Corporation study.

Other drug prices have exponentially risen in recent years as well, such as EpiPen. A self-injecting device for a drug that neutralizes severe allergic reactions, its cost rose from just over $100 in 2009 to $608.61 in 2016. 

In October, Michigan Governor Gretchen Whitmer issued an executive order to build an insulin manufacturing facility in Michigan for in-state residents, and designated $150 million for its construction in her fiscal 2024 budget. State health insurers endorsed the plan, applauding Whitmer’s efforts to lower insulin prices in Michigan. 

But a 2020 study published in JAMA Internal Medicine found that insulin accounted for just 18 percent of out-of-pocket diabetes expenses for people with Type 1 diabetes on private insurance. Of the $2,500 per year average out-of-pocket cost for this population, insulin pumps, syringes, and glucose monitors accounted for the majority.

Pediatrician Kao-Ping Chua, a researcher at Michigan Medicine’s C.S. Mott Children’s Hospital and the study’s lead author, told Bridge, “The danger is that if you are solely focused on insulin, it doesn’t help people with diabetes with their other expenses.”