NATIONWIDE — Diabetes mellitus affects approximately 37.3 million people—11.3 percent of the United States population.

Insulin replacement therapy has remained the mainstay of treatment for type 1 diabetes, and is also important for type 2 diabetes, especially in later stages. 

If left untreated, diabetes can lead to several complications. Heart disease, stroke, kidney disease and amputations are just a few of the problems, according to the CDC. 

But cost can keep people from getting the treatment they need.

Dollar signs

In the past two decades, the prices of most insulin products have tripled, mainly due to a lack of competition and high barriers for new entrants in the market, according to Herman and Kuo at the Endocrinology and Metabolism Clinics journal.

Previously, many people have had to pay a lot of money for insulin, with some even paying over $70  a month or even more. 

Out-of-pocket costs totaled $1 billion in 2020, more than four times the amount spent in 2007.

However, the Inflation Reduction Act (IRA), which became law on August 17, 2022, has brought significant changes. This legislation limits the out-of-pocket costs for insulin paid for by Medicare to $35 per month, beginning January 1, 2023. 

The law encompasses Medicare Part D, which includes injectable insulin, inhaled insulin and disposable pumps. 

Starting July 1,  people receiving Medicare Part B are also covered, as long as the insulin is administered through non-disposable pumps that are considered durable medical equipment. 

So the IRA has made insulin more affordable for people, ensuring easier access to necessary medications and benefiting the local population significantly. The $35 insulin cap is estimated to save 1.5 million people an average of $500 a year, according to the U.S. Department of Health and Human Services (HHS). 

Previously, many people were non-adherent to their insulin medication, partly because of the cost. Many local residents cite cost of medicines, limited insurance, etc. as a barrier to getting covered. 

But the IRA can help them. 

Take care of your health

To better assess the effects of this new law on diabetics, I spoke with Dr. Bruce Ellsweig, the medical director of Sullivan County [NY] Public Health Services, who shed light on the struggles faced by many individuals in accessing essential medications, especially insulin. We talked about the effects the IRA will have on local citizens. 

“Insulin reduces primary emergency room visits and hospitalization,” Dr. Ellsweig said, and that hyperglycemia (high blood sugar levels) affects “every organ in the body” and can lead to “a myriad of complications, from skin ulcers, to losing limbs, to brain problems, liver dysfunction, heart problems, etc.” Fortunately, the IRA’s changes would reduce the cost of insulin for many people, although, he added, “accessibility with many other drugs is still a barrier.”  

As a final message, Dr. Ellsweig said that people “should be aware of their own responsibility” to take care of their own health. “Don’t forget about immunizations, COVID, RSV, [etc.] because health care also depends on you taking care of your own body.”

He believes that “without a doubt” the Inflation Reduction Act, through reducing the pricing of insulin, will further enable citizens to take care of their own health. 

Other sources: the Kaiser Family Foundation and the Centers for Disease Control